Hepatitis A, B, and A/B vaccination series completion among US adults: A claims-based analysis

Figures & data

Table 1. Baseline characteristics of commercial/Medicare and of Medicaid enrollees who meet study selection criteria, by type of vaccine at initial vaccination dose.

	Commercial/Medicare			Medicaid
	Hepatitis A vaccine	Hepatitis B vaccine	Hepatitis A/B vaccine	Hepatitis A vaccine	Hepatitis B vaccine	Hepatitis A/B vaccine
	N = 183,000	N = 147,453	N = 64,870	N = 3,570	N = 7,189	N = 3,063
Age, mean (SD)	42.1 (14.8)	44.4 (14.2)	45.8 (11.6)	37.1 (13.2)	38.9 (12.3)	40.2 (11.9)
Female, %	55.3	55.4	60	66.9	75.1	70.9
Health plan type, %
PPO	55.7	56.5	49.8	NA	NA	NA
HMO	21.1	19.0	18.2	41.1	49.8	36.2
Comprehensive	2.2	4.6	2.0	51.5	43.8	55.7
Other	20.9	20.0	30.0	7.5	6.4	8.0
Previous vaccinations, %
Influenza	29.8	33.2	33.9	35.5	33.3	33.1
Diphtheria, tetanus, and/or pertussis	24.1	26.1	20.0	16.1	15.7	11.3
Pneumonia	4.1	6.8	4.5	10.1	8.8	8.8
Zoster	2.1	1.7	1.7	0.0	0.1	0.2

Abbreviations: NA, not applicable; SD, standard deviation; PPO, preferred provider organization, HMO: health maintenance organization.

* Includes consumer-driven health plan, exclusive provider organization, high deductible health plan, point-of-service, and point-of-service with capitation.

^† This vaccination category includes the individual diphtheria vaccine, the individual tetanus vaccine, the combined diphtheria and tetanus vaccine, and the combined diphtheria, tetanus, and pertussis vaccine.

Figure 1. Rates of vaccination series completion among (a) adult commercial/Medicare (N = 350,240) and (b) adult Medicaid patients (N = 12,599)*

*Schedule of vaccine series was determined by type of vaccine (monovalent hepatitis A or B or bivalent hepatitis A/B) administered on index date. Completion schedules with a bivalent vaccine on the index date are shown stratified by whether series fulfilled hepatitis A or B coverage; Hepatitis A vaccine is a 2-dose series; however, discrepancies in series completion for hepatitis A allow for bivalent vaccine to be included in the measurement, thus needing three doses, as appropriate, to be complete. The bivalent inclusion required 3 doses for completion.

Figure 2. Study design scheme; Abbreviations: CPT, Current Procedural Terminology

*Hepatitis A adult dosage, CPT 90632; Hepatitis B adult standard 3 doses, CPT: 90740; Hepatitis B for dialysis or immunocompromised patients, 3 doses, CPT: 90746; Hepatitis B for dialysis or immunocompromised patients, 4 doses, CPT: 90747; Hepatitis A and B adult dosage, CPT: 90636.

Table 2. Hepatitis A, B, or A/B Vaccine Completion Adult Schedule Guidelines^11,12

Type of Vaccine^,	Dosing Schedule	Completion criteria
Monovalent HepA	2-dose series given on a 0-, 6–12 or a 0-, 6-18-month schedule depending on the HAV vaccine	Time b/w 1^st and 2^nd dose ≥6 months
Monovalent HepB	3-dose series given on a 0-, 1-, 6-month schedule4-dose series given on a 0-, 1-, 2-, 6-month schedule for adults on hemodialysis	Time b/w 1^st and 2^nd dose is ≥1 monthTime b/w 2^nd and 3^rd dose is ≥8 weeksTime b/w 1^st and 3^rd dose is ≥16 weeksTime b/w 1^st and 2^nd dose is ≥1 monthTime b/w 2^nd and 3^rd dose is ≥4 weeksTime b/w 1^st and 4^th dose is ≥16 weeks
Bivalent HepA-HepB	Standard dosing: 3-dose series given on a 0-, 1-, and 6-month schedule Accelerated dosing: 4-dose series given on days 0, 7, and 21 to 30 followed by a booster dose at month 12	HAV series completion criteria:Time b/w 1^st and 2^nd dose is ≥1 monthTime b/w 2^nd and 3^rd dose is ≥5 monthsHBV series completion criteria:Time b/w 1^st and 2^nd dose is ≥1 monthTime b/w 2^nd and 3^rd dose is ≥8 weeksTime b/w 1^st and 3^rd dose is ≥16 weeksNA

^a Type of vaccine (monovalent HepA or HepB or bivalent HepA-HepB) administered on index date was used to determine schedule of vaccine series.

^b Vaccine series may include: 1) monovalent vaccines only, 2) a combination of both monovalent and bivalent vaccines, 3) either monovalent vaccines only or a combination of monovalent and bivalent vaccines, 4) bivalent vaccines only, or 5) either bivalent vaccines only or a combination of monovalent and bivalent vaccines.

^c Completion schedules when initiating with a bivalent vaccine on the index date were stratified by whether series fulfilled hepatitis A or B coverage.

^d Because CPT codes do not differentiate between standard dosing and accelerate dosing vaccination schedules, completion was assessed as at least 3 doses as per the standard dosing schedule.

Centers for Disease Control and Prevention. Epidemiology and prevention of vaccine-preventable diseases: Hepatitis A. [accessed 9/9/2017]. https://www.cdc.gov/vaccines/pubs/pinkbook/hepa.html.

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Centers for Disease Control and Prevention. Epidemiology and prevention of vaccine-preventable diseases: Hepatitis B. [accessed 9/9/2017]. https://www.cdc.gov/vaccines/pubs/pinkbook/hepb.html.

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