Hepatitis B vaccination coverage among high-risk adults 18-49 years, U.S., 2009

Background

Approximately 43,000 new hepatitis B virus (HBV) infections occurred in 2007. Although hepB vaccination has been recommended for adults at high-risk for incident HBV infection for many years, coverage remains low.

Methods

We used the 2009 National Health Interview Survey to assess self-reported HepB vaccine uptake (≥1 dose), series completion (≥3 dose), and independent predictors of vaccination among high-risk adults aged 18-49 years. High-risk adults were defined as those reporting male sex with men; injection drug use; hemophilia with receipt of clotting factors; sexually transmitted disease in prior five years; sex for money or drugs; HIV positive; sex with persons having any above risk factors; or who “felt they were at high risk for HIV”. Persons with none of the aforementioned risk factors were considered non-high risk. Bivariate analysis was conducted to assess vaccination coverage. Independent predictors of vaccine uptake and series completion were determined using a logistic regression.

Results

Overall, 7.0% adults aged 18-49 years had high-risk behaviors. Unadjusted coverage with ≥1 dose was 50.5% among high-risk compared to 40.5% among non-high-risk adults (p-values <0.001) while series completion (≥3 doses) was 41.8% and 34.2%, respectively (p-values <0.001). On multivariable analysis, ≥1 dose coverage, but not series completion, was higher (Risk Ratio 1.1, 95% CI = 1.0-1.2, p-value = 0.021) among high-risk compared to non-high risk adults. Other characteristics independently associated with a higher likelihood of HepB vaccination among persons 18-49 years included younger age groups, females, higher education, ≥2 physician contacts in the past year, ever tested for HIV, health care personnel, received influenza vaccination in the previous year, and ever received hepatitis A vaccination. Vaccine uptake with ≥1 dose increased by 5.1% (p = 0.047) among high-risk adults between 2004 and 2009.

Conclusions

A small increase in ≥1 dose HepB vaccination coverage among high-risk adults compared with non-high risk adults was documented for the first time in 2009. Higher coverage among persons 18-30 years may reflect aging of persons vaccinated when they were children and adolescents. To improve protection against hepatitis B among high-risk adults, healthcare providers should offer hepatitis B vaccination to persons at high risk and those who seek vaccination to protect themselves and facilitate timely completion of the three (3) dose HepB series.     

2004-2009年滦南县HIV/STD感染情况分析

目的了解2004-2009年滦南县艾滋病性病(human immunodeficiency virus/sexually transmitted dis-ease,HIV/STD)感染情况的变化趋势及主要患病人群特征,评价滦南县艾滋病性病预防控制工作的效果,为制定下一步预防控制策略提供科学依据。方法分析2004-2009年滦南县HIV/STD传染病报告数据,比较各年份报告HIV/STD的构成变化和感染者人口学特征。结果 2004-2008年,滦南县HIV/STD报告感染总数由87例降低到15例以下,2009年报告感染总数回升至34例。2007-2009年连续3年HIV感染报告例数为0例,报告感染数最多的性病为尖锐湿疣、非淋菌性尿道炎和淋病。感染者中男性多于女性,并且2004-2007年男性比例呈上升趋势,2008-2009年有所降低;感染者年龄分布以30岁以下为主,20岁以下感染者比例由2004年的27.5%增至2009年的55.9%;学历以中学为主;职业以农民、工人和待业者为主,2008-2009年农民比例降低至30.0%,工人和待业者升高至50.0%;婚姻状况以已婚为主,但未婚者所占比例由20%升高至30...     

参加美沙酮维持治疗海洛因成瘾者传播艾滋病高危行为及应对

美沙酮维持治疗(methadone maintenance treatment,MMT)可以减少海洛因成瘾者感染或传播艾滋病病毒(human immunodeficiency virus,HIV)的相关危险行为,但部分参加者在治疗期间仍然会有吸毒等危险行为发生。治疗期间发生危险行为的原因受治疗前和治疗本身等多种因素影响。采用较高治疗剂量、提高保持率、加强综合干预措施等可以减少海洛因成瘾者治疗期间危险行为的发生,提高MMT预防HIV传播的效果。     

Bridging Populations—Sexual Risk Behaviors and HIV Prevalence in Clients and Partners of Female Sex Workers,Bangkok, Thailand 2007

The aim of this study is to estimate HIV prevalence and assess sexual behaviors in a high-risk and difficult-to-reach population of clients of female sex workers (FSWs). A modified variation of respondent-driven sampling was conducted among FSWs in Bangkok, where FSWs recruited 3 FSW peers, 1 client, and 1 nonpaying partner. After informed consent was obtained, participants completed a questionnaire, were HIV-tested, and were asked to return for results. Analyses were weighted to control for the design of the survey. Among 540 FSWs, 188 (35%) recruited 1 client, and 88 (16%) recruited 1 nonpaying partner. Clients’ median age was 38 years. HIV prevalence was 20% and was associated with younger age at first sexual experience [relative risk (RR) = 3.10, 95% confidence interval (CI) 1.16–8.24] and condom use during last sexual encounter with regular partner (RR = 3.97, 95% CI 1.09–14.61). Median age of nonpaying partners was 34 years, and HIV prevalence was 15.1%. There were 56 discordant FSW–client pairs and 14 discordant FSW–nonpaying partner pairs. Condom use was relatively high among discordant FSW–client pairs (90.1%) compared to discordant FSW–nonpaying partner pairs (18.7%). Results suggest that sexual partners of FSWs have a high HIV prevalence and can be a bridge for HIV transmission to other populations. Findings also highlight the importance of initiating surveillance and targeted programs for FSW partners, and demonstrate a recruitment method for hard-to-reach populations.     

Human papillomavirus vaccine coverage in the United States, National Health and Nutrition Examination Survey, 2007-2008

Objectives

This study aims to estimate human papillomavirus (HPV) vaccine coverage by demographic and sexual behavior characteristics 1-2 years after vaccine licensure in a nationally representative sample of females aged 9-59 years in the United States.

Methods

In 2007-2008, a total of 2775 females aged 9-59 years responded to questions on HPV vaccine receipt in the National Health and Nutrition Examination Survey (NHANES). Demographic and sexual characteristics were evaluated for select age categories in bivariate analyses after adjusting for survey design.

Results

Overall, 15.2% of females aged 11-26 years reported HPV vaccine initiation; vaccine initiation varied significantly by age. We found no significant difference in vaccine initiation by race or poverty level in either 11-18 or 19-26-year olds. Significantly more 19-26-year olds with private insurance initiated vaccine (16.3%) than those with public insurance (4.0%) (p = 0.04). Among females aged 14-18 years, vaccine initiation was higher in those who ever had sex (28.6%) compared to those who had never had sex (17.8%) (p = 0.05).

Conclusions

These results describe HPV vaccine initiation shortly after vaccine licensure. Vaccine initiation was highest in females aged 14-18 years. Efforts should be made to increase HPV vaccine coverage for the recommended age groups.     

Structural-level factors affecting implementation of the methadone maintenance therapy program in China

This study identifies structural-level factors influencing methadone maintenance therapy (MMT) program implementation in China. Twenty-eight service providers and 560 randomly selected clients from 28 MMT clinics in the study area underwent face-to-face interviews. Number of clients, retention rate, coverage, and structural-level factors were collected from a survey of service providers. Individual-level factors and self-reported illicit drug use information were obtained from clients. Urine specimens were collected from the client participants to test for heroin use. Clinics affiliated with the local Centers for Disease Control and Prevention (CDC) had more clients, higher retention rates, and broader coverage than those not affiliated with the CDC. Longer operating hours, incentive for compliant clients, and comprehensive services were positively associated with client recruitment and coverage. Comprehensive services and incentives for compliant clients were negatively associated with concurrent illicit drug use. Comprehensive services should be incorporated into the MMT program. Extended operating hours and incentives for compliant clients should be implemented.     

The Geographic Distribution of AIDS in the United States: Is There a Rural Epidemic?

The goal of this study was to examine where people with acquired immune deficiency syndrome (AIDS) in the United States live and the degree to which AIDS is present in rural areas. AIDS cases reported to the Centers for Disease Control and Prevention (CDC) in 1996 were categorized by metropolitan statistical area (MSA) size and compared to the general population. Data were analyzed by region, race/ethnicity and risk exposure; AIDS incidence rates were compared over time by MSA size. Relative to the U.S. population, AIDS cases were disproportionately black (43 percent vs. 11 percent), male (80 percent vs. 48 percent), and from the Northeast (32 percent vs. 20 percent). In all regions, a greater proportion of AIDS cases reside in large MSAs compared with the general population. Risk exposures differ little by MSA size, except in the Northeast. The proportion of people with AIDS who reside in large MSAs exceeds the proportion of the population in those areas, especially when race/ethnicity is considered. AIDS rates have increased in non-MSAs relative to large MSAs, yet do not indicate that the epidemic is increasing rapidly in rural areas. Fewer AIDS cases are reported from smaller communities, yet require medical and social services that may burden the rural health care system.     

Awareness and use of untested barrier methods by HIV-seropositive gay and bisexual men.

Little is known about HIV-seropositive men's awareness and use of untested barrier methods during anal intercourse. A sample of 240 HIV-seropositive men (69.2% men of color) completed a self-administered survey that included items on nonoxynol-9 (N-9), female condoms, and the simultaneous use of two male condoms (double bagging). Most participants (79.6%) had heard of N-9 being used to prevent HIV transmission during anal intercourse. Of these, 20.0% rated N-9 as more effective than condoms, and 14.6% had used N-9 instead of condoms. Fewer men (35.4%) were aware of female condoms being used during anal intercourse. Overall, few respondents (5.4%) had used female condoms; 53.8% of whom rated the device as more pleasurable than male condoms. Most men (69.6%) had heard of double bagging, and 35.2% had engaged in this practice. Of these, 45.1% rated the practice as less pleasurable than using a single condom. Few associations were observed between participant characteristics and the awareness or use of these barrier methods. The widespread use of these untested methods emphasizes the urgent need to further educate HIV-seropositive men about the potential risks of N-9 use and to test the effectiveness of other strategies that may serve as alternatives to male condom use.