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PREVAC B Management of hepatitis B prevention among migrants AASLD, San Francisco, 2008

PREVAC B Management of hepatitis B prevention among migrants AASLD, San Francisco, 2008. AUBERT Jean-Pierre DI PUMPO Alexandrine SANTANA Pascale GERVAIS Anne 3. GERVIH. What is prevention of hepatitis B?. People who carry no hepatitis B marker have to be vaccinated

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PREVAC B Management of hepatitis B prevention among migrants AASLD, San Francisco, 2008

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  1. PREVAC BManagement of hepatitis B preventionamong migrantsAASLD, San Francisco, 2008 AUBERT Jean-Pierre DI PUMPO Alexandrine SANTANA Pascale GERVAIS Anne3 GERVIH

  2. What is prevention of hepatitis B? • People who carry no hepatitis B marker have to be vaccinated • 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

  3. 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)

  4. Endpoints • Primary endpoints • 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? • What are the factors that influence such strategies? • Secondary endpoints • What are HBV markers prevalences among those populations?

  5. 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 subsaharianAfrica, or Asia • Aged >18 • Assessing one of the investigatorsbetween 5/11/2007 and 29/2/2008 • Exclusion criteria • If HIV carrier: Not immunodepressed (CD4 cells count<350/mm3)

  6. 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) Results • 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

  7. 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

  8. 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 HBcAB 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 choice Case 1 : make an injection or consider the patient is protected Case 2: complete serology or consider the patient is protected Anti HBc Antibody alone: an issue for managing prevention of HBV • What do GPs do? • 14% completeserology • 32% decide the patient isprotected • 47% vaccinate • 7% missing data

  9. 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

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