TABLE 4-3 Estimated Chance That an Acute Hepatitis B Infection Becomes Chronic with Age

Age (years)

Estimated Chance That Acute HBV Infection Becomes Chronic (%)

1

88.5

2

52.5

3

41.3

4

34.6

5

29.8

6

26.1

7

23.3

8

20.9

9

19.0

10

17.3

11

15.9

12

14.7

13

13.6

14

13.0

15

11.7

16

11.0

17

10.3

18

9.6

19

9.0

NOTE: Calculated using a formula from Edmunds et al., 1993.

infection than the general US population (Hutton et al., 2007). However, ring vaccination—vaccination of the close contacts of people found to be chronically infected with HBV—is cost-effective (Hutton et al., 2007).

Figure 4-1 shows estimated cost effectiveness of hepatitis B vaccination for different age groups and different incidences of acute hepatitis B. The leftmost line of the graph represents a recent estimate of acute HBV incidence in the general US population (Hutton et al., 2007). This estimate is expressed as the annual percentage of people in the population who acquire acute HBV infection. At that incidence, hepatitis B vaccination of adults in the general US population costs more than $100,000 per QALY gained, and is not considered to be cost-effective.

In 2004, just over half (54.6%) the adults at high risk for HBV infection had received the hepatitis B vaccine, including about 75% of health-care workers and 64% of public-safety workers for whom vaccination is recommended (CDC, 2006; Simard et al., 2007). Of adults with acute hepatitis B, 61% reported having missed an opportunity for vaccination (Williams et al., 2005). Low coverage of high-risk adults is attributed to the lack of dedicated vaccine programs, limited vaccine supply, inadequate funding, and noncompliance by the involved populations (Mast et al., 2006).



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