Institute Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), INSERM, Sorbonne Universités, F-75012 Paris, France.
Laboratoire de Virologie, Hôpital Saint-Antoine, AP-HP, F-75012 Paris, France.
World J Gastroenterol. 2017 Oct 14;23(38):7037-7046. doi: 10.3748/wjg.v23.i38.7037.
To determine whether hepatitis B virus (HBV)-testing could serve as a gateway to vaccinate non-immunized individuals in a low-prevalent country.
Non-immunized subjects participating in a multi-center, HBV-testing campaign in Paris, France were identified and contacted via telephone 3-9 mo after testing in order to determine vaccination status. Vaccination coverage was evaluated in per-protocol (for all respondents) and intent-to-treat analysis (assuming all non-responders did not vaccinate).
In total, 1215/4924 (24.7%) enrolled subjects with complete HBV serology were identified as non-immunized and eligible for analysis. There were 99/902 successfully contacted subjects who had initiated HBV vaccination after screening: per-protocol, 11.0% (95%CI: 9.0-13.2); intent-to-treat, 8.2% (95%CI: 6.7-9.8). In multivariable analysis, vaccination was more likely to be initiated in individuals originating from moderate or high HBV-endemic countries ( < 0.001), patients with limited healthcare coverage ( = 0.01) and men who have sex with men ( = 0.02). When asked about the reasons for not initiating HBV vaccination, the most frequent response was "will be vaccinated later" (33.4%), followed by "did not want to vaccinate" (29.8%), and "vaccination was not proposed by the physician" (21.5%). Sub-group analysis indicated a stark contrast in vaccination coverage across centers, ranging from 0%-56%.
HBV-vaccination after HBV screening was very low in this study, which appeared largely attributed to physician-patient motivation towards vaccination. Increased vaccination coverage might be achieved by emphasizing its need at the organizational level.
确定乙型肝炎病毒（HBV）检测能否成为在低流行国家为未免疫个体接种疫苗的切入点。
在法国巴黎的一项多中心 HBV 检测活动中，确定了未免疫的参与者，并在检测后 3-9 个月通过电话联系他们，以确定接种疫苗的状况。通过方案规定（针对所有应答者）和意向治疗分析（假设所有未应答者都未接种疫苗）评估接种疫苗的覆盖率。
在总共纳入的 4924 名完成 HBV 血清学检测的参与者中，有 1215 名（24.7%）被确定为未免疫且符合分析条件。在 902 名成功联系到的筛查后开始接种 HBV 疫苗的受试者中，方案规定接种率为 11.0%（95%CI：9.0-13.2）；意向治疗分析接种率为 8.2%（95%CI：6.7-9.8）。多变量分析显示，来自 HBV 中高度流行国家的个体（<0.001）、医疗保健覆盖有限的患者（=0.01）和男男性行为者（=0.02）更有可能开始接种疫苗。当被问及未开始接种 HBV 疫苗的原因时，最常见的回答是“以后会接种”（33.4%），其次是“不想接种”（29.8%）和“医生未建议接种”（21.5%）。亚组分析表明，各中心的疫苗接种覆盖率差异很大，范围从 0%-56%。
在这项研究中，HBV 筛查后接种 HBV 疫苗的比例非常低，这主要归因于医患双方对接种疫苗的积极性。通过强调组织层面的需求，可能会提高接种疫苗的覆盖率。
