Background:
Prior to 2017 hepatitis B (HBV) was not part of routine immunisation in Scotland. An outbreak of acute HBV in the 1980s led to concerted efforts to improve targeted vaccination, predominantly delivered via prisons and alcohol and drug recovery services (ADRS). Recently sporadic cases of acute HBV in people who inject drugs have given concern for declining vaccine coverage. We sought to evaluate rates of vaccine related and acquired immunity, using current hepatitis C infection (HCV) as a proxy for risk of HBV acquisition.
Methods:
250 sequential individuals in NHS Greater Glasgow and Clyde (GGC) with samples from May 2024 onwards testing positive for HCV RNA and negative for HBsAg, underwent further analysis for anti-HBc Ab and anti-HBs Ab. Basic demographic information (Age & Sex), along with location of testing were recorded. Adequate vaccination was defined as anti-HBs > 100 IU/ml.
Results:
The median age was 44.8 years (SD 13.1), with 182 (72.8%) male. Over half of tests were sent from either hospital settings (83 (33.2%) outpatient, 68 (26%) inpatient). A combination of prisons (38, 15.2%), ADRS (19, 7.6%), 3rd sector (13, 5.2%), and homeless health (5, 2%) accounted for 30% of testing. 23 (9.2%) of individuals were anti-HBc positive. 43 (17.2%) had evidence of adequate vaccination. 154 (61.6%) had anti-HBs <10 iu/ml, 30 (12%) had anti-HBs 10 -100 iu/ml. Adequate vaccination rates were higher in ADRS samples than prison (31.6% vs 21.1%), though suboptimal in each.
Conclusion:
Rates of vaccine acquired immunity amongst people with hepatitis C in GGC are low and give concern for possible outbreaks of HBV amongst people who inject drugs. Work to improve vaccination in ADRS and prisons is required, along with improved access to low threshold and opportunistic vaccination across all settings where people who inject drugs receive healthcare. |