Local Approach Needed to Increase Hepatitis B Vaccinations in Indonesia

Putri Bungsu Machmud

A knowledge of the risk of infection results in higher rates of hepatitis B virus (HBV) infection vaccine adherence in Indonesia, according to new research.

A team, led by Putri Bungsu Machmud, Institute of Medical Epidemiology, Biometrics, and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Universitätklinikum Halle (Saale), Medical School of the Martin-Luther-University Halle–Wittenberg, assessed the factors associated with the willingness to be vaccinated against hepatitis B in Indonesia, considering cultural and geographic differences.

Low Adherence to HBV Vaccines

The majority of individuals with chronic hepatitis B infections do not actually know they are infected. However, this may cause hepatitis B infections to go unnoticed and undiagnosed until the virus has already caused severe liver damage.

In Indonesia, there has been a zero dose of hepatitis B for newborns since 1997, followed by 3 additional doses for children.

“However, hepatitis B vaccination coverage was overall low (less than 70% for each dose) with substantial differences between provinces,” the authors wrote. “This difference may be due to the cultural and political situations in each province and the different histories.”

Surveys

In the institution-based cross-sectional survey, the investigators sought responders in 16 community health centers. The results were stratified by province using a multivariable logistic regression model to assess the variables associated with the willingness to receive the hepatitis B vaccine. The investigators compared the results from 2 provinces in Indonesia—Aceh and Yogyakarta.

The surveys were conducted between February and March 2020 and health care workers and outpatients were included in the study.

Perceptions

The results show individuals from Yogyakarta had a higher knowledge and risk perception of hepatitis B. This group was more often willing to get vaccinated than participants from Aceh.

They also found a high-risk perception of HBV was associated with the willingness to be vaccinated against hepatitis B in participants from either province.

Additionally, a fair and high knowledge of hepatitis be infection and vaccination, being female, and having health insurance covering the vaccination costs were associated with the willingness to be vaccinated for individuals in Yogyakarta.

For the Aceh cohort, health care workers in high-risk units for hepatitis B had a higher willingness to be vaccinated compared to individuals who were not high-risk health care workers.

“Given the different factors associated with the willingness to be vaccinated against hepatitis B in Aceh and Yogyakarta, this study also highlights the need of a locally adjusted, culture-based approach to improve the hepatitis B vaccination program,” the authors wrote.

The study, “Understanding hepatitis B vaccination willingness in the adult population in Indonesia: a survey among outpatient and healthcare workers in community health centers,” was published online in the Journal of Public Health.