1 / 18

PREVAC B Management of hepatitis B prevention among migrants

PREVAC B Management of hepatitis B prevention among migrants. AUBERT Jean-Pierre, DI PUMPO Alexandrine, SANTANA Pascale, MAJERHOLC Catherine, PY Anne-Marie, TAULERA Olivier, WAJSBROT Alain, GERVAIS Anne, PETREQUIN Cécile Dept of General Practice, University Paris VII, Paris, France

ivi
Download Presentation

PREVAC B Management of hepatitis B prevention among migrants

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. PREVAC BManagement of hepatitis B prevention among migrants AUBERT Jean-Pierre, DI PUMPO Alexandrine, SANTANA Pascale, MAJERHOLC Catherine, PY Anne-Marie, TAULERA Olivier, WAJSBROT Alain, GERVAIS Anne, PETREQUIN Cécile Dept of General Practice, University Paris VII, Paris, France WONCA Europe, Istanbul, Sept 3, 2008

  2. Background (1) • In France (INVS 2004) • Among people with Social Security: • HBs AG carriers • 0,65 % general population • 5 % people born in Africa • 1 % people born in Asia • Anti HBc AB carriers • 7 % general population • 50 %people born in Africa • 29 % people born in Asia • Nothing is known about people without social security • …but those people attend GPs (they can have consultations for free)

  3. Background (2) • Behaviour of GPs and hospital doctors regarding hepatitis B prevention is not well known • Some datas are available, related to hepatitis B vaccination • But… vaccination is just a part of prevention skills

  4. What is prevention of hepatitis B? • People who carry no hepatitis B marker have to bevaccinated • everybodyshouldreceive information about thisdisease and its transmission • …BUT … • The messages to deliverdifferfrom one group to another: • HBs AG carriers (‘HB carriers’) • People with no HBV marker (‘HB free’) • People protectedagainst HBV, by vaccination or infection) (‘HB protected’)

  5. How to manage HBV prevention? • Three main serologic groups of people in theory…. • ….but actually numerous serologic profiles • ….54 different serologic profiles can be found in medical files • Development of an internet program, • to help doctors manage prevention, • To help doctors decide wich prevention skill has to be used • internet-accessible information leaflets for patients, related to the serologic profile (uploaded by doctor)

  6. Endpoints • Main endpoints • Is it possible for GP to manage complete HBV prevention strategies among migrant people coming from subsaharian Africa and Asia, with help of an internet-based program? • What are the factors that influence such strategies? • Secondary endpoints • What are HBV markers prevalences among those populations?

  7. Method • 26 GP investigators • All of them related to health networks • All of them working in northen Paris and north-east suburb (high rates of migrants) • data prior to 31/12/2007 are presented (preliminary results)

  8. Inclusion/exclusion criteria • Inclusion criteria • Born in subsaharian Africa, or Asia • Age >18 • To assess one of the investigators between 5/11/2007 and 29/2/2008 • Exclusion criteria • If HIV carrier: Not to be immuno depressed (CD4 cells count<350/mm3)

  9. PREVAC B: GP Patients • 373 GP patients, among them: • 61% women • 83% born in subsaharian Africa (17% Asia) • 24% no social security • 50% less than 7 years of school 15% no school at all

  10. Results Preventive skill • application of preventive skill: • 63% patients • 92% exluding missing results Information • Leaflets given to • 61% patients • 89% exluding missing results • 74% HBV carriers • 100% vaccinated people • 54% patients with anti HBc alone • 82% HBV contact, non-carrier • 74% no HBV marker

  11. Results Screening before study • 41% patients had been screened for HBV before study Vaccination before study • 49% patients that required vaccination had been vaccinated before the study • Thus 51% actually required vaccination …. During study • 12% patients who required vaccination refused it • Vaccination was actually started for 75% of patients who required it • Predictive factor for failure of vaccination strategy • Social precarity p=0,02 • Predictive factor for success • High level of education (college, university) p=0,01

  12. HBV carriers 11% HBV Contact non-carriers 36 % Vaccinated 28% No marker 25% HBV markers prevalences

  13. HBV prevalences

  14. Anti HBc Antibody alone: an issue for managing prevention of HBV What’s the problem? • Your patient has one of the following results • Hbs AG neg, anti HBs AB neg, anti HBc AB pos • Hbs AG neg, anti HBs AB not given, anti HBc AB pos • There is no consensus within guidelines • Vaccinate or not vaccinate (one-shot)? How did we solve the problem? • We decided to give the investigator the choice • Case 1 : make an injection or consider the patient protected • Cas 2: complete serology or consider the patient protected

  15. What do doctors do? • Facing isolated anti HBc AB (n=28) • 14% complete serology • 32% decide the patient is protected • 47% vaccinate • 7% missing data

  16. Predicitive factors of contact • Africa/ Asia p=0,002 • Mali, Ivory Coast, Congo/other countries in Africa p=0,0002 • Age more than 40 p=0,04 • Less than 5 years of school p=0,01

  17. Conclusion • With help of an internet-based program, GP can manage full prevention of hepatitis B transmission. • preliminary results • 41% patients screened before study • Among patients whose serology requires vaccination, only one out of two had actually started vaccination • Isolated anti HBC AB requires clear guidelines • Prevalences of HBV carriage is quite superior to available datas when EVERY MIGRANT is included.

  18. Thank you for your attention

More Related