Subject(s)
Adenomatous Polyposis Coli/diagnosis , Colonoscopes/adverse effects , Colonoscopy/adverse effects , Intestinal Perforation/etiology , Sigmoid Diseases/etiology , Colonoscopy/methods , Equipment Design , Equipment Safety , Follow-Up Studies , Humans , Intestinal Perforation/surgery , Laparotomy , Male , Middle Aged , Risk Assessment , Sigmoid Diseases/surgeryABSTRACT
The U.S. Army administers the hepatitis A virus (HAV) vaccination for prophylaxis against HAV infection. There is little comparative data as to whether prescreening for previous HAV infection before immunization is less costly than universal vaccination. We designed a study to determine the prevalence of previous HAV infection in U.S. Army recruits and then perform a cost analysis. The cost analysis compared selective vaccination versus universal vaccination. Basic demographic information, including age, gender, geographic origin, and ethnicity, were collected after which patients were tested for HAV antibodies. A total of 1,332 individuals was prospectively enrolled with 183 individuals (13.74%) having evidence of previous HAV infection. Minority recruits were found to have a higher prevalence than Caucasian recruits (p = 0.0451. The cost analysis demonstrates that vaccination without prescreening was the least costly of two vaccination strategies for this cohort. To achieve current vaccination goals, all U.S. military recruits should be vaccinated without evaluation for previous HAV immunity.
Subject(s)
Hepatitis A Vaccines/therapeutic use , Hepatitis A/epidemiology , Military Personnel , Vaccination/economics , Adolescent , Adult , Costs and Cost Analysis , Female , Hepatitis A Vaccines/economics , Humans , Immunity , Male , Prevalence , United States/epidemiologyABSTRACT
OBJECTIVES: There are few prospective studies estimating the prevalence of hepatitis A in chronic liver disease patients. Furthermore, there are minimal cost-comparative data as to whether or not screening for hepatitis A exposure before immunization is an effective fiscal strategy. The objectives of this study were to determine the prevalence of prior hepatitis A infection and to perform a prospective cost analysis for hepatitis A immunization in patients with chronic liver disease. METHODS: This is a prospective cohort study of 100 patients with chronic liver diseases. Patients were screened for potential risk factors for hepatitis A including history of jaundice, socioeconomic status, birth origin, and ethnic background. Each patient underwent testing for evidence of prior infection using an ELISA. Seronegative patients then went on to receive an immunization series. Cost analysis of vaccination without prescreening (universal strategy) was compared to cost analysis of prescreening and selective immunization of those without prior infection (selective strategy). RESULTS: Fifty-three patients (53%) had serological evidence of prior hepatitis A infection (95% CI = 43-63%). Of the risk factors assessed, foreign birth was associated with prior hepatitis A exposure (p = 0.0002). Cost analysis revealed that prescreening for hepatitis A before vaccination was cost saving given the current prevalence. CONCLUSIONS: The seroprevalence of hepatitis A in those with chronic liver diseases was 53%. Cost analysis revealed that screening for hepatitis A before immunization is cost saving, and this strategy should be applied to follow current vaccination guidelines.
