APH 2000, 58, 37-48:

Relevance and feasibility of hepatitis B vaccine administration to prostitutes in Brussels, Belgium.

C. Prévost, C. Cheront, F. Bertrand, and R. Tonglet

Keywords: hepatitis B prevention and control, hepatitis B vaccines, prostitution, Belgium

Background: Universal hepatitis B vaccination requires extending vaccination services to the currentty unreached. Prostitutes are among those whom hepatitis B vaccination would especially benefit, as they are at greater risk of infection than the general population and have limited access to health care. We sought to evaluate the relevance and feasibility of the integration of hepatitis B vaccination into a health promotion programme targeting prostitutes in Brussels, Belgium.

Methods: From September 15, 1995, to September 14, 1997, we gained informed consent to hepatitis B vaccination from 205 prostitutes reached on their work site. The overall prevalence of past or present hepatitis 8 infection was 28%, and 148 individuals were eligible for the study. These had to receive three doses of H-B-VAX II vaccine (Pasteur Mérieux MSD) at months 0, 1, and 6. The minimum length of follow-up was 12 months within blood testing (end of data collection: September 14, 1998).

Results: At the end of the follow-up, 139 (95%), 124 (84%), and 100 (689,%) individuals had received one, two, or three doses, respectively. Half of the 148 eligible individuals had received one, two, or three doses within 14 (95% Cl: 10- 16), 63 (56- 73), and 259 (245-280) days of blood testing, respectively. An optimal seroconversion, was obtained in 87% of the individuals who achieved the vaccination schedule, and we estimated that an effective protection was achieved at least in 59% (0.68 x 0.87) of the eligible prostitutes.

Conclusion: We conclude that hepatitis B vaccine administration to prostitutes is relevant and feasible. For achieving performance objectives in such a vulnerable population, we recognize the need to pay attention to technical (short vaccination schedule) and operational (active recruitment, confidentiality, free provision of services) issues.