6542 Philadelphia Department of Public Health, Philadelphia, PA, USA.
Prevention Point Philadelphia, Philadelphia, PA, USA.
Public Health Rep. 2020 Sep/Oct;135(5):691-699. doi: 10.1177/0033354920943528. Epub 2020 Aug 13.
Although many people who use drugs meet criteria for vaccination against hepatitis A virus (HAV) and hepatitis B virus (HBV), estimates of susceptibility (ie, lack of immunity) are not well established. This study sought to identify the prevalence of and characteristics associated with HAV and HBV susceptibility among people who use drugs attending an urban syringe services program.
We initiated this seroprevalence study in 2018 among 438 clients of a syringe services program who met study criteria, including provision of a blood specimen and a self-reported history of drug use. We assessed HAV and HBV susceptibility and infection via serological testing. We examined associations between participant characteristics and serology status by using descriptive statistics and multivariable logistic regression models.
Of the initial 438 clients identified, 353 (80.6%) met study criteria. Of 352 participants with conclusive HAV test results, 48.6% (n = 171) were HAV susceptible; of 337 participants with conclusive HBV test results, 32.6% (n = 110) were HBV susceptible, 24.3% (n = 82) showed evidence of past or present HBV infection, and 43.0% (n = 145) had vaccine-derived immunity. Compared with participants born before 1970, participants born during 1980-1989 had 5.90 (95% CI, 2.42-14.40) times the odds of HAV susceptibility and 0.18 (95% CI, 0.06-0.53) times the odds of HBV susceptibility, and participants born during 1990-1999 had 6.31 (95% CI, 2.34-17.00) times the odds of HAV susceptibility. Decreased odds of HAV susceptibility were associated with homelessness (adjusted odds ratio = 0.48; 95% CI, 0.28-0.82).
Despite applicable HAV and HBV vaccination recommendations, substantial gaps exist in HAV and HBV susceptibility among a population of people who use drugs. These findings highlight the need for increased HAV and HBV vaccination efforts among people who use drugs.
尽管许多吸毒者符合甲型肝炎病毒 (HAV) 和乙型肝炎病毒 (HBV) 疫苗接种标准，但对其易感性（即缺乏免疫力）的估计尚未得到很好的确立。本研究旨在确定在参加城市注射器服务计划的吸毒者中，HAV 和 HBV 易感性的流行情况和相关特征。
我们于 2018 年在符合研究标准的 438 名注射器服务计划客户中启动了这项血清流行率研究，包括提供血液样本和自我报告的吸毒史。我们通过血清学检测评估 HAV 和 HBV 的易感性和感染情况。我们使用描述性统计和多变量逻辑回归模型来检查参与者特征与血清学状态之间的关联。
在最初确定的 438 名客户中，有 353 名（80.6%）符合研究标准。在有明确 HAV 检测结果的 352 名参与者中，48.6%（n=171）对 HAV 易感；在有明确 HBV 检测结果的 337 名参与者中，32.6%（n=110）对 HBV 易感，24.3%（n=82）显示过去或现在 HBV 感染的证据，43.0%（n=145）有疫苗衍生的免疫力。与出生于 1970 年前的参与者相比，出生于 1980-1989 年的参与者感染 HAV 的几率高 5.90 倍（95%CI，2.42-14.40），感染 HBV 的几率低 0.18 倍（95%CI，0.06-0.53），而出生于 1990-1999 年的参与者感染 HAV 的几率高 6.31 倍（95%CI，2.34-17.00）。HAV 易感性降低与无家可归有关（调整后的优势比=0.48；95%CI，0.28-0.82）。
尽管有适用的 HAV 和 HBV 疫苗接种建议，但在吸毒者人群中，HAV 和 HBV 易感性仍存在显著差距。这些发现强调了需要在吸毒者中加强 HAV 和 HBV 疫苗接种工作。
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