Trudy V Murphy

Center for HIV/AIDS Educational Studies and Training, New York, New York, United States

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Publications (69)334.86 Total impact

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    ABSTRACT: Hepatitis B (HepB) vaccination is the most effective measure to prevent HBV infection and its consequences. In the United States, routine HepB vaccination was recommended for infants in 1991 and catch-up vaccination has been recommended for adolescents since in 1995. The purpose of this study is to assess HepB vaccination among adolescents 13-17 years in the United States. The 2006-2012 NIS-Teen were analyzed. Vaccination trends and coverage by birth cohort among adolescents were evaluated. Multivariable logistic regression and predictive marginal models to identify factors independently associated with HepB vaccination. HepB vaccination coverage increased from 81.3% in 2006 to 92.8% in 2012. Coverage varied by birth cohort and 79-83% received vaccination before 2 years of age for those who were born during 1995 and 1999. Among those who had not received vaccination by 11 years of age, for the 1993-1995 birth cohorts, 9-15% were vaccinated during ages 11-12 years, and 27-37% had been vaccinated through age 16 years. Coverage among adolescents 13-17 years in 2012 ranged by state from 84.4% in West Virginia to 98.7% in Florida (median 93.3%). Characteristics independently associated with a higher likelihood of HepB vaccination included living more than 5 times above poverty level, living in Northeastern or Southern region of the United States, and having a mixed facility as their vaccination provider. Those with a hospital listed as their vaccination provider and those who did not have a well-child visit at age 11-12 years were independently associated with a lower likelihood of HepB vaccination. Efforts focused on groups with lower coverage may reduce disparities in coverage and prevent hepatitis B infection. Parents and providers should routinely review adolescent immunizations. Routine reminder/recall, expanded access in health care settings, and standing order programs should be incorporated into routine clinical care of adolescents. Copyright © 2015. Published by Elsevier Ltd.
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    ABSTRACT: Background: Ninety-percent of perinatal hepatitis B virus (HBV) infection results in chronic HBV which usually is asymptomatic, but carries a 25% risk of premature death from progressive liver injury, cirrhosis, and liver cancer. In 1990, the Centers for Disease Control and Prevention (CDC) funded the Perinatal Hepatitis B Prevention Program (PHBPP) to accelerate elimination of perinatal HBV transmission in the United States. The annual rate of perinatal chronic HBV (CHBV) infections reported by PHBPP (0.8%-2.4%) was consistently lower than the annual rate estimated in CDC models employed from 2000-2009, suggesting not all cases in infants were identified. To better understand the factors with greatest impact on the estimated number of cases, we applied updated inputs to the current CDC model and performed sensitivity analyses for best and worst case scenarios. Methods: Models employed estimates of annual births to hepatitis B surface antigen (HBsAg)-positive women, data from PHBPP, and National Immunization Surveys (NIS) hepatitis B (HepB) vaccine coverage. Prenatal maternal HBsAg screening rates, the efficacy of post-exposure prophylaxis (PEP) consisting of HepB vaccine and hepatitis B immune globulin, and perinatal HBV transmission rates were from published literature. Results: The modeled estimate of the number of perinatal CHBV infections in 2009 was 952, equivalent to a baseline infection rate of 3.84%. Best and worst case sensitivity analysis yielded perinatal CHBV infection rates of 0.60% and 15.41%. One-way sensitivity analysis identified three major drivers: the proportion of infants receiving timely PEP, efficacy of PEP, and the perinatal HBV transmission rate. Three-way sensitivity analysis yielded perinatal CHBV infection rates of 0.70% and 13.64%. Conclusion: Modeling suggests a substantial number of perinatal HBV infections that occurred in 2009 in the United States were not identified by PHBPP. Limitations of the data contributed to discrepancies between the estimated and reported number of cases, but remain useful programmatic goals of achieving elimination of perinatal CHBV infection.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: Hepatitis B virus (HBV) infection, the most common form of chronic hepatitis worldwide, is a major public health problem affecting an estimated 360 million people globally. Mother-to-child transmission (MTCT) is responsible for more than one third of chronic HBV infections worldwide. An estimated 15%-40% of persons chronically infected develop HBV-related complications, such as cirrhosis and hepatic carcinoma, and 25% die from these complications. MTCT can occur during pregnancy or during delivery. Screening pregnant women for HBV infection, providing infant postexposure prophylaxis, and maternal treatment with antiviral medications are strategies for reducing MTCT transmission rates and the global burden of new chronic HBV infections. Administration of hepatitis B immune globulin (HBIG) and hepatitis B (HepB) vaccine within 24 hours of birth, followed by completion of the vaccine series, is 85%-95% efficacious for prevention of MTCT. Despite timely post-exposure prophylaxis, MTCT occurs in 5%-15% of infants. Hepatitis B surface antigen (HBsAg) positive, hepatitis e antigen (HBeAg) positive mothers with HBV DNA level ≥10(6) copies/mL (>200 000 IU/mL) are at greatest risk of transmitting HBV to their infants. Consensus recommendations and evidence-based guidelines for management of chronic HBV infection and screening of pregnant women have been developed. The safety and efficacy of antiviral drug use during pregnancy are areas of ongoing research. Substantial advances have been achieved globally in reducing MTCT, but MTCT remains an ongoing health problem. Attaining a better understanding of the mechanisms of MTCT, implementing existing policies on maternal screening and infant follow-up, and addressing research gaps are critical for further reductions in MTCT transmission.
    09/2014; 3(Suppl 1):S7-S12. DOI:10.1093/jpids/piu064
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    ABSTRACT: Objective To resolve discrepant hepatitis B surface antigen (HBsAg) results for pregnant women screened for hepatitis B virus (HBV) infection. Study design A case was defined as discrepant HBsAg (reactive followed by non-reactive) result during the same pregnancy. The Centers for Disease Control and Prevention examined a convenience sample of cases passively reported by US Perinatal Hepatitis B Prevention Programs. Using a standard form, available results were obtained for hepatitis B tests and vaccination histories. Results were independently reviewed by 3 viral hepatitis experts and a clinical virologist to resolve discrepancies. The initial HBsAg result was classified as probable true positive, probable false positive, or unresolved. Results From April 2009-December 2011, 142 (75.9%) of 187 reported discrepant cases met the case definition. Of the 142 initial reactive HBsAg results, 113 (79.5%) were laboratory-confirmed, and 89 (62.7%) were resolved. Among these 89 cases, the initial test was a probable true positive in 14 (15.7%), and a false positive in 75 (84.3%). Total antibody to hepatitis B core antigen was positive for 11 (78.6%) of the true positive cases and negative for 67 (89.3%) of the false positive cases. True positives included 2 cases of resolving acute HBV infection and one case recently given hepatitis B vaccination. Conclusions In this retrospective analysis of discrepant HBsAg-reactive screening results from pregnant women, the majority were false positives, but true positives occurred. Testing for total hepatitis B core antibody, an indicator of past or current HBV infection, was useful for resolving discrepancies.
    Journal of Pediatrics 07/2014; 165(4). DOI:10.1016/j.jpeds.2014.06.043 · 3.74 Impact Factor
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    ABSTRACT: Objective. To examine the cost-effectiveness of pre- and postexposure approaches for ensuring hepatitis B protection among previously vaccinated healthcare personnel (HCP). Design. A decision-analytic model was developed for alternative strategies of ensuring hepatitis B protection under assumptions of 68% and 95% long-term protection after a primary vaccination series. Costs and quality-adjusted life years (QALYs) lost from infections were estimated, and incremental cost-effectiveness ratios (ICERs) were calculated relative to a no intervention alternative over 10 years of intervention. Separate analyses were performed for trainees and nontrainees, using the healthcare system perspective. Trainees face higher risk of exposure and likely received primary vaccination as infants. Setting. General healthcare settings. Participants. Trainee and nontrainee HCP. Interventions. Preexposure testing for antibody to hepatitis B surface antigen followed by additional vaccination for HCP without protective antibody levels; postexposure evaluation and management for HCP reporting blood or body fluid exposures Results. The preexposure strategy prevents more infections and has higher costs than the postexposure strategy or no intervention. For trainees, 10-year preexposure evaluation ICERs are $832,875 and $144,457 per QALY for 95% and 68% long-term vaccine protection, respectively. Trainee 10-year postexposure evaluation ICERs are $1,146,660 and $191,579 per QALY under the 95% and 68% long-term protection assumptions, respectively. For nontrainees, 10-year ICERs are $745,739 and $1,129,286 per QALY for the preexposure and postexposure evaluation strategies, respectively. Conclusions. ICERs may inform decision makers as they decide whether the added cost of the preexposure strategy provides sufficient value in preventing infections.
    Infection Control and Hospital Epidemiology 07/2014; 35(7):845-854. DOI:10.1086/676865 · 3.94 Impact Factor
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    ABSTRACT: To estimate the cost-effectiveness of testing pregnant women with hepatitis B (hepatitis B surface antigen [HBsAg]-positive) for hepatitis B e antigen (HBeAg) or hepatitis B virus (HBV) DNA, and administering maternal antiviral prophylaxis if indicated, to decrease breakthrough perinatal HBV transmission from the U.S. health care perspective. A Markov decision model was constructed for a 2010 birth cohort of 4 million neonates to estimate the cost-effectiveness of two strategies: testing HBsAg-positive pregnant women for 1) HBeAg or 2) HBV load. Maternal antiviral prophylaxis is given from 28 weeks of gestation through 4 weeks postpartum when HBeAg is positive or HBV load is high (10 copies/mL or greater). These strategies were compared with the current recommendation. All neonates born to HBsAg-positive women received recommended active-passive immunoprophylaxis. Effects were measured in quality-adjusted life-years (QALYs) and all costs were in 2010 U.S. dollars. The HBeAg testing strategy saved $3.3 million and 3,080 QALYs and prevented 486 chronic HBV infections compared with the current recommendation. The HBV load testing strategy cost $3 million more than current recommendation, saved 2,080 QALYs, and prevented 324 chronic infections with an incremental cost-effectiveness ratio of $1,583 per QALY saved compared with the current recommendations. The results remained robust over a wide range of assumptions. Testing HBsAg-positive pregnant women for HBeAg or HBV load followed by maternal antiviral prophylaxis if HBeAg-positive or high viral load to reduce perinatal hepatitis B transmission in the United States is cost-effective.
    Obstetrics and Gynecology 05/2014; 123(5):929-937. DOI:10.1097/AOG.0000000000000124 · 4.37 Impact Factor
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    ABSTRACT: Purpose Annually, an estimated 25,000 infants are born to hepatitis B surface antigen (HBsAg)-positive women in the United States. Hepatitis B (HepB) vaccine and hepatitis B immune globulin (HBIG) are recommended at birth, followed by completion of vaccine series and post-vaccination serologic testing (PVST). In a large cohort of infants born to HBsAg-positive women, factors influencing vaccine response were evaluated. Methods Data were from HBsAg-negative infants born to HBsAg-positive women in the Enhanced Perinatal Hepatitis B Prevention Program (EPHBPP) from 2008 to 2013. Vaccine non-responders were defined as infants with antibody to hepatitis B surface antigen (anti-HBs) <10 mIU/mL at PVST after receiving ≥3 vaccine doses. Multivariable analyses modeled statistically significant predictor variables associated with non-response. Results A number of 17,951 maternal-infant pairs were enrolled; 8654 HBsAg-negative infants born to HBsAg-positive mothers received ≥3 doses of vaccine with anti-HBs results. 8199 (94.7%) infants responded to a primary HepB series; 199 (94.8%) to a second series. Factors associated with anti-HBs <10 mIU/mL included gestational age <37 weeks, vaccine birth dose >12 h after birth, timing of final vaccine dose <6 months after birth, receipt of 3 vs. 4 vaccine doses, and PVST interval >6 months from final vaccine dose in bivariate analysis. PVST interval >6 months from final vaccine dose (OR = 2.7, CI = 2.0, 3.6) was significantly associated with anti-HBs <10 mIU/mL; the proportion increased from 2% at 1–2 months to 21.6% at 15–16 months after the final dose. Receipt of a 4th dose improved the response rate (OR = 0.5, CI = 0.3, 0.8). Conclusions Ninety-five percent of a large cohort of uninfected infants born to HBsAg-positive mothers in the United States responded to primary HepB vaccine series. The proportion of infants with anti-HBs <10 mIU/mL increased with longer interval between the final vaccine dose and PVST. Optimal timing of PVST is within 1–2 months of final vaccine dose to avoid unnecessary revaccination.
    Vaccine 04/2014; DOI:10.1016/j.vaccine.2014.01.099 · 3.49 Impact Factor
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    ABSTRACT: To evaluate the economic impact of the 2009 routine US childhood immunization schedule, including diphtheria and tetanus toxoids and acellular pertussis, Haemophilus influenzae type b conjugate, inactivated poliovirus, measles/mumps/rubella, hepatitis B, varicella, 7-valent pneumococcal conjugate, hepatitis A, and rotavirus vaccines; influenza vaccine was not included. Decision analysis was conducted using population-based vaccination coverage, published vaccine efficacies, historical data on disease incidence before vaccination, and disease incidence reported during 2005 to 2009. Costs were estimated using the direct cost and societal (direct and indirect costs) perspectives. Program costs included vaccine, administration, vaccine-associated adverse events, and parent travel and work time lost. All costs were inflated to 2009 dollars, and all costs and benefits in the future were discounted at a 3% annual rate. A hypothetical 2009 US birth cohort of 4 261 494 infants over their lifetime was followed up from birth through death. Net present value (net savings) and benefit-cost ratios of routine childhood immunization were calculated. Analyses showed that routine childhood immunization among members of the 2009 US birth cohort will prevent ∼42 000 early deaths and 20 million cases of disease, with net savings of $13.5 billion in direct costs and $68.8 billion in total societal costs, respectively. The direct and societal benefit-cost ratios for routine childhood vaccination with these 9 vaccines were 3.0 and 10.1. From both direct cost and societal perspectives, vaccinating children as recommended with these vaccines results in substantial cost savings.
    PEDIATRICS 03/2014; DOI:10.1542/peds.2013-0698 · 5.30 Impact Factor
  • Noele P Nelson, Trudy V Murphy, Brian J McMahon
    Vaccine 02/2014; 32(25). DOI:10.1016/j.vaccine.2014.01.086 · 3.49 Impact Factor
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    ABSTRACT: OBJECTIVE:To analyze the cost-effectiveness of the national Perinatal Hepatitis B Prevention Program (PHBPP) over the lifetime of the 2009 US birth cohort and compare the costs and outcomes of the program to a scenario without PHBPP support. PHBPP's goals are to ensure all infants born to hepatitis B (HepB) surface antigen-positive women receive timely postexposure prophylaxis, complete HepB vaccine series, and obtain serologic testing after series completion.METHODS:A decision analytic tree and a long-term Markov model represented the risk of perinatal and childhood infections under different prevention alternatives, and the long-term health and economic consequences of HepB infection. Outcome measures were the number of perinatal infections and childhood infections from infants born to HepB surface antigen-positive women, quality-adjusted life-years (QALYs), lifetime costs, and incremental cost per QALY gained. The health outcomes and total costs of each strategy were compared incrementally. Costs were evaluated from the health care system perspective and expressed in US dollars at a 2010 price base.RESULTS:In all analyses, the PHBPP increased QALYs and led to higher reductions in the number of perinatal and childhood infections than no PHBPP, with a cost-effectiveness ratio of $2602 per QALY. In sensitivity analyses, the cost-effectiveness ratio was robust to variations in model inputs, and there were instances where the program was both more effective and cost saving.CONCLUSIONS:This study indicated that the current PHBPP represents a cost-effective use of resources, and ensuring the program reaches all pregnant women could present additional public health benefits.
    PEDIATRICS 01/2014; 133(2). DOI:10.1542/peds.2013-0718 · 5.30 Impact Factor
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    ABSTRACT: Objective. To describe the antiviral treatment patterns for chronic hepatitis B (CHB) among pregnant and nonpregnant women. Methods. Using 2011 MarketScan claims, we calculated the rates of antiviral treatment among women (aged 10-50 years) with CHB. We described the pattern of antiviral treatment during pregnancy and ≥1 month after delivery. Results. We identified 6274 women with CHB during 2011. Among these, 64 of 507 (12.6%) pregnant women and 1151 of 5767 (20.0%) nonpregnant women received antiviral treatment (P < 0.01). Pregnant women were most commonly prescribed tenofovir (73.4%) and lamivudine (21.9%); nonpregnant women were most commonly prescribed tenofovir (50.2%) and entecavir (41.3%) (P < 0.01). Among 48 treated pregnant women with an identifiable delivery date, 16 (33.3%) were prescribed an antiviral before pregnancy and continued treatment for at least one month after delivery; 14 (29.2%) started treatment during the third trimester and continued at least one month after delivery. Conclusion. Among this insured population, pregnant women with CHB received an antiviral significantly less often than nonpregnant women. The most common antiviral prescribed for pregnant women was tenofovir. These data provide a baseline for assessing changes in treatment patterns with anticipated increased use of antivirals to prevent breakthrough perinatal hepatitis B virus infection.
    Infectious Diseases in Obstetrics and Gynecology 01/2014; 2014:546165. DOI:10.1155/2014/546165
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    ABSTRACT: This report contains CDC guidance that augments the 2011 recommendations of the Advisory Committee on Immunization Practices (ACIP) for evaluating hepatitis B protection among health-care personnel (HCP) and administering post-exposure prophylaxis. Explicit guidance is provided for persons working, training, or volunteering in health-care settings who have documented hepatitis B (HepB) vaccination years before hire or matriculation (e.g., when HepB vaccination was received as part of routine infant [recommended since 1991] or catch-up adolescent [recommended since 1995] vaccination). In the United States, 2,890 cases of acute hepatitis B were reported to CDC in 2011, and an estimated 18,800 new cases of hepatitis B occurred after accounting for underreporting of cases and asymptomatic infection. Although the rate of acute hepatitis B virus (HBV) infections have declined approximately 89% during 1990-2011, from 8.5 to 0.9 cases per 100,000 population in the United States, the risk for occupationally acquired HBV among HCP persists, largely from exposures to patients with chronic HBV infection. ACIP recommends HepB vaccination for unvaccinated or incompletely vaccinated HCP with reasonably anticipated risk for blood or body fluid exposure. ACIP also recommends that vaccinated HCP receive postvaccination serologic testing (antibody to hepatitis B surface antigen [anti-HBs]) 1-2 months after the final dose of vaccine is administered (CDC. Immunization of health-care personnel: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2011;60 [No. RR-7]). Increasing numbers of HCP have received routine HepB vaccination either as infants (recommended since 1991) or as catch-up vaccination (recommended since 1995) in adolescence. HepB vaccination results in protective anti-HBs responses among approximately 95% of healthy-term infants. Certain institutions test vaccinated HCP by measuring anti-HBs upon hire or matriculation, even when anti-HBs testing occurs greater than 2 months after vaccination. This guidance can assist clinicians, occupational health and student health providers, infection-control specialists, hospital and health-care training program administrators, and others in selection of an approach for assessing HBV protection for vaccinated HCP. This report emphasizes the importance of administering HepB vaccination for all HCP, provides explicit guidance for evaluating hepatitis B protection among previously vaccinated HCP (particularly those who were vaccinated in infancy or adolescence), and clarifies recommendations for postexposure management of HCP exposed to blood or body fluids.
    MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control 12/2013; 62(RR-10):1-19.
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    Noele P Nelson, Trudy V Murphy
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    ABSTRACT: Hepatitis A is a communicable disease of the liver caused by hepatitis A virus (HAV), which is a single-stranded, lin-ear, nonenveloped RNA virus of the Picornaviridae family. The incubation period is 14 to 28 days (up to 50 days). The diagnosis is made with a positive test for immunoglob-ulin M antibody to hepatitis A virus (anti-HAV), which is detectable from 2 weeks before the onset of symptoms to 6 months afterward. Children are often asymptomatic; the severity of acute hepatitis A generally increases with age. HAV infection typically causes an acute viral illness with jaundice, is limited to several weeks' duration, and often results in substantial morbidity and associated costs. 1-5 Although uncommon, severe hepatic and extrahepatic com-plications, including liver failure, occur. HAV is shed in the feces. The primary mode of transmis-sion is fecal-oral, and transmission usually occurs through direct contact or person-person contact. HAV' s ability to sur-vive for extended periods in the environment facilitates its transmission through the consumption of contaminated food or water. Blood-borne transmission is rare. Hepatitis A Epidemiology
  • Kathy K Byrd, Peng-Jun Lu, Trudy V Murphy
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    ABSTRACT: We compared self-reported hepatitis B (HepB) vaccine coverage among health-care personnel (HCP) with HepB vaccine coverage among the general population and determined trends in vaccination coverage among HCP. We used the 2010 National Health Interview Survey (NHIS) to determine the weighted proportion of self-reported ≥1- and ≥3-dose HepB vaccine coverage among HCP aged ≥18 years. We used logistic regression to determine independent predictors of vaccination and performed a trend analysis to determine changes in coverage from 2004 to 2010 using data from the 2004-2010 NHIS. Overall, 69.5% (95% confidence interval [CI] 67.2, 71.8) and 63.4% (95% CI 60.8, 65.9) of HCP reported receiving ≥1 and ≥3 doses of HepB vaccine, respectively, compared with 27.1% (95% CI 26.1, 28.1%) and 23.0% (95% CI 22.1, 24.0) among non-HCP. Among HCP with direct patient contact, 80.7% (95% CI 78.2, 83.1) and 74.0% (95% CI 71.2, 76.8) received ≥1 and ≥3 HepB vaccine doses, respectively. Independent predictors of vaccination included direct patient contact, having more than a high school education, influenza vaccination in the past year, and ever having been tested for HIV. There was no significant change in reported coverage from 2004 through 2010. The 2010 HepB vaccine coverage estimate among HCP remained well below the Healthy People 2010 goal of 90%. Efforts to target unvaccinated HCP for preexposure HepB protection should be encouraged.
    Public Health Reports 11/2013; 128(6):498-509. · 1.42 Impact Factor
  • Zhen Zhao, Trudy V Murphy
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    ABSTRACT: Hepatitis B birth dose vaccination is a critical step in preventing perinatal hepatitis B virus infection. This study assesses the prevalence of children who missed the birth dose of hepatitis B vaccination and identifies socio-demographic factors associated with non-receipt of the birth dose among children in the United States. A survey observation study was conducted with the national representative sample of 17,053 U.S. children aged 19-35months obtained from the 2009 National Immunization Survey. Categorical data analysis and multivariable logistic regression in the context of complex sample survey were applied to evaluate the prevalence and determine the independent risk factors. 39.2% of children missed the birth dose of hepatitis B vaccination. Children who reside in states without a universal hepatitis B vaccine supply policy, are not covered by health insurance, and have only 1 vaccination provider are significantly associated with non-receipt of the birth dose hepatitis B vaccination. Children who reside in states without a universal hepatitis B vaccine supply policy, and are not covered by health insurance are two important modifiable risk factors for not receiving the birth dose hepatitis B vaccination, future intervention studies could be needed to help control those modifiable risk factors.
    Preventive Medicine 08/2013; DOI:10.1016/j.ypmed.2013.08.012 · 2.93 Impact Factor
  • Peng-Jun Lu, Kathy K Byrd, Trudy V Murphy
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    ABSTRACT: BACKGROUND: Since 1996, hepatitis A vaccine (HepA) has been recommended for adults at increased risk for infection including travelers to high or intermediate hepatitis A endemic countries. In 2009, travel outside the United States and Canada was the most common exposure nationally reported for persons with hepatitis A virus (HAV) infection. OBJECTIVE: To assess HepA vaccination coverage among adults 18-49 years traveling to a country of high or intermediate endemicity in the United States. METHODS: We analyzed data from the 2010 National Health Interview Survey (NHIS), to determine self-reported HepA vaccination coverage (=1 dose) and series completion (=2 dose) among persons 18-49 years who traveled, since 1995, to a country of high or intermediate HAV endemicity. Multivariable logistic regression and predictive marginal analyses were conducted to identify factors independently associated with HepA vaccine receipt. RESULTS: In 2010, approximately 36.6% of adults 18-49 years reported traveling to high or intermediate hepatitis A endemic countries; among this group unadjusted HepA vaccination coverage was 26.6% compared to 12.7% among non-travelers (P-values<0.001) and series completion were 16.9% and 7.6%, respectively (P-values<0.001). On multivariable analysis among all respondents, travel status was an independent predictor of HepA coverage and series completion (both P-values<0.001). Among travelers, HepA coverage and series completion (=2 doses) were higher for travelers 18-25 years (prevalence ratios 2.3, 2.8, respectively, P-values<0.001) and for travelers 26-39 years (prevalence ratios 1.5, 1.5, respectively, P-value<0.001, P-value=0.002, respectively) compared to travelers 40-49 years. Other characteristics independently associated with a higher likelihood of HepA receipt among travelers included Asian race/ethnicity, male sex, never having been married, having a high school or higher education, living in the western United States, having greater number of physician contacts or receipt of influenza vaccination in the previous year. HepB vaccination was excluded from the model because of the significant correlation between receipt of HepA vaccination and HepB vaccination could distort the model. CONCLUSIONS: Although travel to a country of high or intermediate hepatitis A endemicity was associated with higher likelihood of HepA vaccination in 2010 among adults 18-49 years, self-reported HepA vaccination coverage was low among adult travelers to these areas. Healthcare providers should ask their patients' upcoming travel plans and recommend and offer travel related vaccinations to their patients.
    Vaccine 03/2013; 31(19). DOI:10.1016/j.vaccine.2013.03.011 · 3.49 Impact Factor
  • Sarah F Schillie, Trudy V Murphy
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    ABSTRACT: INTRODUCTION: Hepatitis B vaccination starting at birth provides a safety net for infants exposed to hepatitis B virus (HBV) during delivery or in early life. Hepatitis B vaccine is recommended in the United States for infants prior to birthing facility discharge, and within the first 12h of life for infants born to hepatitis B surface antigen (HBsAg)-positive mothers. We performed a literature review and summarized the response to recombinant hepatitis B vaccine among infants. METHODS: Studies published between 1987 and 2011 assessing seroprotection from recombinant hepatitis B vaccine starting within the first 30 days of life were eligible. Seroprotection was defined using an antibody to hepatitis B surface antigen (anti-HBs) threshold of 10mIU/mL at series completion. Infant seroprotection was compared in trial arms varying by maternal hepatitis B antigen status (e antigen [HBeAg], HBsAg), hepatitis B immune globulin (HBIG) administration, birth weight, vaccine dosage, schedule, and age at first dose. RESULTS: Forty-three studies were included. The median seroprotection proportion overall was 98% (range 52%, 100%). The final median seroprotection proportions did not vary appreciably by maternal HBsAg status, HBIG administration, or schedule. Higher compared to lower dosage resulted in earlier increases in anti-HBs but not in final seroprotection proportions. Infants with birth weights <2000g compared to ≥2000g had lower median seroprotection proportions (93% and 98%, respectively). Median seroprotection proportions were also lower when infants with birth weights <2000g were vaccinated at 0 through 3 days of age compared to 1 month of age or older (68% versus 95%, respectively). CONCLUSION: High levels of protection from recombinant hepatitis B vaccine are achieved in term infants vaccinated at birth, effectively preventing transmission of HBV and resultant morbidity and mortality. Implications, if any, for long-term protection are unknown for differences in responses among infants vaccinated at birth compared to ages older than 1 month.
    Vaccine 12/2012; DOI:10.1016/j.vaccine.2012.12.012 · 3.49 Impact Factor
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    Diabetes care 12/2012; 35(12):2690-7. DOI:10.2337/dc12-0312 · 7.74 Impact Factor
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    ABSTRACT: Background: U.S. infants typically receive 3 doses of hepatitis B (HepB) vaccine to protect against infection. When HepB-containing combination vaccines became available in the late 1990s, 4 doses of HepB were permitted when 3 doses followed a monovalent birth-dose. Because detection of hepatitis B vaccine-induced antibody might be greater among infants who receive >3 doses of HepB, we assessed the proportion U.S. infants who received ≥4 doses. Methods: We analyzed data from the 2010 National Immunization Survey for children aged 19-35 months to determine the weighted proportion of children who received ≥4 doses of HepB vaccine. Multivariate logistic regression was used to determine characteristics associated with receipt of a birth dose plus ≥3 doses of combination vaccine. Results: Of 17,004 children surveyed, 30.1% received ≥4 doses of hepatitis B vaccine, of whom 68.5% received a birth dose and ≥3 doses of combination vaccine. Provider-related characteristics associated with receipt of a birth dose and ≥3 doses of combination vaccine included children with ≥3 vaccination providers (aOR 2.1, 95% CI 1.3-3.2, one provider as referent) and children who received vaccination exclusively from public or hospital providers (private providers as referent) (aOR: 1.5, 1.2-1.9, and aOR: 1.7, 1.4-2.1, respectively). Non-Hispanic black (aOR 0.75, 0.60-0.93) and multiple race children (aOR 0.73, 0.60-0.90) had lower odds of receiving a birth dose and ≥3 doses of combination vaccine compared with non-Hispanic white children. Conclusions: A sizable minority of children received ≥4 doses of HepB. Investigation is needed to determine the effect of an additional dose on long-term protection against infection.
    140st APHA Annual Meeting and Exposition 2012; 10/2012
  • Kathy Byrd, Peng-jun Lu, Trudy Murphy
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    ABSTRACT: Background: Healthcare personnel (HCP) are at risk of exposure to bloodborne pathogens including hepatitis B virus. The Advisory Committee on Immunization Practices (ACIP) recommends that all HCP receive >3 doses of hepatitis B vaccine (HepB). In 2009, estimated ≥3 doses coverage was approximately 65% among HCP aged ≥18 years. The Healthy People 2010 goal for HCP HepB vaccination was 90%. Methods: We used the 2010 National Health Interview Survey (NHIS) to determine weighted proportions of self-reported HepB vaccination coverage (≥1 and ≥3 doses) among HCP aged ≥18 years. A multivariable logistic regression analysis was performed to determine factors independently associated with receipt of HepB vaccination. Results: In 2010, the median age of all HCP respondents was 43 years (range: 18-85 years). Overall, 69.5% (95% CI: 67.2%71.8%) and 63.4% (60.8%-65.9%) of HCP, aged ≥18 years, reported receiving ≥1 and ≥3 doses of HepB vaccination, respectively, compared with 27.1% (26.1%-28.1%) and 23.0% (22.1%-24.0%) among non-HCP. Approximately 80.7% (78.2%-83.1%) and 74.0% (71.2%-76.8%) of HCP with direct patient contact received ≥1 and ≥3 doses of HepB vaccination, respectively; 91.2% of all HCP who received an initial HepB dose completed the vaccine series. Among HCPs, younger age, female sex, having direct patient care, ever tested for HIV, higher level of education and being above the poverty level was each independently associated with receipt of ≥1 dose. Conclusion: The 2010 estimate of HepB vaccination coverage among HCP remained below the Healthy People 2010 goal. Efforts to immunize unvaccinated HCP should increase.
    140st APHA Annual Meeting and Exposition 2012; 10/2012

Publication Stats

2k Citations
334.86 Total Impact Points


  • 2011–2015
    • Center for HIV/AIDS Educational Studies and Training
      New York, New York, United States
  • 2001–2014
    • Centers for Disease Control and Prevention
      • • Division of Viral Hepatitis
      • • Division of Bacterial Diseases
      • • National Center for Immunization and Respiratory Diseases
      • • Division of HIV/AIDS Prevention, Surveillance and Epidemiology
      Атланта, Michigan, United States
  • 2009
    • U.S. Department of Health and Human Services
      Washington, Washington, D.C., United States
  • 2005
    • Duke University
      Durham, North Carolina, United States
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2004
    • Malawi Centers of Disease Control and Prevention
      Lilongwe, Central Region, Malawi