A risk-based strategy for adult hepatitis B (HepB) vaccination just hasn’t worked, according to Kevin A. Ault, MD, FACOG, FIDSA, the division director of the Department of Obstetrics and Gynecology, University of Kansas Medical Center, in Kansas City.
“The risk-based strategy has been given over a decade to prove itself, and that hasn’t panned out because of the complex list of risk factors,” Dr. Ault told the CDC’s Advisory Committee on Immunization Practices (ACIP).
The list for at-risk adults is indeed complex. There are four risks under those who might be exposed through sexual contact, such as having multiple partners or living with someone who is hepatitis B surface antigen–positive, and six under the category of those at risk from percutaneous or mucosal exposure to blood, such as injection drug users, those with diabetes and hemodialysis patients. In addition, there are “others”: those at risk because of HIV, chronic liver disease, hepatitis C virus (HCV), incarceration or international travel. And finally, there is a catchall—“all other persons seeking protection from HBV infection.”
Determining whether the patient in front of you should be vaccinated is challenging in the time constraints of an office or clinic visit, Dr. Ault said. It’s especially difficult because many patients do not report a risk, added Mark K. Weng, MD, MSc, FAAP, the lead of the ACIP’s Hepatitis Work Group.
Read more at Pharmacy Practice News.