Methods: Using ICD-9 diagnosis codes to identify individuals with HBV infection, we analyzed medical records of 70,995 males and 29,010 females from all service branches, divided in equal cohorts (n=6,667) between 1997 and 2011. Descriptive statistics were used to characterize individuals with HBV by accession year cohort.
Results: Chronic HBV prevalence was 0.14% (n=139) and did not differ between men and women (p=0.75) or between U.S.- and foreign-born individuals (12.5% of sample; p=0.47). The total sample was 70% white, 17% African-American and 8.4% “other” race, which included Hispanic/Asian/Native Americans; race/ethnicity data was missing for 5.1% of individuals. The prevalence of chronic HBV was significantly higher (p<0.001) among individuals categorized as “other” (0.60%) than among whites (0.06%) and African-Americans (0.27%). In addition, the prevalence of sexually transmitted infections (STIs) was significantly higher for HBV-positive than HBV-negative individuals (p<0.001): 7.7% of HBV-negative individuals were diagnosed with a pathogen-specific STI, compared with 21% for HBV-positive individuals, in whom chlamydia (8.6%) and gonorrhea (5.8%) were most common. Following the implementation of mandatory vaccination, HBV prevalence decreased from 0.22% pre-2002 to 0.10% post-2002 (p<0.001). There were no significant changes in patient demographics or in the percentage of patients diagnosed with additional STIs before and after 2002 (19% vs 23%, p=0.61).
Conclusion: Mandatory screening and vaccination in the U.S. military has reduced HBV diagnoses by more than half; however, HBV infections continue to occur. Demographic characteristics of HBV-positive individuals in our cohort likely demonstrate a moderate level of pre-existing infection, though the high proportion of HBV-positive individuals with additional STI diagnoses suggests potentially ongoing sexual transmission. Vaccination efforts should be continually reviewed to minimize the risk of HBV transmission in the military.
O. Mesner, None
J. L. Sanchez, None
A. Ganesan, None
G. E. Macalino, None
B. Agan, None
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