Hepatitis B vaccination coverage and uptake in prisons across England and Wales 2003-2010: a retrospective ecological study

Abstract

Objective: To describe the custodial hepatitis B vaccination programme performance and examine these data by geographical region and prison category.

Design: Retrospective ecological study.

Data source: Health Protection Agency (HPA) published data.

Setting: Custodial primary healthcare providers located in prisons across England and Wales.

Participants: 147 prisons which reported vaccination data between July 2003 and April 2010 to the HPA Prison Infection Prevention team.

Main outcome measures: Hepatitis B vaccination coverage (July 2003 to April 2010) and uptake (December 2007 to April 2010).

Results: Median hepatitis B vaccination coverage was 22% (interquartile range [IQR] 5-49%) and uptake was 36% (IQR 16-59%). Vaccination coverage varied significantly between July 2003 and November 2007 compared to December 2007 and April 2010 (median 12% [IQR 2-31%] versus median 48% [IQR 26-67%], Mann-Whitney W=14,689,158.0, p<0.001). There was significant variation between vaccination coverage (Kruskal-Wallis H=613.44, DF=9, p<0.001) and uptake (Kruskal-Wallis H=247.99, DF=9, p<0.001) across the HPA regions. Compared to England and Wales, estimated population median vaccination coverage was significantly (p≤0.05) lower in three regions and one prison category and higher in four regions and seven prison categories; estimated population median vaccination uptake was significantly lower in three regions and three prison categories and higher in two regions and four prison categories.

Conclusion: Prisoners are a vulnerable group with a high prevalence of hepatitis B infection and the custodial setting plays an important role in the delivery of hepatitis B vaccination to this hard to reach group. This study suggests that variation in hepatitis B vaccination coverage and uptake may exist by geographical region and prison category. Further research is required to confirm and identify possible explanations for our findings.