JUVENILE-OFFENDERS AND HEPATITIS-B - RISK, VACCINE UPTAKE AND VACCINATION STATUS

Objective: To determine the hepatitis B vaccination status of juvenile offenders in a custodial setting, their perceived risk of hepatitis B infection, and factors influencing vaccine uptake. Design: 130 males aged 14-17 years resident at the Melbourne Juvenile Justice Centre for at least one week between mid-January and mid-December 1996 were invi ted to participate; 90 (69%) completed a doctor-administered questionn aire, and blood for serological testing was obtained from 83 of these participants. Main outcome measures: Whether hepatitis B vaccine had b een offered; whether hepatitis B vaccine had been given; the presence of antibodies to hepatitis B and C; risk factors and self-perceived ri sk of hepatitis B. Results: About a quarter of participants (22/83) ha d protective levels of antibody to hepatitis B surface antigen (anti-H Bs). Forty (44%) participants reported having been offered hepatitis B vaccine; they were more likely to be vaccinated and have protective l evels of anti-HBs. Perceived risk for bloodborne virus infection was l ow, although two-thirds of participants were at high risk of hepatitis B infection. On serological testing, 6.4% (5/78) were positive for an tibody to hepatitis B core antigen (anti-HBc), and a further 2.6% (2) had equivocal antibody levels. Of the 71 who were negative for anti-HB c, 51 (71.8%) were negative for anti-HBs. Conclusions: The targeted he patitis B vaccination program has not adequately protected this group at high lifetime risk of hepatitis B. Failure to deliver vaccine may r eflect lack of contact with healthcare services, oversight in offering vaccine and reluctance of youth to participate in preventive healthca re measures, often through not seeing themselves to be at risk. Univer sal approaches to vaccination may be more successful in vaccinating th is group.