Hepatitis B Vaccination and Screening Awareness in Primary Care Practitioners

Introduction. The goals of Healthy People US 2020 have called for increased screening and vaccination of high-risk groups for Hepatitis B (HBV). Methods. We performed a survey of 400 randomly chosen primary care practitioners (PCPs) in Wisconsin to assess their knowledge, attitudes, and practices regarding screening and vaccination for HBV. Results. Screening rates of patients at risk of sexual transmission were low, with 61% of respondents stating that they screen patients who had more than 1 sex partner in 6 months and 86% screening patients with a history of sex with prostitutes. Screening rate for persons with a history of intravenous drug use was 94%. Children of immigrants were screened by 65%, persons on hemodialysis by 73%, and prison inmates by 69%. Screening increased with provider experience with HBV. Deficiencies in vaccination rates mirrored screening practices. Major barriers to screening were cost, someone else’s responsibility, time constraints, or lack of knowledge. Conclusions. Without improved education and practices of PCPs about HBV screening and vaccination, the goals of healthy people 2020 regarding HBV will not be met. Barriers to screening and vaccination need to be addressed. Cost-effectiveness of alternative strategies such as universal vaccination under the age of 50 should be explored. 1. Introduction Worldwide over 400 million people are carriers of hepatitis B; in the United States an estimated 1.25 million people are chronically infected and an estimated 51,000 new cases occurred in 2005 [1, 2]. Although the incidence of HBV has declined since the 1980s in all age groups, the decline has been slower in adults, particularly in males from ages 25–44 [2]. 1.1. Vaccination Guidelines Immunization Guidelines from the Centers for Disease Control (CDC) published in 1991 and updated in 1995 and 1999 call for universal vaccination of all persons younger than 18 years of age and adults older than 18 who are at risk for hepatitis B infection [3]. In December 2006, the Advisory Committee on Immunization Practices from the CDC released the first comprehensive statement on hepatitis B immunization since universal vaccination was advocated in 1991 [4]. These updated guidelines apart from reemphasizing the recommendations from previous iterations emphasized the importance of administering hepatitis B vaccination in primary care clinics as part of routine clinical care and to remove barriers for this care. Although guidelines abound, 10% of practitioners are completely unaware of the existence of 78% of the guidelines [5] and current