Hepatitis and Liver Cancer A National Strategy for Prevention and Control of Hepatitis B and C (2010) / Chapter Skim
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4 Immunization
4 Immunization
Pages 109-146
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From page 109... ...
It also summarizes what is known about hepatitis B vaccination rates in specific populations (for example, infants, children, and adults, including subgroups of at-risk adults, such as incarcerated people and occupationally exposed people)
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From page 110... ...
It is also used after liver transplantation for end-stage hepatitis B to prevent recurrence of the disease in the transplanted liver. Current vaccination Recommendations, Requirements, and Rates The Advisory Committee on Immunization Practices (ACIP)
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Data from National Immunization Surveys demonstrate that national newborn hepatitis B vaccination coverage did not change appreciably after implementation of the 2005 ACIP hepatitis B vaccination recommendation (CDC, 2009b)
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from the 2007 National Immunization Survey, which were collected after implementation of the 2005 ACIP recommendation, CDC estimates that the national newborn hepatitis B vaccine coverage was 46% at the age of 1 day (CDC, 2009b)
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tis B vaccine are being missed or delayed, which the committee believes is due to the lack of a delivery-room policy for hepatitis B vaccination. Missing or delaying the birth dose for infants born to HBsAg-positive women substantially increases the risk that they will develop chronic hepatitis B
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eOn a case-by-case basis and only in rare circumstances, first dose may be delayed until after hospital discharge for an infant who weighs ≤2,000 g and whose mother is HbsAg-negative, but only if physician's order to withhold birth dose and copy of mother's original HBsAgnegative laboratory report are documented in infant's medical record. Abbreviations: HBsAg, hepatitis B surface antigen; ACIP, Advisory Committee on Immuniza Immunization Practices; HBIG, hepatitis B immune globulin.
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From page 115... ...
Test mother for HBsAg Continue vaccine series beginning at age of 1–2 months according to recommended schedule based on mother's HBsAg result (see Table 4-1) Do not count birth dose as part of vaccine series Negative Delay first dose of hepatitis B vaccine until age of 1 month or hospital discharge Complete vaccine series (see Table 4-1)
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. Studies have found racial and ethnic disparities in childhood vaccination rates: Asian and Pacific Islander (API)
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. Other studies also have found that school-entry mandates are effective in increasing hepatitis B vaccination rates (CDC, 2001b; Koff, 2000; Olshen et al., 2007; Zimet et al., 2008)
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. Figure 4-1 shows estimated cost effectiveness of hepatitis B vaccination for different age groups and different incidences of acute hepatitis B
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. However, declining hepatitis B vaccination rates were reported in a study of six STD clinics in the United States (Harris et al., 2007)
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. In an anonymous HIV-testing program in Madison, WI, 86% of patients were considered to be at high risk for HBV infection; 51% of the 86% initiated hepatitis B vaccination, and 80% who initiated vaccination completed the vaccine series (Savage et al., 2000)
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From page 121... ...
It is important to have a health-record system that tracks immunizations so that the vaccine series can be continued if later incarcerations occur. Ideally, immunizations administered in jails will be captured in an adult immunization registry (see discussion on immunization-information systems below)
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HEPATITIS AND LIVER CANCER TABLE 4-4 Studies of Hepatitis B Vaccination Rates in Injection-Drug Users Reference Location Sample; Design Cross-sectional studies of vaccination rates Seal et al., 2000 San Francisco, CA 135 under 30 years old, 96 at least 30 years old Cross-sectional Lum et al., 2008 San Francisco, CA 831 young IDUs Cross-sectional Kuo et al., 2004 Baltimore, MD 324 IDUs, NIDUs Cross-sectional Additional vaccination studies Campbell et al., 2007 5 US cities 3,181 Cohort; vaccination protocol varied by city Altice et al., 2005 New Haven, CT; mobile 134 HBV-negative IDUs health van at SEP Observational Des Jarlais et al., 2001 Anchorage, AK; AK cohort referred to clinic New York City (350) ; New York City cohort offered on-site vaccination at SEP (36)
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IMMUNIZATION Percentage Previously Percentage Ever Offered Percentage Completed vaccinated vaccination vaccination Series 25% under 30 years old, 13% at least 30 years old 22%; 18% among HCV positive 10% IDUs; 14% NIDUs Vaccination highest where available on site (83% had at least one dose) ; incentives did not affect vaccination rates 3% 94% had one dose; 77% had two doses; 66% had three doses 30/36 (83%)
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. Identifying At-Risk Adults As discussed above, recommendations regarding childhood hepatitis B vaccination are aimed at achieving universal coverage, and recommendations regarding adult vaccination focus on the identification of risk populations for targeted immunization efforts.
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. Recommendation In 2007, there were more than 40,000 new acute HBV infections in adults (Daniels et al., 2009)
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. President Clinton established the national Childhood Immunization Initiative by directing the secretary of health and human services to work with states to build "an integrated immunization registry system." That initiative led to the Initiative on Immunization Registries, which was spearheaded by the NVAC with support from CDC's National Immunization Program and the Department of Health and Human Services National Vaccine Program Office (Bartlett et al., 2007)
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From page 127... ...
.One recommendation was that CDC and the Health Resources and Services Administration (HRSA) devote resources to the inclusion of adult immunization records in all grantee IISs, and another was that all grantees be required to implement adult immunization activities and adopt ACIP recommendations for routine adult immunization.
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From page 128... ...
. Studies in children involving various vaccine series, including hepatitis B vaccine, and in adults transitioning to Medicare have shown notable increases in vaccination rates in those with insurance coverage (IOM, 2009)
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Unlike the VFC program, Section 317 provides federal funds for both vaccine purchase and vaccine-related infrastructure, such as population needs assessments, surveillance, compliance monitoring, training, and schoolbased delivery systems. The program targets immunization coverage for underinsured children and youths not eligible for the VFC program and to a small degree uninsured and underinsured adults.
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Abbreviations: EPSDT, Early Periodic Screening, Diagnosis, and Treatment program; FEHBP, Federal Employees Health Benefits Program; VFC, Vaccines for Children; CHIP, Children's Health Insurance Program.
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whose income is too high for Medicaid, too low for private insurance
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. Private Insurance Plans Employers provide over 66% of all health insurance for 177 million Americans under the age of 65 years (U.S.
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Abbreviations: PPO, preferred provider organization; POS, point of service; HMO, health maintenance organization; HDHP, high-deductible health plan. SOURCES: HIAA, 1988; Kaiser Family Foundation and HRET, 2008; KPMG, 1996.
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Families of non-Medicaid VFC-covered children may be responsible for the administration portion of the vaccination cost. Private health insurance has gaps for vaccination coverage because it does not universally cover all ACIP-recommended vaccinations for children and adults.
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Private and public insurance coverage for hepa titis B vaccination should be expanded. • Public Health Section 317 should be expanded with sufficient fund ing to become the public safety net for underinsured and uninsured adults to receive the hepatitis B vaccination.
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Feasibility of Preventing Chronic Hepatitis C The outcomes of HCV infections in humans and chimpanzees suggest that it may be possible to develop a vaccine to prevent HCV infection. Spontaneous clearance of the virus in 15–45% of persons after acute HCV infection demonstrates that immunity can prevent chronic infection and its long-term consequences, such as cirrhosis and hepatocellular carcinoma (HCC)
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It may not be possible to produce a vaccine that prevents HCV infection, but a product that prevents acute HCV infections from becoming chronic would probably achieve many of the same benefits. In cases where acute HCV infection does not resolve within a few months, early treatment can prevent most cases from evolving into chronic HCV infection.
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Studies to develop a vaccine to prevent chronic hepatitis C virus infection should continue. REFERENCES ACIP (Advisory Committee on Immunization Practices)
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2009b. Hepatitis B vaccine birth dose rates, national immunization survey.
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2005. Immunization coverage among Hispanic ancestry, 2003 national immunization survey.
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2009. National Vaccine Advisory Committee recommendations for federal adult immunization programs regarding im munization delivery, assessment, research, and safety monitoring.
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2008. Hepatitis B virus infection and immunization status in a new generation of injection drug users in San Francisco.
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2008. Effect of a school-entry vaccination require ment on racial and ethnic disparities in hepatitis B immunization coverage levels among public school students.
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2006b. Associations between childhood vacci nation coverage, insurance type, and breaks in health insurance coverage.
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Morbidity and Mortality Weekly Report 55(RR-11)
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