Serological Surveillance of Hepatitis B Infection and Vaccination Status of Vietnamese Americans

Author: Truongson Hoang

Primary Advisor: Jiajie Zhang, PhD

Committee Members: Muhammad Walji, PhD; Chiehwen E. Hsu, PhD

Masters thesis, The University of Texas School of Health Information Sciences at Houston.

Abstract

Vietnamese Americans (VA) have one of the highest rates of hepatitis B virus (HBV) infection and liver cancer of all ethnic groups in the United States. Houston, Texas has the third largest VA community in the US. However, no current baseline HBV prevalence and immunization status is available for this population. Vaccination against and screening for HBV can reduce epidemiological transmission of the disease and reduce HBV-related sequelae in this endemic population.

Objectives: To reduce and ultimately eliminate the hepatitis disparities between VAs and their counterparts, we sought to understand the HBV infection status and susceptibility of Houston's VA adults in a HBV prevention program. Through lessons learned from this study, we also discuss the recommendations from the Institute of Medicine Report on HBV for disease control and interventions in high-risk populations.

Methods: Data was collected through a collaborative community-based HBV project aimed at screening 1,000 Asian Americans (including 263 VA adults). Participants provided blood sample for serological testing and answered a short questionnaire. We provided descriptive statistics, employed chi-square and Fisher's exact tests for comparative analysis and logistic regression for prediction analysis between independent and outcome variables.

Results: Serological test results indicate that 56.7% had been infected with HBV, 4.6% are chronically infected, and 24.3% are immune due to vaccination. Older age (45 years or older), being married or divorced, and having knowledge of family history with HBV or liver disease are factors associated with infection status. Under a univariate prediction model, having a high school diploma and having knowledge of family history with the disease increased the odds of vaccination while being older decreased this odd. Older age was a significant predictor of not having been vaccinated against HBV under a multivariate regression analysis.

Conclusion: While public education campaign and vaccination mandate had a positive effect on HBV control in Houston's VA community, the disease remains more prevalent in this VA sample than those in the non-Asian community. Findings from our study strongly warrant more focused interventions targeted at the at-risk VA groups, especially adults over age 45, those with lower educational attainment, and those who are aware of family history, and ongoing HBV surveillance in this population. To control the spread of HBV and to eradicate this disease in the Vietnamese American population, education and outreach efforts to this community must embody a multipronged, multi-tiered, and culturally appropriate approach that embraces community participation.