1. A Viral Hepatitis Immunization Initiative in Massachusetts Correctional Facilities Franny Elson, MS Mary Conant, RN, BSN Division of Epidemiology and Immunization Bureau of Communicable Disease Control Massachusetts Department of Public Health

2. 2 Background Availability of CDC funding to support high- risk adult hepatitis B initiatives was announced in the Fall of 2007 Available vaccines through program: hepatitis B monovalent and hepatitis A/B combination vaccine Funds could only be used for the purchase of vaccine

3. 3 Hepatitis in Corrections “Recent estimates indicate 12%-39% of all Americans with chronic hepatitis B virus or hepatitis C virus infections were releasees during the previous year.” 1 Hepatitis C seropositivity rates in Massachusetts Department of Corrections facilities have been measured as 27.3% in men and 43.9% in women. 2 [1] CDC. Prevention and control of infections with hepatitis viruses in correctional settings. MMWR 2003; 52(No. RR-1). [2] Eastman, E. Validation of self-reported risk as a method for identifying anti-hepatitis C positive individuals at time of intake physical examination at Massachusetts Department of Correction facilities. Abstract. APHA 4051.0 (2001).

4. 4 Massachusetts Corrections Department of Corrections (DOC) –17 correctional facilities (prisons) –Average daily inmate count: 10,000 County Sheriff Departments –13 counties (jails and houses of correction) –Average daily inmate count: 12,000

5. 5 Adult Hepatitis B Vaccination Initiative Funds Awarded to Massachusetts Number of Doses Dollar Amount Awarded Hepatitis B7,774$192,256.00 Combined hepatitis A/B 11,000$414,040.00 Total18,774$606,296.00

6. 6 Adult Hepatitis B Vaccination Initiative Goals of the initiative: –Vaccinate at-risk adults in correctional health facilities against HAV and HBV –Establish a system for facilities to vaccinate at-risk inmates upon intake Objectives: –100% of at-risk inmates offered at least one dose of HAV and HBV vaccine –Facilities to be fully implemented by June 30, 2008

7. 7 Implementation Vaccine became available February 2008 Orientation materials sent to participating facilities –Educational materials –Data collection forms –Description of the process –Contact information –Standing orders –Screening forms Clinics were offered to all county facilities and one DOC facility

8. 8 Implementation MDPH has organized and run 6 clinics at 3 facilities (Worcester and Hampden County jails, MCI-Framingham prison) Boston Public Health Commission oversees clinics at Suffolk County jail and House of Correction Other county facilities have run clinics without direct MDPH assistance

9. 9 Clinic Planning Cross-trained MDPH staff in viral hepatitis/harm reduction/EDS/ICS operations –Trained nurses and screeners Determined medical and clinic oversight Developed staffing and safety plans Planned clinic logistics and procurement of supplies Implemented NIMS/ICS Conducted site assessment/health education day Developed standing orders and emergency protocols

10. 10 Hampden County Clinics Facility holds 1,800 male inmates Education Day one week before clinic #1 2 clinics were conducted by 4 vaccination teams Each team consisted of 3 nurses, and 3 screeners with one Spanish interpreter included in each team

11. 11 Hampden County Clinics First clinic on 1/31/08 vaccinated 683 inmates Second clinic on 2/28/08 vaccinated 531 inmates –499 received their 2 nd dose –32 received their 1 st dose

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13. 13 Worcester County Clinics Facility holds 1,251 male inmates Education Day one week before clinic #1 2 clinics were conducted by 4 vaccination teams Each team consisted of a Corrections Officer or facility nurse, 3 MDPH nurses, and 3 screeners with one Spanish interpreter included in each team

14. 14 Worcester County Clinics First clinic on 3/13/08 vaccinated 558 inmates Second clinic on 4/10/08 vaccinated 570 inmates –373 received their 2 nd dose –197 received their 1 st dose

15. 15 CCID Hepatitis B Initiative Worcester County Jail

16. 16 MCI-Framingham Clinics Facility holds 700 female inmates Education Day one week before clinic #1 Facility logistics allowed for one main clinic location in the gymnasium Clinic staff consisted of Correction Officers, 3 staff nurses, 6 MDPH nurses, and 9 MDPH screeners Spanish interpreters were located at both the screening and vaccination tables

17. 17 MCI-Framingham Clinics First clinic on 9/25/08 vaccinated 327 inmates Second clinic on 10/23/08 vaccinated 304 inmates –245 received their 2 nd dose –59 received their 1 st dose

18. 18 Results 9 county facilities and DOC are ordering and administering vaccine 12,710 doses have been distributed 8,471 doses have been administered Data according to reports received as of March 15th, 2009

19. 19 Lessons Learned Facility staff were key partners Training for nurses and screeners was essential Interpreters were in high demand Ability to adapt clinic procedures was important Demonstrated need for ongoing EDS training and linking harm reduction concepts to emergency preparedness planning

20. 20 Next Steps Continue providing vaccine to facilities currently ordering vaccine Determine true cost of initiative through a programmatic and financial evaluation Strengthen project sustainability via use of local infrastructure Continue search for infrastructure funding

21. 21 Adult Hepatitis B Vaccination Initiative Funds Awarded to Massachusetts – 2009 grant year Number of Doses Dollar Amount Awarded Hepatitis B3,486 $86,801.40 Combined hepatitis A/B 8,791$339,684.24 Total12,277$426,486.00

22. 22 Adult Hepatitis B Vaccination Initiative 2009 grant year Hepatitis B and combination hepatitis A/B vaccine will be distributed to correctional facilities that demonstrated success in 2008 Vaccine will also be distributed to local boards of health, community health centers and other providers with high-risk clients Distribution will begin in the next several weeks

23. 23 Questions? Please contact: Mary.Conant@state.ma.us Franny.Elson@state.ma.us Thank you!