Self-reported hepatitis B diagnoses and vaccination history in trans and non-binary communities in Germany, the...

In Germany, little is known about hepatitis B (HepB) prevalence and vaccination coverage among transgender and non-binary people (TNBP), a WHO-defined viral hepatitis key population. Our study aimed to assess self-reported HepB diagnoses, self-reported positive vaccination history, and potential predictors for a positive vaccination history in a subset of participants for whom the German standing committee on vaccination recommend HepB vaccination.

We analysed data from a 2022 cross-sectional online survey of TNBP in Germany. We calculated percentages and prevalence ratios (PR) with 95% confidence intervals (CI). Predictors of a positive vaccination history among participants potentially recommended for HepB vaccination (e.g. > 1 sexual partner in the last 12 months, people who inject drugs) were identified using a bootstrapped stepwise selection procedure.

We analysed the answers from 2,358 participants. Of these, 0.6% (13/2,358) reported previous HepB diagnosis and the proportion of self-reported positive vaccination history was 56.3% (1,225/2,175). Positive vaccination history varied across subgroups, with higher proportions among participants identifying on the male spectrum than on the female (PR: 1.29; 95% CI: 1.14, 1.47) or non-binary spectrum (PR: 1.27; 95% CI: 1.13, 1.44), participants with higher education levels compared to lower (PR: 1.44, 95% CI: 1.26, 1.68), and in big cities compared to rural areas (PR: 1.22, 95% CI: 1.07, 1.41). Overall, 550 (21.7%) participants were identified as potentially being recommended for HepB vaccination, with a total of 213 participants reporting a negative HepB vaccination history. 65% of these 213 participants were younger than 30 years and should have received the recommended childhood HepB vaccination. The proportion of positive vaccination history increased with the number of hepatitis facts known. The bootstrapped stepwise selection procedure identified knowledge of hepatitis facts as potential predictor for a positive vaccination history (relative selection frequency: 100%).

Self-reported HepB diagnoses were rare among participants and comparable to prevalence estimates in the general population in Germany. To reduce the number of TNBP with unmet vaccination needs and to improve vaccine uptake in this population, gaps in knowledge and lived experiences of TNBP need to be considered in the planning and implementation of targeted interventions. The collection of reliable data is essential on the road to achieve elimination by 2030.