Hepatitis B Seroprevalence and the Relationship Between Being Hepatitis B Vaccinated and Infected with Social Determinants of Health: Manisa, 2014

Background: In Turkey, newborns have been vaccinated for hepatitis B at birth, one, and six months of age since 1998. Objectives: The current study aimed at determining the seroprevalence of hepatitis B in pre- and post-vaccination periods in the population above two years of age in Manisa province during year 2014 and to evaluate the relationship between being vaccinated and infected with some social determinants of health. Methods: A total of 1230 people were randomly selected from the general population over two years of age. The presence of hepatitis B surface antigen (HBsAg), HBs antibody (anti-HBs), and hepatitis B core antibody was detected using commercial kits. The dependent variables were being vaccinated or infected, and the independent variables were gender, age, education level, occupational class, annual per capita equivalent income, perceived income, household density, and place of residence. Results: The percentage of participants with a seronegative, vaccinated or infected serologic profile was 50.8%, 28.0%, and 21.2%, respectively. Among participants vaccinated in the national immunization program, 0.6% were positive for HBsAg and 75.1% for anti-HBs only, whereas 22% were seronegative. In the vaccinated group, there was a statistically significant association between living in the village (OR: 3.13 %95 CI 1.49 to 6.58) or rural districts (OR 4.46 %95 CI 1.97 to 10.08) during childhood, having low income (OR: 1.78, 95% CI 1.05 to 3.01) and being vaccinated. In the unvaccinated group, people with low income were less likely to be vaccinated (OR = 0.56, 0.34 to 0.91); individuals, who lived in rural districts during childhood were 2.13 times (95% CI 1.01 to 4.51) more likely to be vaccinated for hepatitis B than individuals, who lived in a city or abroad. There was also an association between being male (OR: 1.40, 95% CI 1.03 to 1.92), living in a village (OR: 0.50, 95% CI 0.33 to 0.75) or rural district (OR: 0.64, 95% CI 0.42 to 0.97) during childhood and being infected. Conclusions: In this study, up-to-date data on the seroepidemiology of hepatitis B was obtained in a sample representing the community. The researchers concluded that routine hepatitis B vaccination initiated 16 years ago induced high levels of immunity in the great majority of the population aged < 22 years old living in Manisa.