Trends in Hepatitis B Vaccine Coverage and Acute Hepatitis B Incidence among Adolescents in California Elisha Larez and Celia Woodfill California Department of Health Services, Immunization Branch March 2006

California Immunization Requirements for Hep B Vaccine 1997: 3 doses of Hep B vaccine were required for entry into licensed child care and kindergarten 1999: 3 doses of Hep B vaccine (or the 2 dose adolescent formulation) were required for entry into 7th Grade Statewide more than 450,000 7th grade students were subject to this requirement

California Promotions & Campaigns for Adolescent Recommendations Adolescent IZ Marketing Plan Preteen Vaccine Week California School Nurses Organization (CSNO) Partnership Back to School 1999 Campaign

California Hep B Campaigns & Activities for Adolescents Movie Ad Campaign Vaccinate Before You Graduate Campaign College Informing Campaign Preteen Vaccine Week

Study Objectives To examine trends in Hep B vaccine coverage and acute Hep B incidence among adolescents, following implementation of a 7th Grade school entry requirement in California

Study Methods Yearly trends of Hep B vaccine coverage among 7th Grade students were analyzed using school assessment data reported from 1999-2003 Yearly trends of Hep B doses given to 10-14 year olds in public clinics were analyzed using vaccine usage data reported from 1994-2005 Yearly trends of acute Hep B incidence among 12-18 year olds were analyzed using disease surveillance data reported from 1994-2005

Percent of 7th Grade Students Immunized, California 1999-2003

3+ Hep B Vaccine Coverage Among 7th Grade Students, California 1999-2003

Doses of Hep B Vaccine Given to 10-14 year olds in Public Clinics, California 1994-2005 7th Grade Requirements Adolescent Campaigns

Estimated 3+ Hep B Vaccine Coverage by Age, California 2005

Cases and Rates of Acute Hep B in 12-18 year olds, California 1994-2005 Adolescent Campaigns 7th Grade Requirements

Study Conclusions & Next Steps Hep B vaccine coverage is on the rise and acute Hep B incidence is declining among adolescents in California Findings have important implications for vaccines targeted for adolescents Further research needed to determine acceptability of using laws requiring adolescent vaccination