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Despite the long-standing recommendation to vaccinate men who have sex with men (MSM) attending genitourinary medicine (GUM) clinics, coverage of vaccination in this group has been difficult to achieve.[2,3] In a study of GUM attendees, post infection immunity (anti-HBs prevalence) was found to be 31% in homosexual men and vaccine coverage to be 40% in London and only 24% outside London. Yee and Rhodes...
Despite the long-standing recommendation to vaccinate men who have sex with men (MSM) attending genitourinary medicine (GUM) clinics, coverage of vaccination in this group has been difficult to achieve.[2,3] In a study of GUM attendees, post infection immunity (anti-HBs prevalence) was found to be 31% in homosexual men and vaccine coverage to be 40% in London and only 24% outside London. Yee and Rhodes highlight the need for cheap and available hepatitis B vaccine as one way to increase immunisation rates among homo/bisexual men.
In England, the Department of Health (DH) has introduced specific vaccination standards for MSM as part of their strategy for sexual health. All MSM who are attending GUM clinics for the first time should be offered vaccination against hepatitis B. To help facilitate this, the DH has distributed extra doses of vaccine to all GUM clinics in England.
As Yee and Rhodes point out, vaccination uptake rates need to be monitored to determine whether this strategy will be effective. To help achieve this, a simple surveillance system called HepB3, was introduced to all GUM clinics across England in December 2002. The survey is being coordinated by the Communicable Disease Surveillance Centre (CDSC) on behalf of the DH. In an attempt to avoid adding to the already substantial workload of clinics,[7,8] the breadth of data requested has been kept to a minimum. None-the-less, it will enable first dose and complete courses of vaccine among new MSM attendees to be monitored, along with reasons for non-vaccination. While in essence the study is merely an audit, this is the first step towards enhanced surveillance of hepatitis B vaccination. It is proposed that the HepB3 survey will eventually be assimilated into the Programme of Enhanced Surveillance of Sexually Transmitted Infections, currently operating in GUM clinics in London and parts of South East England and which is planned for roll out nationwide over the next few years. This will enable immunisation data to be linked with anonymised, patient-based, demographic data such as ethnicity, previous infection and some behavioural information. Over the next few years, it will be possible to determine whether the DH’s strategy for increasing hepatitis B vaccination rates in MSM has been effective, and our understanding of factors influencing vaccination coverage in this group should be substantially improved.
(1) Department of Health. Immunisation Against Infectious Diseases – The Green Book 1996 http://www.doh.gov.uk/greenbook
(2) MacKellar DA, Valleroy LA, et al. Two decades after vaccine license: hepatitis B immunization and infection among young men who have sex with men. American Journal of Public Health 2001;91(6): 965-971.
(3) Rhodes SD, DiClemente RJ, et al. Correlates of hepatitis B vaccination in a high-risk population: An internet sample. American Journal of Medicine 2001;110: 628-632.
(4) Department of Health. Prevalence of HIV and hepatitis infections in the United Kingdom 2000. Annual report of the UA prevalence monitoring programme 2001: 32-36.
(5) Yee LJ, Rhodes SD. Understanding correlates of hepatitis B virus vaccination in men who have sex with men: what have we learned? Sex Transm Infect 2002;78: 374-377.
(6) Department of Health. The National Strategy for Sexual Health and HIV – Implementation Action Plan, June 2002. http://www.doh.gov.uk/sexualhealthandhiv/index.htm
(7) Djuretic T, Catchpole M, et al. Genitourinary medicine services in the United Kingdom are failing to meet current demands. Int J STD & AIDS 2001;12:571-572.
(8) Foley E, Patel R, et al. Access to Genitourinary medicine clinics in the United Kingdom. Sex Trans Infect 2001;77(1):12-14.