Hepatitis vaccination adherence and completion rates and factors associated with low compliance: A claims-based analysis of U.S. adults.

Poor compliance with multi-dose vaccine schedules by adults for whom hepatitis (Hep) A and B vaccines are recommended contributes to major Hep A and B disease burdens among high-risk U.S. adults. Evidence on hepatitis vaccine series adherence, completion, timeliness of completion, and factors associated with these outcomes, is limited and not readily generalizable for U.S. adults. This retrospective, observational study examined adherence, completion, its timeliness, and the impact of sociodemographic and clinical factors on these outcomes among a large, geographically representative sample of U.S. adults. We analyzed the Optum Clinformatics SES administrative claims database (1/1/2010-6/30/2020) for recipients of 2-dose (HepA, HepB2) or 3-dose (HepB3, HepAB) hepatitis vaccines. Adherence was defined as receipt of booster doses within specified assessment periods, per label-recommended schedules. Completion (receipt of all doses) was assessed at 6, 12, 18, and 24 months.The study included 356,828 adults ≥19 years old who were continuously enrolled in a medical benefit plan for one (HepB2), six (HepB3; HepAB), or 18 months (HepA) prior to and following the index date (first observed vaccine dose). Adherence and 24-month completion rates were: HepA (27.0%, 28.4%), HepB2 (32.2%, 44.8%), HepB3 (14.3%, 37.3%), HepAB, (15.3%, 33.8%). Kaplan-Meier completion curves plateaued after about 6 months for HepB2 and about 12 months for HepA, HepB3, and HepAB vaccines. Logistic regression analyses showed risk for low adherence/completion was generally associated with male gender, younger age, Black or Hispanic race/ethnicity, lower educational or household income attainment, and more comorbidities. Adherence and completion rates for all hepatitis vaccine series are low, especially for males, younger adults, those with lower socio-economic status and more comorbidities. To our knowledge, this is the largest claims-based analysis of adherence and completion rates for U.S. adults initiating all currently available HepA and HepB vaccines. Findings may inform hepatitis vaccination programming.

Imputing QALYs from single time point health state descriptions on the EQ-5D and the SF-6D: a comparison of methods for hepatitis a patients.

OBJECTIVES: To explore the impact of applying different non-standardized analytical choices for quality of life measurement to obtain quality-adjusted life years (QALYs). In addition to more widely discussed issues such as the choice of instrument (e.g. EQ-5D or SF-6D?) researchers must also choose between different recall periods, scoring algorithms and interpolations between points of measurement. METHODS: A prospective survey was made among 114 Belgian patients with acute hepatitis A illness. Using non-parametric tests and generalized linear models (GLM's), we compared four different methods to estimate QALY losses, two based on the EQ-5D (administered during the period of illness without recall period) and two based on the SF-6D (administered after illness with 4 weeks recall period). RESULTS: We found statistically significant differences between all methods, with the non-parametric SF-6D-based method yielding the highest median QALY impact (0.032 QALYs). This is more than five times as high as the EQ-5D-based method with linear health improvement, which yields the lowest median QALY impact (0.006 QALYs). CONCLUSIONS: Economic evaluations of health care technologies predominantly use QALYs to quantify health benefits. Non-standardised analytical choices can have a decision-changing impact on cost-effectiveness results, particularly if morbidity takes up a substantial part of the total QALY loss. Yet these choices are rarely subjected to sensitivity analysis. Researchers and decision makers should be aware of the influence of these somewhat arbitrary choices on their results.

Previous hepatitis a virus infection is related to slower psychomotor speed in elderly adults.

BACKGROUND: Patients with chronic viral hepatitis are at a higher risk for cognitive dysfunction. Little is known about the association between hepatitis A virus (HAV) infection and cognitive function. METHODS: From the National Health and Nutrition Examination Survey, 1999-2002, we selected study participants (> or =60 years, n = 1,529) without hepatitis B, C, or D virus infection; without previous hepatitis A vaccination; and without abnormal liver function. HAV-seropositive participants represented people with previous HAV infection. Psychomotor speed and executive functioning domain of cognitive function were measured by the Digit Symbol Substitution Test (DSST). RESULTS: HAV-seropositive participants had lower DSST scores than HAV-seronegative participants (weighted mean, 44.4 vs 53.9, p < .001). We designated HAV-seronegative participants as the reference group. Univariate analysis demonstrated that the weighted beta coefficient of DSST score was -9.55 (95% confidence interval [CI] -9.57 to -9.54, p < .001) for the HAV-seropositive participants. In a multivariable model, the weighted adjusted beta coefficient of DSST score was -2.48 (95% CI -2.49 to -2.46, p < .001) for the HAV-seropositive participants. CONCLUSION: HAV seropositivity is associated with slower psychomotor speed among the U.S. community-dwelling elders.

Pretravel health preparation among US residents traveling to India to VFRs: importance of ethnicity in defining VFRs.

BACKGROUND: International travelers visiting friends and relatives (VFRs) in lower income countries experience high rates of travel-related infections. We examined demographic characteristics and pretravel preparation practices among US residents traveling to India to determine factors that may contribute to higher infection rates and that would allow for improved prevention strategies. METHODS: A cross-sectional study was conducted among US residents traveling to India in departure areas for flights to India at three US international airports during August 2005. Eligible travelers were US residents going to India who were English speaking and >or=18 years. Self-administered questionnaires were used to assess knowledge of and compliance with pretravel health recommendations. RESULTS: Of 1,574 eligible travelers, 1,302 (83%) participated; 60% were male and the median age was 37. Eighty-five percent were of South Asian/Indian ethnicity and 76% reported VFR as the primary reason for travel. More than 90% of VFRs had at least a college education and only 6% cited financial barriers as reasons for not obtaining travel health services. VFRs were less likely than non-VFR travelers to seek pretravel health advice, to be protected against hepatitis A or typhoid fever, and less likely to be taking appropriate antimalarial chemoprophylaxis. However, when stratified by ethnicity, travelers of South Asian ethnicity were less likely than other travelers to adhere to pretravel health recommendations, regardless of VFR status. CONCLUSIONS: Similar to previous studies, VFR status was associated with pretravel health practices that leave travelers at risk for important infectious diseases. This association differed by ethnicity, which may also be an important marker of nonadherence to pretravel health recommendations. These findings have important implications for identifying at-risk travelers and properly targeting prevention messages.

Hepatitis A in a Chinese urban population: the spectrum of social and behavioural risk factors.

BACKGROUND: Viral hepatitis is a major public health problem in China. Hepatitis A infections represent a substantial proportion of these, particularly in urban centres. Little is known about the social and behavioural factors in the urban household environment that influence the transmission of hepatitis A. METHODS: We conducted a register-based case-control study to investigate the risk factor patterns for hepatitis A in the general population of the City of Wuhan, in the PR China. Cases were selected from district-based health registers. One control, matched for sex and age, was identified from the case's neighbourhood. Home-based interviews combined with household observation were performed to obtain information on social, behavioural and economic risk factors and the household's indoor and outdoor environment. Analysis included conditional logistic regression. RESULTS: Hepatitis A infection was associated with a variety of social and household-related factors, like handwashing habits (after working in the garden: adjusted odds ratio [OR] = 8.24, 95% confidence interval [CI]: 1.5-44.2, before food preparation: OR = 4.68, 95% CI: 1.8-12.0; before eating: OR = 4.92, 95% CI: 1.5-15.7), and the source of fresh vegetables (OR = 3.90, 95% CI: 1.6-9.8). Hygiene in the kitchen and the household surroundings and the disposal of children's stools in vegetable gardens or refuse pits were significantly associated with univariate analysis only. The lack of possession of luxury consumer items as a surrogate indicator for income was significantly associated with the disease (OR = 2.47, 95% CI: 1.0-6.1). The study clearly established that exposure to health and hygiene education was less in the group of hepatitis A cases when compared to healthy controls (OR = 2.80, 95% CI: 0.9-8.3). CONCLUSION: The results of this study underline how social and behavioural factors are important determinants for hepatitis A in urban Chinese populations. These issues could be addressed by appropriate health and hygiene education targeted at high risk groups, and by strengthening existing procedures for monitoring and control of food hygiene.

[The symptom picture in patients with acute viral hepatitis. A systematic study using the Giessen Symptom Questionnaire]. / Das Beschwerdebild bei Patienten mit akuter Virushepatitis. Eine systematische Untersuchung mit dem Giessener Beschwerdebogen.

As part of a study on the relationship between psychosocial factors and the course of acute viral hepatitis A, B and NANB, bodily complaints of 41 patients were examined and two major complaint factors evolved. One complex of specific liver complaints, consisting of fatigue and an excessive need for sleep, gastrointestinal and skin symptoms, correlated with the degree of liver damage and can most readily be regarded as organdependent. A smaller group of general complaints did not correlate with liver damage. It seems to represent a complex symptomatology, which is probably partly psychologically determined. Patients with hepatitis B suffer the severest liver damage and present the most specific complaints. Patients with hepatitis NANB show the mildest symptomatology and patients with hepatitis A hold a medium position. The hepatitis types do not differ in respect to their general complaints. While sex-related differences in the level of complaints are still visible during the prodromal phase, sex and age-related differences disappear during the acute phase. Further morbidity also does not influence symptomatology at this stage. At discharge, however, sex-related differences and the effects of further morbidity on the remaining complaints reaper.