Prophylaxis

An important method of preventing acquisition of an STD is to protect persons who have been exposed. Antimicrobial therapy is frequently administered to individuals exposed to bacterial infections. Currently, the only effective vaccine available for prevention of an STD is hepatitis B vaccine. Vaccines for herpes simplex virus are in clinical trials, and vaccines for other STDs are in various stages of development (NIH, 1996).

Although an effective vaccine against hepatitis B virus infection has been available for over a decade, the vaccine's impact has been small because the initial vaccination strategy of selective vaccination of persons with identifiable risk factors was not successful (CDC, 1991b). The Advisory Committee on Immunization Practice (ACIP) recommended in 1991 that hepatitis B vaccine become a routine childhood immunization to protect against later exposures in adolescence or adulthood (CDC, 1991b). Immunization of certain adults, including men who have sex with men and heterosexual persons at high risk for STDs, was also recommended. In 1994, the advisory committee further recommended vaccination of all 11-12-year-old children who had not been previously vaccinated as part of a routine adolescent immunization visit (CDC, 1995b). Current data on hepatitis B vaccination coverage of persons in high-risk groups, including sexually active adolescents and men who have sex with men, are limited, but vaccination coverage is considered to be low (CDC, 1996c; Frank Mahoney, CDC, Hepatitis Branch, personal communication, July 1996). In a recent study, only 3 percent of young men who have sex with men in the San Francisco area were adequately vaccinated against hepatitis B virus (CDC, 1996c). Reasons for inadequate vaccination of adolescents and men who have sex with men include lack of awareness among clinicians of groups at high risk for hepatitis B virus infection and lack of clinical opportunities to provide immunization, especially for adolescents (CDC, 1991b).

Hepatitis B vaccination of adolescents has been successfully implemented in school-based clinics, primary care clinics, and other clinical settings (CDC, 1994b; Kollar et al., 1994). Initiatives to administer hepatitis B vaccine to STD clinic patients show that such programs are feasible, although completion of all three vaccine doses is sometimes problematic (Moran et al., 1992; Lafferty et al., 1995). Since 1994, hepatitis B vaccine has been accessible free of charge under the Vaccines for Children program for children less than 19 years of age at high risk for hepatitis B virus infection, including adolescents seen in STD clinics and correctional facilities (CDC, 1994a). To be eligible for the program, children must be enrolled in Medicaid, have no health insurance, be an American Indian/Alaska Native, or have health insurance that does not cover hepatitis B immunization. Outside of limited federal demonstration projects, there are no major programs or public funds to increase vaccination of adults at high risk for sexually transmitted hepatitis B virus infection. Frequency of coverage for adult hepatitis



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