PREVAC BManagement of hepatitis B prevention among

migrantsAASLD, San Francisco, 2008

AUBERT Jean-Pierre

DI PUMPO Alexandrine

SANTANA Pascale

GERVAIS Anne3

GERVIH

What is prevention of hepatitis B?

1. People who carry no hepatitis B marker have to be vaccinated

2. everybody should receive information about this disease and its transmission– …BUT …– The messages to deliver differ from one group to another:

HBs AG carriers (‘HB carriers’) People with no HBV marker (‘HB free’) People protected against HBV, by vaccination or infection) (‘HB

protected’)

* Chevalier P et al. Exercer 2008

How can GPs manage HBV prevention?

In theory, three main serologic groups of people regarding HBV (HBV free, HBV carriers, HBV protected)….

– but actually up to 54 different serologic profiles can be found within medical files (including many incomplete profiles!)

Development of an internet program, – to help doctors manage prevention, – To help doctors decide wich prevention skill has to be used

internet-accessible information leaflets for patients, targeting each serologic profile (uploaded by doctor)

Endpoints

Primary endpoints1. Is it possible for GPs to manage full HBV prevention

strategies (targeted information and vaccination when required) among migrant people with help of an internet-based program?

2. What are the factors that influence such strategies?

Secondary endpoints1. What are HBV markers prevalences among those

populations?

Method

26 GP investigators,related to health networks of northen Paris (high rates of migrants). Data prior to 31/12/2007 are presented

373 migrant patients included:• Inclusion criteria

• People born in subsaharian Africa, or Asia• Aged >18• Assessing one of the investigators between 5/11/2007 and

29/2/2008• Exclusion criteria

• If HIV carrier: Not immuno depressed (CD4 cells count<350/mm3)

Results

WITH HELP OF THE INTERNET-ACCESSIBLE PROGRAM– 92% patients received information and/or vaccination (when

required) from their GP– 89% patients were given information leaflet, targeting their

own serologic status, by their GP

– Social precarity is related to failure of vaccination strategy (p=0.02)– High education level is related to success of vaccination strategy (p=0.01)

• 74% of HBV carriers• 100% of vaccinated people• 54% of patients with anti HBc alone• 82% of HBV contact, non-carrier• 74% of people with no HBV marker

Prevalences

PREVALENCES:• HBV carriers: 11%• HBV Contact non-carriers: 36 % • Vaccinated :28%• No HBV marker : 25%

PREDICTIVE FACTORS FOR CONTACT:• Africa/ Asia p=0,002• Mali, Ivory Coast, Congo/ other countries in Africa p=0,0002• Age more than 40 p=0,04• Less than 5 years of school p=0,01

21%

18%

13%

9%

8%

6%

5%

4%

0% 10% 20% 30%

Mali n=57

Asia n=45

Ivory Coast n=39

Congo n=39

Other francophone Af …

Cameroun n=33

Other non francoph Af …

Senegal n=27

HBV carriers prevalences related to country of birth

Anti HBc Antibody alone: an issue for managing prevention of HBV

What’s the problem? Patient has one of the following résults:Case 1: Hbs AG neg, anti HBs AB neg, anti HBc AB pos

Case 2: Hbs AG neg, anti HBs AB not available, anti HBc AB pos

There is no consensus within guidelines– Vaccinate (one-shot) or not?

How did we solve the problem? We decided to give the investigator the

choiceCase 1 : make an injection or consider the patient is

protectedCase 2: complete serology or consider the patient is

protected

What do GPs do?

• 14% complete serology

• 32% decide the patient is protected

• 47% vaccinate

• 7% missing data

Conclusion :

With help of an internet-based program, GP can manage full prevention of hepatitis B transmission (information targeting patient’s serologic status, and vaccination when required)

preliminary results Isolated anti HBC AB requires clear guidelines Prevalences of HBV carriage are quite superior to

previous available datas