McGregor J, Marks P J, Hayward A, Bell Y, Slack R C B
School of Nursing, University of Nottingham, Medical School, Queens Medical Centre, Nottingham NG7 2UH.
J Public Health Med. 2003 Jun;25(2):165-70. doi: 10.1093/pubmed/fdg035.
Hepatitis B infection in injecting drug users is an important public health problem. Active immunization against hepatitis B is immunogenic and safe, but uptake rates in targeted vaccination programmes are low. This study was undertaken to identify factors associated with the uptake of hepatitis B vaccination in injecting drug users attending a needle exchange service.
A retrospective cross-sectional survey of case-note data of injecting drug users who had no markers of hepatitis B infection or immunity was undertaken within a drop-in needle exchange service for injecting drug users in a large urban area in England. A qualitative study using semi-structured interviews with needle exchange staff was also conducted.
Of 207 injecting drug users, 180 (87 per cent) had been offered vaccine, 123 (59 per cent) accepted at least one dose and 55 (27 per cent) received three or more doses. Vaccine was less likely to be offered to those sharing injecting equipment or known to have hepatitis C. Needle sharing was also associated with failure to accept vaccine, as was increasing age and the length of contact with the service.
Those who are most at risk are least likely to be offered vaccine and accept it. This calls into doubt the effectiveness of hepatitis B vaccination strategies targeted at high-risk groups and adds weight to arguments for universal vaccination.
注射吸毒者中的乙型肝炎感染是一个重要的公共卫生问题。乙型肝炎主动免疫具有免疫原性且安全，但在目标疫苗接种计划中的接种率较低。本研究旨在确定在一家针头交换服务机构就诊的注射吸毒者中，与乙型肝炎疫苗接种情况相关的因素。
在英格兰一个大城市地区为注射吸毒者提供的即到即服务的针头交换服务机构内，对无乙型肝炎感染或免疫标志物的注射吸毒者的病历数据进行回顾性横断面调查。还对针头交换工作人员进行了半结构化访谈的定性研究。
在207名注射吸毒者中，180人（87%）被提供了疫苗，123人（59%）接受了至少一剂疫苗，55人（27%）接受了三剂或更多剂疫苗。与他人共用注射器具或已知感染丙型肝炎的人获得疫苗的可能性较小。共用针头也与未接受疫苗有关，年龄增长以及与该服务机构接触时间延长也是如此。
风险最高的人群获得疫苗并接受接种的可能性最小。这使人对针对高危人群的乙型肝炎疫苗接种策略的有效性产生怀疑，并为普遍接种疫苗的论点增加了分量。
