1. E-mail: cdcinfo@cdc.gov | Web: www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Hepatitis B Vaccination Among High-Risk Adults in the United States Jacqueline Avery, MPH 1, Kathleen Koechlin, PhD, MPH, RN 2, Mila Verdugo, MPH 3, Hope King, MSPH 1 1 Centers for Disease Control and Prevention, Atlanta, GA, 2 Ohio Department of Health, Columbus, OH, 3 Chicago Department of Public Health Background  Hepatitis B virus (HBV) infection is the underlying cause of an estimated 3,000 deaths each year in the United States.  In Dec. 2006, CDC and ACIP published recommendations to promote vaccination of adults at risk for HBV.  In Nov. 2007, CDC launched the Adult Hepatitis B Vaccination Initiative to utilize immunization funds for the purchase of adult hepatitis vaccines to distribute to settings that serve individuals at high risk for hepatitis infection.  Nationwide, 56 grantees joined the Initiative. – 48 states, 3 cities, 5 territories  In 2007, the national incidence of acute hepatitis B was 1.5 cases per 100,000 population. – The incidence of acute hepatitis B in Chicago was 2.7 cases per 100,000 population (total pop. 2.8 million). – The incidence of acute hepatitis B in Ohio was 1.1 cases per 100, 000 population (total pop. 11.5 million). Objective To assess the impact of vaccination efforts to at-risk adults from Nov. 1, 2007 – Dec. 31, 2009 by using the following outcomes:  Total doses of hepatitis B containing vaccine administered  Total number of venues at which hepatitis B containing vaccine was administered  Total number of doses administered at specific venue types  Proportion of those vaccinated who complete the 3-dose vaccination series Methods  Data reported by 56 grantees nationally on doses of hepatitis B containing vaccine ordered and administered from Nov. 1, 2007 – Dec. 31, 2009 were analyzed.  Data from the Chicago Department of Public Health in Chicago, IL and the Ohio Department of Health in Columbus, OH were analyzed to assess the impact of vaccination efforts to at-risk adults. – Hepatitis B vaccination series completion rates were calculated on males/females over the age of 18 with varying race and risk group demographics from Nov. 1, 2007 – Oct. 31, 2009. Results Adult Hepatitis B Vaccination Initiative Data (Nov. 1, 2007–Dec. 31, 2009) Demographic and Vaccination Data for Chicago and Ohio (Nov. 1, 2007-Oct. 31, 2009) Limitations Conclusions  When vaccine is supplied at no cost, more at-risk adultsare able to be vaccinated and receive the full benefit of being well- protected against a vaccine preventable disease such as HBV.  More venues enrolled in the Initiative than reported vaccine usage and while usage increased from year one to year two, there was more vaccine ordered than administered. This may indicate that while there is a strong interest in this Initiative, the lack of infrastructure funding may be a barrier to maximum implementation.  Collaboration amongLHDs, community partners, and non- traditional settings (jails, SA treatment sites, and MSM events) can provide effective vaccination services to traditionally hard-to-access populations.  Additional education and resources are needed to raise awareness on the importance of receiving the hepatitis vaccinations and completing the 3-dose series. Contacts  Kathleen Koechlin, PhD, MPH, RN Adult Viral Hepatitis Prevention Coordinator Ohio Department of Health Email: Kathleen.Koechlin@odh.ohio.gov  Mila Verdugo, MPH Chicago Department of Public Health Email: Verdugo_Mila@cdph.org  Hope King, MSPH Team Leader/Lead Health Scientist, Prevention Branch CDC, Division of Viral Hepatitis Email: hking@cdc.gov National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention Division of Viral Hepatitis Setting Participating Venues Venues Reporting Total Doses Ordered Total Doses Administered STD Clinics588328 (56%)205,846167,476 (81%) Jails17976 (42%)86,56059,334 (69%) SEP228 (36%)7,7083,212 (42%) Primary Care497173 (35%)51,26825,661 (50%) HIV C&T9751 (53%)11,9438,870 (74%) Prisons17482 (47%)135,36681,774 (60%) SA Treatment19762 (31%)46,24427,538 (60%) Local HD1,020416 (41%)326,376260,564 (80%) Other25064 (26%)30,91722,748 (74%) Total3,0241,260 (42%)902,228657,177 (73%) STD = Sexually Transmitted Disease; SEP = Syringe Exchange Program; HIV C&T = Human Immunodeficiency Virus Counseling and Testing; SA = Substance Abuse. AA = African American; API = Asian Pacific Islander, H = Hispanic; White = White; MSM = Men who have Sex with Men; SA = Substance Abuse;; STD = Sexually Transmitted Disease.  Data collected through the Initiative cannot be used to determine the number of individuals who received vaccine or those who received a complete 3-dose vaccination series.  Vaccination history and previous HBV infection is unknown.  Follow-up vaccinations received outside of the selected agencies were not collected.  The time lapse between doses may be longer than the standard 0, 1, 6 month time intervals when vaccinating in settings serving high-risk adults, therefore the limited time frame may not capture the true series completion rate.  These data include persons who were not due for all three doses during the selected time frame and therefore could not have completed the vaccine series and been included in the series completion rate.  LHD infrastructure and data management vary by grantee.  Challenges exist with gathering and cleaning data. Hepatitis B Vaccine Administered by Race for Chicago and Ohio (Nov. 1, 2007-Oct. 31, 2009) Year 1 Vs. Year 2 Administration Data (Nov. 1, 2007-Dec. 31, 2008; Jan. 1–Dec. 31, 2009 Hepatitis B Vaccination Series Completion Rates for Chicago and Ohio (Nov. 1, 2007-Oct. 31, 2009 Hepatitis B Vaccine Administered by Age Groups for Chicago and Ohio (Nov. 1, 2007-Oct. 31, 2009) Doses Ordered and Administered Data (Nov. 1, 2007–Dec. 31, 2009) Hepatitis B Vaccine Administered by Facility Type for Chicago and Ohio (Nov. 1, 2007-Oct. 31, 2009)