Introduction: China has about 120 million hepatitis B virus (HBV) carriers and a 7.2% hepatitis B surface antigen (HBsAg) prevalence in 2006.This creates a huge disease burden and also leads to significant economic losses. Since 2002, a free universal infant hepatitis B vaccination programme has provideda 3-dose primary vaccination for all infants. Although some economic evaluations of this programme have been conducted, a comprehensive cost-effectiveness analysis (CEA) to estimate long-term benefit using mathematical modeling would aid understanding of population strategies for hepatitis B control in large populations. Moreover, the most common mode of infection is perinataltransmission at birth. However the more effective immunization programme involving screening women during pregnancy for HBV-carrier status and providing passive-active vaccination for newborns has not been implemented in China. Aims: To identify the most cost-effective universal infant hepatitis B vaccination strategy for China. Method: A hospital-based survey was conducted during 2010-2011 in a general hospital in Shenzhen, China, in order to obtain costing data to estimate the economic burden of chronic hepatitis B patients. Annual direct and indirect costs from this study were used as cost parameters in the CEA models. Mathematical models were developed to simulate perinatal transmission, vaccination programmes and disease progression using Markov modeling and decision trees. Quality-adjusted life year (QALYs) as well as health and monetary outcomes were also assessed. Univariate sensitivity analysis and probabilistic sensitivity analysis using Monte Carlo simulation were performed to test parameter uncertainty. Two programmes of screening of pregnant women for both HBsAg and/or HBeAg and the infant passive-active vaccination were compared with the current vaccine-only programme in one CEA, while the other CEA estimated the effect of the current infant programme compared with no vaccination. Findings: The estimated total economic burden including annual direct and indirect cost among hepatitis B patients of RMB 43104.5 (US$6340.8). The economic burdens of associated disease states of hepatitis B infection were highest for hepatocellular carcinoma (HCC) (RMB 77297.1), decompensated cirrhosis (RMB 50725.7), chronic active hepatitis B (CAH) (RMB 37449.5) and finally compensated cirrhosis (RMB 37276.9). The average total economic burden per hepatitis B patient amounted to 46% of Shenzhen GDP per capitain 2010, and 5.4% of the city’s annual per capita income. The current vaccine-only infant vaccination programme was justified by costsavings, from both a societal and health care payer’s perspective, reducing new HBV infections by about 76%. This has produced a gain of 743,000 life-years and 620,000 QALYs given current numbers and savings of US$2~3billion saved over the lifetime of a national cohortof 10,000,000 newborns. A universal control programme involving the screening of pregnant women for HBsAg and passive-active vaccination, would reduce new infections by 13%, saving 436,000 life years and gaining 121,000 QALYs for a saving of about US$546 million compared with current vaccine-only programme. Implications: The universal infant hepatitis B vaccination programme is currently a cost-effective strategy for hepatitis B control in China.A beneficial amendment to the current strategy wouldinclude screening of all pregnant women for HBsAg and vaccinating newborns in a passive-active way. / published_or_final_version / Public Health / Doctoral / Doctor of Philosophy

published_or_final_version / Nursing Studies / Master / Master of Nursing

Objectives To systematically review all studies HBV screening and vaccination health behaviour according to the Health Belief Model theoretical framework including perceived susceptibility, severity, barriers and benefits, cues to action and self-efficacy. Methodology The literature search used PUBMED, MEDLINE, CINAHL plus, Wan Fang database, and Chinese Journal Net with English and Chinese language. About 73 studies (PUBMED: 33 MEDLINE: 10, CINAHL plus: 3, Wan Fang database: 16, Chinese journal net: 11) in total were identified; after applying the inclusion and exclusion criteria, 11 studies met the criteria and in the final analysis. The target group included high infection rate groups (pregnant women, unprotected sexual behaviour, and immigrant group) and illness groups (chronic Hepatitis B and Hepatitis B virus carriers). Results and Discussion HBV screening and vaccination behaviour were determined by perceived the susceptibility, perceived severity, perceived barriers and benefits, and cues to action. The self-efficacy was seldom designed in the questionnaire of the reviewed articles. The Health belief model was a useful model for explaining HBV screening and vaccination behaviour. Screening- and vaccination-related beliefs of the screening and vaccination vary by high risk groups. From the review more attention to self-efficacy and perceived control may improve vaccination uptake. There were contrast results with the social economic characteristics, such as age, gender, income, in determining the HBV screening and vaccination behaviour. Conclusion and Implication As the policy maker, health care providers need to develop specific interventions paying attention to the different aspects of the Health Belief Model to improve the perceived of Hepatitis B virus. / published_or_final_version / Public Health / Master / Master of Public Health

This dissertation discusses the political dimensions of scientific practice in Taiwan from two perspectives: the social contingencies of scientific knowledge and the role of government in medical science. The history of Taiwanese hepatitis B control program from 1980 to 1993 provides a valuable case study to investigate these issues. The controversies over the safety of the hepatitis B plasma vaccine display the social contingency of scientific knowledge. On the basis of different concerns or political interests, numerous participants joined the scientists in interactively shaping and reshaping the vaccine safety. When participants used various strategies and contradictory scientific knowledge to argue against each other, the credibility of experts and their scientific knowledge was downgraded, which in tum prevented scientific knowledge from serving as the sole arbitrator of resolving the controversies. The socially contingent characteristics of scientific knowledge provided a space for government agencies participating in shaping scientific knowledge formation. This historical case displays how the Taiwanese government significantly influenced the scientific knowledge formation regarding hepatitis B control in Taiwan. The government designed science policy to promote hepatitis B control, and government officials were involved in resolving the controversies over the safety of the hepatitis B plasma vaccine. Government scientists not only gave government agencies a certain degree of interpretative authority in the controversies, but also produced alternative scientific knowledge to support the government's science policy. When the government policy changed in response to social problems, the scientific knowledge regarding hepatitis B control also changed. This dissertation concludes by calling for more attention toward studying the role of government in scientific practice. Without considering how the Taiwanese government participated in the hepatitis B control program, our understanding about the formation and change of scientific knowledge regarding hepatitis B control would be incomplete. / Ph. D.

The study investigated knowledge, attitudes and vaccination status of registered nurses regarding prevention and control of hepatitis B (HB). An analytical, cross-sectional study was conducted, and data was collected using self-administered questionnaires. 53.0% of the respondents (n=219) had good knowledge and 96.3% had positive attitudes regarding HB prevention and control. 86.8% had received at least 1 dose of the HB vaccine, but only 54.7% had received the 3 doses for complete vaccination. A positive attitude score was a significant predictor of HB vaccination uptake (OR=1.424, p=0.003). Female registered nurses were 3.479 times (95% CI: 1.495-8.098; p=0.004) more likely to be vaccinated than male registered nurses. Registered nurses are aware that hepatitis B virus infection can be prevented by a safe and effective vaccine, however, there is need to improve awareness and encourage complete HB vaccination uptake among all registered nurses to ensure their protection against the risk of HBV infection. / Health Studies / M. P. H. (Health Studies)

At a state university in the Pacific Northwest, the authors surveyed 477 matriculating college students about their immunization status, knowledge, self-perceived risk, and health risk behaviors for hepatitis A and B vaccinations. Review of immunization records revealed that 10% of these students were completely immunized for hepatitis A and 58.8% were completely immunized for hepatitis B. Although their knowledge about hepatitis A and B was very good, there were no significant differences in immunization status or health risk behaviors based on their knowledge or their self-perceived risk of hepatitis A and B. About 66% of students perceived they had no risk or low risk for hepatitis A and B and only 5% felt they had a high risk. In spite of the low self-perceived risk, health risk behaviors for hepatitis A and B were common in this population of college students. In the past twelve months, 56.2% of these students reported being sexually active (vaginal, oral, anal sex), including 20.5% who had two or more sexual partners. Students with multiple sexual partners reported having unprotected sex at a high frequency: 61.3% vaginal, 81.1% oral-genital, and 13.2% anal. The non-sexual health risk behaviors were also common in this population: 53.2% had body piercing/tattoos, and 26.5% traveled internationally to regions with intermediate to high rates of hepatitis A (Africa, SE Asia, Central/South America). These students who traveled internationally were more likely to be immunized for hepatitis A, although 70% remained unimmunized. In addition, students with multiple sexual partners or with a body piercing/tattoo were more likely to be immunized for hepatitis B. However, about one-third of these students with multiple sexual partners or body piercing/tattoo have not completed the hepatitis B series. The theory of planned behavior was applied to determine factors that are associated with college students' decision to be vaccinated for hepatitis A and B. For hepatitis A and B vaccinations, important attitude constructs identified were 'vaccine effectiveness, vaccine adverse effects, anticipation anxiety, inconvenience, and vaccine expense.' The subjective norm constructs with the greatest influence for college students were: 'parents, family doctor, and student health services staff'. The significant perceived behavioral constructs were 'parents reminder, student health services (SHS) reminder, and SHS hepatitis vaccine clinic.' In conclusion, there is still a sizable portion of unvaccinated college students who possess health risk behaviors for hepatitis A and B, such as multiple sexual partners, unprotected sexual behaviors, body piercing/tattoos, and international travel. With a greater understanding of college students' attitudes, subjective norms, and perceived behavioral control college health services could develop more effective strategies to educate unvaccinated college students about these risks and motivate them to be immunized. / Graduation date: 2003