Hepatitis B vaccination coverage and uptake in prisons across England and Wales 2003-2010: a retrospective ecological study.

OBJECTIVE

To describe the custodial hepatitis B vaccination programme performance and examine these data by geographical region and prison category.

DESIGN

Retrospective ecological study.

DATA SOURCE

Health Protection Agency (HPA) published data.

SETTING

Custodial primary healthcare providers located in prisons across England and Wales.

PARTICIPANTS

147 prisons which reported vaccination data between July 2003 and April 2010 to the HPA Prison Infection Prevention team.

MAIN OUTCOME MEASURES

Hepatitis B vaccination coverage (July 2003 to April 2010) and uptake (December 2007 to April 2010).

RESULTS

Median hepatitis B vaccination coverage was 22% (interquartile range [IQR] 5-49%) and uptake was 36% (IQR 16-59%). Vaccination coverage varied significantly between July 2003 and November 2007 compared to December 2007 and April 2010 (median 12% [IQR 2-31%] versus median 48% [IQR 26-67%], Mann-Whitney W=14,689,158.0, p<0.001). There was significant variation between vaccination coverage (Kruskal-Wallis H=613.44, DF=9, p<0.001) and uptake (Kruskal-Wallis H=247.99, DF=9, p<0.001) across the HPA regions. Compared to England and Wales, estimated population median vaccination coverage was significantly (p≤0.05) lower in three regions and one prison category and higher in four regions and seven prison categories; estimated population median vaccination uptake was significantly lower in three regions and three prison categories and higher in two regions and four prison categories.

CONCLUSION

Prisoners are a vulnerable group with a high prevalence of hepatitis B infection and the custodial setting plays an important role in the delivery of hepatitis B vaccination to this hard to reach group. This study suggests that variation in hepatitis B vaccination coverage and uptake may exist by geographical region and prison category. Further research is required to confirm and identify possible explanations for our findings.