Compliance with and response to hepatitis B vaccination in remaining quilombo communities in Central Brazil Adesão e resposta à vacinação contra hepatite B em comunidades remanescentes de quilombos no Brasil Central

Compliance with and responses to the hepatitis B vaccine were evaluated in remaining quilombo communities in Central Brazil. A total of 708 individuals who were susceptible to hepatitis B virus infection were invited to participate in the hepatitis B vaccination program in eight communities. Although 567 (80%) individuals received the first dose, only 198 (28%) complied with the full vaccination scheme. Of 148 subjects who agreed to be tested for anti-HBs, 123 (83.1%; 95%CI: 75.9-88.6) responded to the vaccine. A geometric mean titer of 512mIU/mL (95%CI: 342.5-765.3) was found. Male sex and older age were independently associated with non-response. Additional health education programs and alternative hepatitis B vaccine schedules are needed to improve the vaccination coverage in these communities in Central Brazil. Hepatitis B Virus; Hepatitis B Vaccines; African Descendants Introduction Worldwide, there are approximately two billion people with serological evidence of hepatitis B virus (HBV) exposure, and of these, more than 350 million are chronic carriers. These chronically infected individuals are at high risk of liver cirrhosis and hepatocellular carcinoma, mainly in the developing world, such as sub-Saharan Africa where the prevalence of HBV carriers exceeds 8%. HBV infection is commonly diagnosed by the presence of hepatitis B antigen (HBsAg), which indicates acute or chronic infection. Antibodies to the hepatitis B core antigen (anti-HBc), another marker for HBV infection, appear in the acute phase of infection and persist for an indefinite time after virus clearance. The presence of antibodies against HBsAg (anti-HBs) is a marker of recovery and immunity. Anti-HBs coexisting with anti-HBc usually indicates a previous HBV infection, and anti-HBs as the only marker indicates immunity through the hepatitis B vaccination 1. The hepatitis B vaccination is the most effective strategy to prevent HBV infection. Safe and effective vaccines against HBV infection have been available since 1982. In 1991, the World Health Organization recommended that the hepatitis B vaccination should be adopted by national immunization programs in all countries 1. Brazil included the hepatitis B vaccine into childhood immunization schemes in 1998. Additionally, Cad. Saúde Pública, Rio de Janeiro, 25(4):738-742, abr, 2009 738 ARTIGO ARTICLE