Skip to main content
PMC home page
The BMJ logoLink to The BMJ
. 1991 Jul 13;303(6794):97–101. doi: 10.1136/bmj.303.6794.97

Failure to deliver hepatitis B vaccine: confessions from a genitourinary medicine clinic.

N Bhatti 1, R J Gilson 1, M Beecham 1, P Williams 1, M P Matthews 1, R S Tedder 1, I V Weller 1
PMCID: PMC1670616  PMID: 1830505

Abstract

OBJECTIVE--To audit hepatitis B immunisation of homosexual or bisexual men in a genitourinary medicine clinic. DESIGN--Retrospective case note review of all homosexual and bisexual men presenting to a genitourinary clinic as new patients during 12 months in 1988 and follow up review of notes to May 1990. SETTING--One department of genitourinary medicine, Middlesex Hospital. PATIENTS--758 homosexual or bisexual men, of whom 207 started a course of hepatitis B vaccine in 1988. Case notes were unavailable for one patient. MAIN OUTCOME MEASURES--The proportion of patients screened for hepatitis B virus markers, the proportion of susceptible patients immunised, the proportion completing the vaccine course, and the proportion rendered immune. RESULTS--25 men had been previously tested for hepatitis markers; of the 732 not previously tested, 440 (60.1%) were screened for hepatitis B markers. 207 (69%) of the 300 patients without hepatitis B serological markers started the vaccine course, and 141 (68%) completed it, with 75 (84%) of the 89 tested after immunisation being immune. An estimated 24% of susceptible new patients were rendered immune as a result of the immunisation policy. Patients who presented with a further episode of a sexually transmitted disease were more likely to have been screened (25% v 12%, p less than 0.0001) and immunised (31% v 18% p = 0.02); those known or found to be positive for HIV antibody were more likely to have been screened (23% v 14%, p = 0.047) but less likely to have been immunised (6% v 17%, p = 0.004). CONCLUSIONS--The major failure was that in not screening; failure to immunise patients found to be susceptible and failure of compliance with the vaccine course contributed. Non-response to the vaccine was of minor importance. Improvements in vaccine delivery are required. IMPLICATIONS--Other providers should be encouraged to review their performance.

Full text

PDF
100

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adler M. W., Belsey E. M., McCutchan J. A., Mindel A. Should homosexuals be vaccinated against hepatitis B virus? Cost and benefit assessment. Br Med J (Clin Res Ed) 1983 May 21;286(6378):1621–1624. doi: 10.1136/bmj.286.6378.1621. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. André F. E., Safary A. Summary of clinical findings on Engerix-B, a genetically engineered yeast derived hepatitis B vaccine. Postgrad Med J. 1987;63 (Suppl 2):169–177. [PubMed] [Google Scholar]
  3. Bodsworth N., Donovan B., Nightingale B. N. The effect of concurrent human immunodeficiency virus infection on chronic hepatitis B: a study of 150 homosexual men. J Infect Dis. 1989 Oct;160(4):577–582. doi: 10.1093/infdis/160.4.577. [DOI] [PubMed] [Google Scholar]
  4. Carne C. A., Weller I. V., Waite J., Briggs M., Pearce F., Adler M. W., Tedder R. S. Impaired responsiveness of homosexual men with HIV antibodies to plasma derived hepatitis B vaccine. Br Med J (Clin Res Ed) 1987 Apr 4;294(6576):866–868. doi: 10.1136/bmj.294.6576.866. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Christopher P. J., Crewe E. B., Mailer P. T., Murphy A. M. Hepatitis B infection among STD clinic patients in Sydney. Aust N Z J Med. 1984 Aug;14(4):491–494. doi: 10.1111/j.1445-5994.1984.tb03624.x. [DOI] [PubMed] [Google Scholar]
  6. Collier A. C., Corey L., Murphy V. L., Handsfield H. H. Antibody to human immunodeficiency virus (HIV) and suboptimal response to hepatitis B vaccination. Ann Intern Med. 1988 Jul 15;109(2):101–105. doi: 10.7326/0003-4819-109-2-101. [DOI] [PubMed] [Google Scholar]
  7. Coutinho R. A., Lelie N., Albrecht-Van Lent P., Reerink-Brongers E. E., Stoutjesdijk L., Dees P., Nivard J., Huisman J., Reesink H. W. Efficacy of a heat inactivated hepatitis B vaccine in male homosexuals: outcome of a placebo controlled double blind trial. Br Med J (Clin Res Ed) 1983 Apr 23;286(6374):1305–1308. doi: 10.1136/bmj.286.6374.1305. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Ellis W. R., Murray-Lyon I. M., Coleman J. C., Evans B. A., Fluker J. L., Bull J., Keeling P. W., Simmons P. D., Banatvala J. E., Willcox J. R. Liver disease among homosexual males. Lancet. 1979 Apr 28;1(8122):903–905. doi: 10.1016/s0140-6736(79)91376-x. [DOI] [PubMed] [Google Scholar]
  9. Francis D. P., Hadler S. C., Thompson S. E., Maynard J. E., Ostrow D. G., Altman N., Braff E. H., O'Malley P., Hawkins D., Judson F. N. The prevention of hepatitis B with vaccine. Report of the centers for disease control multi-center efficacy trial among homosexual men. Ann Intern Med. 1982 Sep;97(3):362–366. doi: 10.7326/0003-4819-97-3-362. [DOI] [PubMed] [Google Scholar]
  10. Fulford K. W., Dane D. S., Catterall R. D., Woof R., Denning J. V. Australia antigen and antibody among patients attending a clinic for sexually transmitted diseases. Lancet. 1973 Jun 30;1(7818):1470–1473. doi: 10.1016/s0140-6736(73)91810-2. [DOI] [PubMed] [Google Scholar]
  11. Hentzer B., Skinhøj P., Høybye G., Nielsen A. O., Kvorning S. A., Faber V. Viral hepatitis in a venereal clinic population. Relation to certain risk factors. Scand J Infect Dis. 1980;12(4):245–249. doi: 10.3109/inf.1980.12.issue-4.02. [DOI] [PubMed] [Google Scholar]
  12. Jeffries D. J., James W. H., Jefferiss F. J., MacLeod K. G., Willcox R. R. Australia (hepatitis-associated) antigen in patients attending a venereal disease clinic. Br Med J. 1973 May 26;2(5864):455–456. doi: 10.1136/bmj.2.5864.455. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Krogsgaard K., Lindhardt B. O., Nielson J. O., Andersson P., Kryger P., Aldershvile J., Gerstoft J., Pedersen C. The influence of HTLV-III infection on the natural history of hepatitis B virus infection in male homosexual HBsAg carriers. Hepatology. 1987 Jan-Feb;7(1):37–41. doi: 10.1002/hep.1840070109. [DOI] [PubMed] [Google Scholar]
  14. Loke R. H., Murray-Lyon I. M., Balachandran T., Evans B. A. Screening for hepatitis B and vaccination of homosexual men. BMJ. 1989 Jan 28;298(6668):234–234. doi: 10.1136/bmj.298.6668.234. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Loveday C., Pomeroy L., Weller I. V., Quirk J., Hawkins A., Williams H., Smith A., Williams P., Tedder R. S., Adler M. W. Human immunodeficiency viruses in patients attending a sexually transmitted disease clinic in London, 1982-7. BMJ. 1989 Feb 18;298(6671):419–422. doi: 10.1136/bmj.298.6671.419. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. McCusker J., Hill E. M., Mayer K. H. Awareness and use of hepatitis B vaccine among homosexual male clients of a Boston community health center. Public Health Rep. 1990 Jan-Feb;105(1):59–64. [PMC free article] [PubMed] [Google Scholar]
  17. Mulley A. G., Silverstein M. D., Dienstag J. L. Indications for use of hepatitis B vaccine, based on cost-effectiveness analysis. N Engl J Med. 1982 Sep 9;307(11):644–652. doi: 10.1056/NEJM198209093071103. [DOI] [PubMed] [Google Scholar]
  18. Polakoff S. Acute viral hepatitis B, reported to the Public Health Laboratory service. J Infect. 1990 Mar;20(2):163–168. doi: 10.1016/0163-4453(90)93522-t. [DOI] [PubMed] [Google Scholar]
  19. Schreeder M. T., Thompson S. E., Hadler S. C., Berquist K. R., Zaidi A., Maynard J. E., Ostrow D., Judson F. N., Braff E. H., Nylund T. Hepatitis B in homosexual men: prevalence of infection and factors related to transmission. J Infect Dis. 1982 Jul;146(1):7–15. doi: 10.1093/infdis/146.1.7. [DOI] [PubMed] [Google Scholar]
  20. Szmuness W., Stevens C. E., Harley E. J., Zang E. A., Oleszko W. R., William D. C., Sadovsky R., Morrison J. M., Kellner A. Hepatitis B vaccine: demonstration of efficacy in a controlled clinical trial in a high-risk population in the United States. N Engl J Med. 1980 Oct 9;303(15):833–841. doi: 10.1056/NEJM198010093031501. [DOI] [PubMed] [Google Scholar]
  21. Tedder R. S., Cameron C. H., Wilson-Croome R., Howell D. R., Colgrove A., Barbara J. A. Contrasting patterns and frequency of antibodies to the surface, core, and e antigens of hepatitis B virus in blood donors and in homosexual patients. J Med Virol. 1981;6(4):323–332. doi: 10.1002/jmv.1890060407. [DOI] [PubMed] [Google Scholar]
  22. Weller I. V., Brown A., Morgan B., Hawkins A., Briggs M., Waite J., Cameron C. H., Tedder R. Spontaneous loss of HBeAg and the prevalence of HTLV-III/LAV infection in a cohort of homosexual hepatitis B virus carriers and the implications for antiviral therapy. J Hepatol. 1986;3 (Suppl 2):S9–16. doi: 10.1016/s0168-8278(86)80095-2. [DOI] [PubMed] [Google Scholar]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES