Morbidity and Mortality Weekly Report Weekly / Vol. 59 / No. 17 May 7, 2010 The Adult Hepatitis Vaccine Project — Hepatitis Awareness Month — California, 2007–2008 May 2010 Since hepatitis B vaccine was first released in 1981, a public May 2010 marks the 15th anniversary of Hepatitis health goal has been to vaccinate adults at risk for infection Awareness Month in the United States, and May 19 is because of risky sexual behaviors and needle-sharing prac- World Hepatitis Day. Globally, viral hepatitis is the cause tices (1,2). However, vaccination coverage for this group has of most (78%) primary liver cancer, the third leading remained low (3). During 2007, in the United States, among cause of cancer deaths in the world (1). Prevention of the estimated 43,000 persons newly infected with hepatitis B hepatitis B and hepatitis C virus transmission and treat- virus (HBV), the highest rate was reported among persons aged ment for early disease can prevent primary liver cancer 25–44 years, and the majority of these infections were among (2). This issue of MMWR includes a report describing at-risk adults (1). Surveillance data were similar in California vaccination of at-risk adults with hepatitis B vaccine in (4). In 2006, when the Advisory Committee on Immunization California and a report on continued increases in hepa- Practices (ACIP) recommended that hepatitis B vaccination be tocellular carcinoma incidence in the United States. offered to all adults as part of routine prevention services in set- The Institute of Medicine (IOM) recently issued tings where a high proportion of those served are at increased Hepatitis and Liver Cancer: A National Strategy for risk (2,5), CDC launched a national initiative encouraging Prevention and Control of Hepatitis B and Hepatitis C. states to use existing federal funds to purchase adult hepatitis The IOM strategy has four components: 1) accurate B–containing (HepB) vaccine. In response, the California public health surveillance, 2) innovative approaches to Department of Public Health (CDPH) established the Adult community education, 3) immunization capacity to Hepatitis Vaccine Project (AHVP) to expand hepatitis B vac- eliminate hepatitis B virus transmission, and 4) devel- cination in sites serving at-risk adults. This report summarizes opment of viral hepatitis services, including screening results for 2007–2008, which indicated that 28,824 doses of with referral for medical management. Taken together, HepB vaccine were administered at 29 participating sites in these strategies can reduce morbidity associated with the first 19 months of AHVP; 13 sites administered HepB viral hepatitis, including primary liver cancer. vaccine for the first time. Federal provision of vaccine resulted Additional information about viral hepatitis is avail- in vaccination of many adults who otherwise might not have able at http://www.cdc.gov/hepatitis. The IOM report been vaccinated against HBV. Increased capacity to vaccinate all is available at http://www.iom.edu. Information about World Hepatitis Day activities is available at http://www. nvhr.org/WHD-2009.htm. INSIDE References 1. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. 517 Hepatocellular Carcinoma — United States, 2001–2006 CA Cancer J Clin 2005;55:74–108. 521 Rotavirus Vaccination Coverage Among Infants Aged 2. Cardoso AC, Moucari R, Figueiredo-Mendes C, et al. Impact of 5 Months — Immunization Information System peginterferon and ribavirin therapy on hepatocellular carcinoma: incidence and survival in hepatitis C patients with advanced Sentinel Sites, United States, June 2006–June 2009 fibrosis. J Hepatol 2010;52:652–7. 525 Announcements 527 QuickStats U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention www.cdc.gov/mmwr MMWR Morbidity and Mortality Weekly Report adults at risk is needed for the elimination of HBV purchase of adult HepB vaccine; phase II (November transmission in the United States. 2007–December 2008) was implemented when addi- In October 2006, CDC encouraged state and local tional federal funds were made available by CDC to immunization programs to use portions of federally California and other states to purchase HepB vaccine appropriated vaccine funds to offer or expand adult for settings serving at-risk adults. hepatitis B vaccination in selected health-care sites AHVP asked participating sites to collect data on that reach adults at increased risk for HBV infec- the number of vaccine doses administered during both tion. One year later, in October 2007, CDC made phases of the project. In addition, AHVP requested available $20 million of federal funds* for the pur- demographic information (age, sex, race, and ethnic- chase of adult HepB vaccine. As part of this national ity) for each person who received vaccine, as well as initiative, the California AHVP was established. The which dose of the 3-dose series was administered. For AHVP selected sites for participation based on 1) this report, the monthly average number of adults who type of setting serving at-risk adults, in accordance received vaccine was calculated by whether vaccine with ACIP recommendations, 2) a feasible plan to services were provided by the site (none versus some integrate immunization services into other activities, services) and by funding phase. Data were analyzed 3) ability to properly handle and administer vaccine, by demographic characteristics and by type of site for including local licensed staff and storage capabil- all adults who received a first dose. Because no data ity, 4) ability and willingness to document vaccine on the number of vaccine-eligible adults at each site administration, and 5) availability of local funds to were available routinely, coverage rates could not be pay for syringes, needles, and other vaccine supplies. calculated. Phase I (June–October 2007) of AHVP began when A total of 29 sites were enrolled in the California CDPH used funds from the CDC initiative for AHVP during June 2007–December 2008, including 11 sexually transmitted disease (STD) clinics, four * 42 USC § 274b (project grants for preventive services). correctional facilities, four community health centers, The MMWR series of publications is published by the Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30333. Suggested citation: Centers for Disease Control and Prevention. [Article title]. MMWR 2010;59:[inclusive page numbers]. Centers for Disease Control and Prevention Thomas R. Frieden, MD, MPH, Director Peter A. Briss, MD, MPH, Acting Associate Director for Science James W. Stephens, PhD, Office of the Associate Director for Science Stephen B. Thacker, MD, MSc, Deputy Director for Surveillance, Epidemiology, and Laboratory Services MMWR Editorial and Production Staff Frederic E. Shaw, MD, JD, Editor, MMWR Series Christine G. Casey, MD, Deputy Editor, MMWR Series Martha F. Boyd, Lead Visual Information Specialist Robert A. Gunn, MD, MPH, Associate Editor, MMWR Series Malbea A. LaPete, Stephen R. Spriggs, Terraye M. Starr Teresa F. Rutledge, Managing Editor, MMWR Series Visual Information Specialists Douglas W. Weatherwax, Lead Technical Writer-Editor Quang M. Doan, MBA, Phyllis H. King Information Technology Specialists Donald G. Meadows, MA, Jude C. Rutledge, Writer-Editors MMWR Editorial Board William L. Roper, MD, MPH, Chapel Hill, NC, Chairman Virginia A. Caine, MD, Indianapolis, IN Patricia Quinlisk, MD, MPH, Des Moines, IA Jonathan E. Fielding, MD, MPH, MBA, Los Angeles, CA Patrick L. Remington, MD, MPH, Madison, WI David W. Fleming, MD, Seattle, WA Barbara K. Rimer, DrPH, Chapel Hill, NC William E. Halperin, MD, DrPH, MPH, Newark, NJ John V. Rullan, MD, MPH, San Juan, PR King K. Holmes, MD, PhD, Seattle, WA William Schaffner, MD, Nashville, TN Deborah Holtzman, PhD, Atlanta, GA Anne Schuchat, MD, Atlanta, GA John K. Iglehart, Bethesda, MD Dixie E. Snider, MD, MPH, Atlanta, GA Dennis G. Maki, MD, Madison, WI John W. Ward, MD, Atlanta, GA 514 MMWR / May 7, 2010 / Vol. 59 / No. 17 MMWR Morbidity and Mortality Weekly Report four substance abuse treatment programs, four syringe TABLE. Number and percentage of first doses of hepatitis B vaccine administered, by selected characteristics of vaccinees exchange programs, and two HIV counseling, testing, and type of setting — California Adult Hepatitis Vaccine and treatment sites. Of the 28,824 doses of HepB Project, June 2007–December 2008 vaccine administered during the 19–month period Characteristic No. (%) (60% of the 47,795 doses purchased by California), Overall 15,865 (100)* 15,865 were first (55%), 8,488 second (29%), and Sex 4,165 (14%) third doses (the remainder were fourth Male 11,366 (72) doses or had missing series data). Twelve sites serving Female 4,239 (27) at-risk adults among the agencies and organizations Transgender 186 (1) Missing or unknown 74 (1) were selected for participation in phase I; an additional Age group (yrs) 17 smaller sites were added in phase II. On average, 10–18 147 (1) 1,123 doses of HepB vaccine were administered each 19–24 2,406 (15) month at the initial 12 sites in phase I, increasing to 25–34 5,348 (34) 35–44 4,009 (25) 1,285 doses per month in phase II (a 14% increase). ≥45 3,611 (23) Among sites with no previous vaccination services, Missing or unknown 344 (2) the monthly average number of HepB vaccine doses Race/Ethnicity administered increased from 809 doses in phase I to White, non-Hispanic 4,989 (31) Black, non-Hispanic 1,918 (12) 842 doses in phase II; among sites where some vac- Hispanic 6,963 (44) cination services were offered, the average number of Asian 1,164 (7) doses increased from 314 to 443. The 17 new sites in Other/Missing or unknown 831 (5) phase II delivered a monthly average of 367 doses of Type of setting (no. of organizations) STD† clinics (11) 9,990 (63) vaccine.