High Hepatitis B Rate Among Young Gay Men

Few get vaccinations despite access to health care

By Janice Billingsley
HealthScoutNews Reporter

http://healingwell.subportal.com/

MONDAY, June 4 (HealthScoutNews) -- Almost one out of five gay men is infected with the potentially fatal hepatitis B virus (HBV) by the age of 22, despite the fact that a vaccine to prevent the disease has been available for almost 20 years, a Centers for Disease Control and Prevention (CDC) study has found.

Only 9 percent of more than 3,000 males between the ages of 15 and 22, who were surveyed over a five-year period, had received a vaccination against HBV. Yet more than 90 percent of them visited health care providers on a regular basis to be tested for the AIDS virus or other sexually transmitted diseases.

"This is an incredible missed opportunity to prevent a very serious disease," says Duncan A. MacKellar, a CDC epidemiologist and author of the study, which appears in this month's American Journal of Public Health. "We have to do a better job of making high-risk men and others aware of the need for, and benefits of, the vaccine."

There is no cure for hepatitis B, whose incidence increased by 37 percent from 1979 to 1989, according to the CDC. There are now more a million people in the United States with chronic HBV infection, and there are almost 5,000 deaths annually from the disease.

Hepatitis B is caused by a virus that attacks the liver and can cause cirrhosis (scarring) of the liver, liver cancer, liver failure and death. The disease is transmitted by direct contact with the blood or body fluids of an infected person. Gay men are among those with a high risk of contracting the disease.

The fact that the vaccine is relatively expensive and that three injections are needed over a six-month period to ensure immunity could be part of the reason why more men have not been vaccinated, but MacKellar also says that many men don't know about the virus.

"Many men are not aware of the seriousness of hepatitis B and the availability of the vaccine," he says.

Further, many health care providers miss the opportunity to inform and vaccinate people at risk for HBV when they come in for other health care.

Particularly worrisome in the study, MacKellar says, was how the prevalence of the disease increased with age. "At 15 years old, only 2 percent were infected, compared to 22 percent at age 22, which is an incredible upward trend," he says.

Since the vaccine came on the market in 1982, there have been various prevention programs to encourage vaccination against the disease. In 1991, an early childhood vaccination program was introduced, and by 1997, 85 percent of children under the age of 3 had received it. Further, in 1994, the vaccine coverage was expanded to include 11- and 12-year-olds, and, in 1997, those under 19 were included in recommended coverage.

But that still leaves many young people vulnerable to the disease, MacKellar says.

"As we integrate HBV vaccines with HIV and STD programs and catch up with adolescents, we will decrease the window period for the disease," he says. "But we [still] have a lot of susceptible persons who can develop cancer and liver disease and could die."

In his study, MacKellar analyzed HBV data from the Young Men's Survey -- a study of about 3,400 men in eight U.S. cities from 1994 through 1998 -- to identify high-risk behavior that led to contracting the AIDS virus. Volunteers were solicited between 10 p.m. and 2 a.m. at various sites like dance clubs, social clubs and businesses. Willing participants were taken to a van where they were interviewed, had blood tests and received counseling for sexually transmitted diseases.

"There is an assumption that most people needing [the vaccine] are health personnel who handle blood, and people forget about the importance of sexual transmission," says Dr. Ronald Gray, of the Population and Family Health Sciences department at Johns Hopkins School of Public Health. "But it should be a part of care for people at risk for HIV. Anyone who's practicing risky behavior of any kind really needs to be aware of it."