摘要：Objectives. We sought to assess the performance of self-reported vaccination with hepatitis B vaccine (HepB) compared with serological status for hepatitis B markers in the general US civilian population. Methods. Using 1999 through 2008 National Health and Nutrition Examination Survey data, we calculated 3 measures of agreement between self-reported HepB vaccination status and serological status: percent concordance, and positive (PPV) and negative predictive values (NPV) of self-report. Logistic regression was used to identify factors associated with agreement between self-report and serological status. Results. Overall agreement was 83% (95% CI = 82.3, 83.7), NPV of self-report was high (0.95; 95% CI = 0.93, 0.95) and PPV was low (0.53; 95% CI = 0.51, 0.54). Birth year relative to the 1991 recommendation for universal infant HepB vaccination had a strong association with agreement, however, the association was positive for those who reported receiving at least 3 doses and negative for those who reported receiving no doses. Conclusions. Although the low PPV in our study could be attributable in part to waning of vaccine-induced anti-HBs over time, national adult HepB vaccination coverage may be lower than previously estimated because national estimates usually depend on self-report of vaccine receipt. Hepatitis B virus (HBV) infection is associated with an estimated 600 000 annual deaths worldwide. 1 In the United States, during 2007 alone, hepatitis B was listed as either the underlying or contributing cause of 1815 deaths. 2 During the period 1999 to 2006, there were an estimated 730 000 US residents with active, chronic HBV infection. 3 HBV infection is vaccine-preventable. In the United States, vaccination was first recommended for all infants in 1991. 4 Along with disease incidence, vaccination coverage is an essential component of surveillance, and both are used to guide national vaccination programs 5 by identifying populations at risk and in need of vaccination. Serological surveys supplement case-surveillance data, providing a measure of prevalence of chronic infection in the population. Furthermore, serological surveys can measure and distinguish between naturally acquired and vaccine-induced immunity, and are often considered the most reliable method of determining vaccination status outside of provider records. However, there are limitations to use of serological surveys to determine hepatitis B vaccination status because antibodies wane over time, 6 and vaccinated individuals may, therefore, appear unvaccinated as time since vaccination increases. Because serological surveys are costly to implement, public health practitioners frequently rely on self-reported vaccination status to assess immunity. Self-reported vaccination coverage is used widely in public health to guide vaccination programs. Validation studies have found high levels of agreement between self-reported vaccination status (pneumococcal 79% 7 ; influenza 89% 8 ) and vaccination documented in medical records. Although some studies comparing self-reported receipt of hepatitis B vaccine (HepB) with serological status have been conducted in special populations such as injection-drug users, HIV-infected individuals and adolescents, to the best of our knowledge, no studies have assessed the performance of self-reported receipt of HepB with serological status as a measure of vaccination coverage in the general US civilian population. This was our objective in the current analysis.
