Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective

Predictors of completion of a hepatitis B vaccination schedule in attendees at a primary health care centre

Virginia Macdonald A , Gregory J. Dore B , Janaki Amin B and Ingrid van Beek A C

A The Kirketon Road Centre, South Eastern Sydney and Illawarra Area Health Service, Sydney, NSW 2011, Australia.

B The National Centre in HIV Epidemiology and Clinical Research, University of NSW, Sydney, NSW 2010, Australia.

C Corresponding author. Email:

Sexual Health 4(1) 27-30
Submitted: 30 January 2006  Accepted: 16 June 2006   Published: 26 February 2007


Background: In Australia, rates of hepatitis B (HBV) transmission continue to be higher in certain populations, including commercial sex workers and injecting drug users (IDU). This study aims to identify rates and predictors of completion of a HBV vaccination schedule in ‘high-risk’ attendees of a primary health care centre in Sydney. Methods: All clients who attended Kirketon Road Centre, a primary health care centre located in Kings Cross, Sydney, with no evidence of HBV immunity were included in the cohort. The study design was observational with historical controls. The main outcome measure was completion of a three-dose HBV vaccine schedule in the study period. Results: Among 2085 clients who received a first vaccination, 1013 (49%) received a second and 435 (21%) received a third vaccination. Univariate analysis found that significant predictors of completion of the vaccine schedule were intention to administer an accelerated schedule (OR 1.49, P = 0.004), not being an IDU (OR 1.29, P = 0.02) and shorter time between first visit and first vaccine dose (OR 1.24, P for trend <0.0001); however, on multivariate analysis, not being an IDU was no longer a predictor of vaccine completion. Conclusion: Implementation of an accelerated vaccination schedule improved completion rates but they were still low, despite the provision of free vaccination in a service specifically targeting the needs of sex workers, IDU and other marginalised populations. Increasing HBV vaccine uptake and completion rates in Australian adults is an important public health issue not only for the prevention of HBV but also for the future application of other potential vaccines, including those against HIV and hepatitis C.


[1]  Williams A 2002 Reduction in hepatitis B related burden of disease – measuring the success of universal immunisation programs. Commun Dis Intell 26 3 458 60 Pubmed Abstract

[2]  Kao J-H Chen D-S 2002 Global control of hepatitis B virus infection. Lancet Infect Dis 2 395 403 doi:10.1016/S1473-3099(02)00315-8 Pubmed Abstract

[3]  National Centre in HIV Epidemiology and Clinical Research (NCHECR). HIV/AIDS, viral hepatitis and sexually transmissible infection in Australia: Annual Surveillance Report 2004. Sydney: NCHECR; 2004.

[4]  O’Sullivan BG Gidding HF Law M Kaldor JM Gilbert GL Dore GJ 2004 Estimates of chronic hepatitis B virus infection in Australia, 2000. Aust N Z J Public Health 28 212 6 Pubmed Abstract

[5]  van Steenbergen JE 2002 Results of an enhanced-outreach programme of hepatitis B vaccination in the Netherlands (1998–2000) among men who have sex with men, hard drug users, sex workers and heterosexual persons with multiple partners. J Hepatol 37 507 13 doi:10.1016/S0168-8278(02)00213-1 Pubmed Abstract

[6]  Minuk GY Sun DF Greenberg R Zhang M Hawkins K Uhanova J et al 2004 Occult hepatitis B virus infection in a North American adult hemodialysis patient population. Hepatology 40 5 1072 7 doi:10.1002/hep.20435

[7]  Anderson B Bodsworth NJ Rohrsheim RA Donovan BJ 1994 Hepatitis B virus infection and vaccination status of high risk people in Sydney: 1982 and 1991. Med J Aust 161 368 71 Pubmed Abstract

[8]  Crofts N Aitken CK 1997 Incidence of bloodborne virus infection and risk behaviours in a cohort of injecting drug users in Victoria, 1990–1995. Med J Aust 167 17 20 Pubmed Abstract

[9]  Kaldor JM Plant AJ Thompson SC Longbottom H Rowbottom J 1996 The incidence of hepatitis B infection in Australia: an epidemiological review. Med J Aust 165 322 6 Pubmed Abstract

[10]  van Beek I Buckley R Stewart M MacDonald M Kaldor 1994 Risk factors for hepatitis C virus infection among injecting drug users in Sydney. Genitourin Med 70 5 321 4 Pubmed Abstract

[11]  Sterling RK Sulkowski MS 2004 Hepatitis C virus in the setting of HIV or hepatitis B coinfection. Semin Liver Dis 24 61 8 doi:10.1055/s-2004-832930 Pubmed Abstract Suppl 2

[12]  Maher L Chant K Jalaludin B Sargent P 2004 Risk behaviours and antibody hepatitis B and C prevalence among injecting drug users in south-western Sydney, Australia. J Gastroenterol Hepatol 19 10 1114 20 doi:10.1111/j.1440-1746.2004.03438.x Pubmed Abstract

[13]  Day C White B Ross J Dolan K 2003 Poor knowledge and low coverage of hepatitis B vaccination among injecting drug users in Sydney. Aust NZ J Public Health 27 5 558 Pubmed Abstract

[14]  Saltoglu N Inal AS Tasova Y Kandemir O 2003 Comparison of the accelerated and classic vaccination schedules against Hepatitis B: three-week Hepatitis B vaccination schedule provides immediate and protective immunity. Ann Clin Microbiol Antimicrob 2 1 10 4 doi:10.1186/1476-0711-2-10 Pubmed Abstract

[15]  Marchout B Picot N Chavanet P Auvergnat JC Armengaud M Devilliers P et al 1993 Three-week hepatitis B vaccination provides protective immunity. Vaccine 11 14 1383 5 doi:10.1016/0264-410X(93)90165-T Pubmed Abstract

[16]  Rogers N Lubman DI 2005 An accelerated schedule for young drug users. Aust N Z J Public Health 29 4 305 7 Pubmed Abstract

[17]  Harries AD Clark M Beeching NJ Lavelle J Mutton KJ 1991 Early anti-HBs antibody response to accelerated and to conventional hepatitis B vaccination regimens in healthy persons. J Infect 23 3 251 4 doi:10.1016/0163-4453(91)92792-4 Pubmed Abstract

[18]  McGregor J Marks PJ Hayward A Bell Y Slack RC 2003 Factors influencing hepatitis B vaccine uptake in injecting drug users. J Public Health Med 25 2 165 70 doi:10.1093/pubmed/fdg035 Pubmed Abstract

[19]  Richter A Anton SE Koch P Dennett SL 2003 The impact of reducing dose frequency on health outcomes. Clin Ther 25 8 2307 35 doi:10.1016/S0149-2918(03)80222-9 Pubmed Abstract

[20]  ul-Haq N Hasnain SS Umar M Abbas Z Valenzuela-Silva C Lopez-Saura P 2003 Immunogencity of 10 and 20 microgram hepatitis B vaccine in a two-dose schedule. Vaccine 21 23 3179 85 doi:10.1016/S0264-410X(03)00232-9 Pubmed Abstract

[21]  Seal KH Kral AH Lorvick J McNees A Gee L Edlin BR 2003 A randomised controlled trial of monetary incentives vs. outreach to enhance adherence to the hepatitis B vaccine series among injection drug users. Drug Alcohol Depend 71 127 31 doi:10.1016/S0376-8716(03)00074-7 Pubmed Abstract

Export Citation