Abstract
BACKGROUND: Hepatitis A (HAV), hepatitis B virus (HBV), and tetanus are common vaccine preventable diseases among individuals with substance use disorders (SUDs). Inpatient encounters are frequent for this population thus represent an important opportunity for preventive care. However, up-to-date data on screening and vaccination for this high-risk population are lacking in the inpatient setting. [Figure: see text] METHODS: Using electronic health records at Kaiser Permanente Southern California (KPSC), we included adults hospitalized between 01/2010 and 06/2023 (study period), with a diagnosis code for SUDs within 2 years prior to index date (first hospitalization admission date during study period). We identified those at risk for HAV and HBV at index date by labs, and evaluated vaccination during any hospitalization or within 90 days of hospital discharge (surveillance period) during study period for tetanus, HAV and HBV. [Figure: see text] RESULTS: We identified 465,282 individuals meeting the study criteria (42% female, 45% non-Hispanic white, mean age 48 years [SD 19]) (Table 1). For tetanus, 79% completed ≥1 dose prior to index date, and 71% received a booster within 10 years prior to index date (Table 2). Among those at risk for tetanus at index date, 61% were vaccinated during a surveillance period, after median 2 (IQR 1, 5) hospitalizations since index date. For HAV, 15% completed vaccination prior to index date. Among those at risk for HAV, 2% were screened for immunity at any hospitalization during follow-up; 1% were vaccinated during a surveillance period, after median 3 (IQR 1, 7) hospitalizations since index date. For HBV, 21% completed and 6% partially completed vaccine series prior to index date. Among those at risk for HBV at index date, 2% and 5% were screened for immunity and active infection, respectively, at any hospitalization during follow-up; 3.2% were vaccinated during a surveillance period, after median 3 (IQR 1, 6) hospitalizations since index date. CONCLUSION: Few with SUDs were screened or vaccinated for tetanus, HAV, or HBV during a hospitalization or at subsequent visits, after a median 2 - 3 hospitalizations after index date. This represents an opportunity for improvement in preventive care and vaccination for this high-risk population in the inpatient setting. DISCLOSURES: Jennifer H. Ku, PhD MPH, GSK: Grant/Research Support|Moderna: Grant/Research Support Yuqian M. Gu, MS, GSK: Grant/Research Support Yi Luo, PhD, GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support Rulin C. Hechter, MD, PhD, MS, Gilead Sciences: Grant/Research Support Bradley Ackerson, MD, Dynavax: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support