Sex: M
Vaccine: HEP
Symptoms: Hepatitis B, Vaccination failure
Clinical narrative: This literature report has been received from the authors of a published article. Men who have sex with men (MSM) were recruited using an adapted respondent-driven sampling method between 2009 and 2011. A detailed description of recruitment procedures had been previously reported. Eligible MSM were residents who were 18 years or older, and traveled internationally in the previous 12 months. Of the original 501 participants enrolled in the study, 478 with blood specimens available for hepatitis B virus (HBV) testing were included in this analysis. Participants completed an interviewer-administered, computer assisted survey. Demographic characteristics collected included age, race, ethnicity, education, and birth country. Participants were asked about the two most recent countries they visited in the previous 12 months. Hepatitis B virus vaccination was self-reported. HBV infection was defined as a positive result by total anti-hepatitis B core (HBc) serological testing. A positive HBc test result did not provide information on stage of infection, for example, acute, chronic, or cleared. Birth and visited countries were classified as HBV-endemic if the national prevalence of HBV surface antigen in that country was 8% or higher. The human immunodeficiency virus (HIV) status was determined by rapid antibody serological testing. Frequency distributions were calculated for categorical variables. Medians and interquartile ranges were calculated for continuous variables. Prevalence ratios (PRs) were estimated for the outcomes of HBV vaccination and infection. Bivariate and multivariable Poisson regression models with robust errors calculated PRs, adjusted PRs (aPRs), and 95% confidence intervals (CIs). Variables associated at P values less than 0.20 in bivariate analyses were included in multivariable analyses. Self-reported HBV vaccination prevalence was 77% overall and was highest among men ages 18 to 40 years (86%), decreasing significantly with every 10-year increase in age (aPR = 0.95; P = 0.04). HBV-infected men (positive for total HBc) were less likely to report vaccination (aPR = 0.60; P less than 0.01). Fifty-eight of the 117 men with HBV infection (50%) reported being vaccinated. The HBV infection prevalence was 25% overall and was higher among older men, increasing significantly with every 10-year increase in age (aPR = 1.49; P less than 0.01). The HIV-positive men were more likely to be infected (aPR = 2.43, P less than 0.01), whereas vaccinated men were less likely to be infected (aPR = 0.46, P less than 0.01). Although race/ethnicity was not significantly associated with HBV infection (P = 0.09), black men were at elevated risk (aPR = 2.22; 95% CI: 1.20, 4.10) compared with white men. Persons who travelled to an HBV-endemic country in the previous 12 months were slightly more likely to report vaccination (82% vs 76%; PR = 1.09; P = 0.08) and less likely to be infected (21% vs 26%; PR = 0.82; P = 0.31). Persons born in an HBV endemic country were slightly more likely to report vaccination (86% vs 77%; PR = 1.12; P = 0.10) and less likely to be infected (19% vs 25%; PR = 0.76 P = 0.41). The HBV vaccination coverage was still not universal among MSM, even though they remain at high risk for infection. Men who have sex with men were a priority population for vaccination programs in the first national vaccination recommendations released in 1982 and are still considered a priority population in the NVHAP for 2017 to 2020. Older men, in particular, have not fully benefited from the availability of a safe and effective vaccine. This public health gap is particularly distressing considering that it was this generation of older MSM who participated in the HBV vaccination efficacy trials. This report refers to 58 patients who were vaccinated with hepatitis B vaccine (recombinant) (manufacturer unknown) (dose, route and lot# unknown) for prophylaxis of hepatitis B infection. On unknown dates, the patients experienced hepatitis B infection (vaccination failure). The outcome of the events was unknown. The reporter considered the events to be related to hepatitis b vaccine (recombinant) (manufacturer unknown). Upon internal review, hepatitis B infection was determined to be medically significant.