Hepatitis B vaccination practices in state and federal prisons

OBJECTIVE: Incarcerated populations are a group at high risk for hepatitis B. About 30% of people experiencing acute hepatitis B virus infection (HBV) have a history of incarceration. Offering routine HBV vaccinations to incarcerated individuals could have a significant effect on public health. The objective of this study is to identify current vaccine practices and the perceived feasibility of routine vaccinations for hepatitis B within correctional settings. METHOD: The authors surveyed the medical directors of state correctional facilities in all 50 states and the federal prison system regarding current HBV vaccine practices. Surveys were faxed or mailed between July 1 and September 1, 2000. RESULTS: Thirty-five states and the federal system responded (response rate = 70.6%). These systems account for 77% of all inmates in federal or state prisons and jails. Two states give hepatitis B vaccine routinely, nine states offer no hepatitis B vaccine, and 26 states and the Federal Bureau of Prisons offer hepatitis vaccine to some inmates. Most states do not spend enough money to vaccinate even those prisoners at highest risk. Under the Vaccine for Children program, 19,520 youths could receive vaccine immediately. According to the respondents, if vaccine were available at no-cost, 25 states and the Federal Bureau of Prisons would routinely offer vaccination to all inmates. CONCLUSIONS: Most correctional systems do not routinely offer vaccine to their incarcerated populations, but would if funds were available. There exists now a unique public health opportunity to prevent a significant proportion of new hepatitis B infections.     

Hepatitis B vaccination of inmates in correctional facilities--Texas, 2000-2002

In December 2002, approximately 2.2 million persons were incarcerated in the United States; an estimated 8 million were released to the community that year. In 2001, approximately 22,000 acute hepatitis B cases and 78,000 new hepatitis B virus (HBV) infections occurred in the United States (3); an estimated 29% of these cases were in persons who had been incarcerated previously. The majority of HBV infections among incarcerated persons are acquired in the community; however, infection also is transmitted within correctional settings. Hepatitis B vaccination of incarcerated persons is recommended to prevent transmission in correctional facilities and in previously incarcerated persons on their return to the community. In May 2000, the Texas Department of Criminal Justice (TDCJ), which oversees custody of state jail and prison inmates, implemented a hepatitis B vaccination program. To determine hepatitis B vaccination rates of inmates during 2000-2002, TDCJ reviewed charts of inmates released during a 3-day period for documentation of vaccination. This report summarizes the results of that study, which indicated that rates of vaccine acceptance and vaccine series completion among inmates were high. Establishing hepatitis B vaccination programs in prisons and jails can prevent a substantial proportion of HBV infections among adults in the outside community.     

Prevalence and incidence of HIV, hepatitis B virus, and hepatitis C virus infections among males in Rhode Island prisons

OBJECTIVES: We evaluated prevalence and intraprison incidence of HIV, hepatitis B virus, and hepatitis C virus infections among male prison inmates. METHODS: We observed intake prevalence for 4269 sentenced inmates at the Rhode Island Adult Correctional Institute between 1998 and 2000 and incidence among 446 continuously incarcerated inmates (incarcerated for 12 months or more). RESULTS: HIV, hepatitis B virus, and hepatitis C virus prevalences were 1.8%, 20.2%, and 23.1%, respectively. Infections were significantly associated with injection drug use (odds ratio = 10.1, 7.9, and 32.4). Incidence per 100 person-years was 0 for HIV, 2.7 for HBV, and 0.4 for HCV. CONCLUSIONS: High infection prevalence among inmates represents a significant community health issue. General disease prevention efforts must include prevention within correctional facilities. The high observed intraprison incidence of HBV underscores the need to vaccinate prison populations.     

Prisoners' attitudes toward Hepatitis B vaccination

BACKGROUND: Hepatitis B continues to be a substantial problem in the United States despite the existence of a safe and effective vaccine. Vaccination programs for inmates could reach many high-risk individuals but little is known about U.S. inmates' willingness to accept hepatitis B virus (HBV) vaccination while incarcerated. The goal of this study was to assess inmates' knowledge about hepatitis B and their willingness to accept hepatitis B vaccination while incarcerated. METHODS: We interviewed 153 male and female inmates at the Rhode Island Department of Corrections (RIDOC) using a voluntary, anonymous survey. RESULTS: Ninety-three percent of inmates said they would agree to receive the hepatitis B vaccine while incarcerated. More than half of the 30% who reported having risk factors for hepatitis B did not consider themselves to be at risk for hepatitis B and almost half (44%) of all inmates were not aware that hepatitis B can be transmitted through unprotected sex. CONCLUSION: Hepatitis B vaccination programs in correctional settings are a public health priority and would be well received by the target population. Such programs would help protect the health of incarcerated persons and the communities to which they return.     

Health care professional communication about STI vaccines with adolescents and parents

Vaccination of adolescents against sexually transmitted infections (STIs) is an important prevention strategy that may reduce the global burden of disease. The World Health Organization, Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices, and other national health agencies recommend the use of existing STI vaccines, and many countries have incorporated them into their routine vaccination schedule. Despite this, however, data indicate that STI vaccine uptake is suboptimal for a variety of reasons. Health care professionals (HCP) have been shown to have a strong beneficial effect on STI vaccine uptake, yet studies demonstrate that many HCPs fail to discuss or recommend them to adolescent patients. This review article focuses on HCP communication about STI vaccines with adolescents and their parents. It describes STI vaccine message content and delivery as well as the context in which HCPs formulate their messaging approach. It also examines other contextual factors that may shape communication about STI vaccines. Studies from many countries indicate that HCPs often possess misinformation about adolescents, including their sexual risk behaviors, as well as STIs, vaccine safety and efficacy, and STI vaccination recommendations. They also have misconceptions of parental barriers to STI vaccination. These may impact STI vaccine communication and have a negative influence on STI vaccine uptake. These findings highlight the critical need for improved HCP education related to adolescent health, sexuality, and STI vaccination. This may be particularly important in settings without an existing infrastructure or expertise in caring for this unique patient population.     

Consent for Adolescent Vaccination: Issues and Current Practices

ABSTRACT: To identify and describe implementation of state-level informed consent requirements for adolescent immunizations, current state regulations on informed consent and immunization services for children and adolescents were identified through the LEXIS-NEXIS® legal data base. Regulations were coded for informed consent characteristics, consent exemptions, and current immunization requirements. State immunization program directors, project managers, and state hepatitis coordinators were surveyed to catalogue how regulations were implemented and document new policies or regulations under consideration.
Parental consent for immunizations is standard practice in 43 states. Most states (n=34) require separate consent for each injection when more than one injection is required to complete a vaccination, but only for a limited number of medical procedures. Nine states allow adolescents to self-consent for hepatitis B vaccination in sexually transmitted disease clinics and family planning clinics as part of the exemption for minors' receipt of sexual health services.
Most states require consent for vaccination services provided to adolescents. Parental consent requirements are a potential barrier to vaccinating adolescents in some settings.     

Hepatitis B Virus Infection in US Correctional Facilities: A Review of Diagnosis,Management, and Public Health Implications

Among the blood-borne chronic viral infections, hepatitis B virus (HBV) infection is one that is not only treatable but also preventable by provision of vaccination. Despite the availability of HBV vaccine for the last 15 years, more than 1.25 million individuals in the USA have chronic HBV infection, and about 5,000 die each year from HBV-related complications. From a societal perspective, access to treatment of chronic viral infections, like HIV and viral hepatitis, is highly cost-effective and has lasting benefits by reducing risk behaviors, morbidity, mortality, as well as disease transmission in the community. Individuals in correctional facilities are specially predisposed to such chronic viral infections because of their high-risk behaviors. The explosion of incarceration in the USA over the last few decades and the disproportionate burden of morbidity and mortality from chronic infections among the incarcerated have put incredible strains on an overcrowded system that was not originally designed to provide comprehensive medical care for chronic illnesses. Recently, there has been a call to address medical care for individuals with chronic medical conditions in correctional settings, including those with infectious diseases. The economic and public health burden of chronic hepatitis B and its sequelae, including cirrhosis and hepatocellular carcinoma, is felt most prominently in managed care settings with limited budgets, like correctional facilities. Prevalence of HBV infection among the incarcerated in the USA is fivefold that of the general population. We present a review of diagnosis, prevention, and the recently streamlined treatment guidelines for management of HBV infection in correctional settings, and discuss the implications and public health impact of these measures.     

Effective strategies for HPV vaccine delivery: the views of pediatricians.

PURPOSE: Pediatricians will play a critical role in human papillomavirus (HPV) vaccine delivery. The objectives of this research were to examine pediatricians' views about key issues related to HPV vaccine delivery and identify their strategies for effective vaccine delivery. METHODS: A diverse sample of practicing pediatricians was recruited from a three-state region using a purposeful sampling strategy. Participants completed in-depth, semi-structured interviews. Qualitative data were analyzed using framework analysis. RESULTS: The mean age of the 31 participants was 47 years (range 30-78 years), and 17 (55%) were female. In all, 18 were white, nine (29%) black, and four (13%) Latino. Participants noted that cultural issues, including a family's religious and ethnic background, were important considerations when recommending an HPV vaccine. Almost all participants believed that vaccination should be universal rather than targeted, but opinions regarding legislative mandates for vaccination varied. Those in favor of mandates cited their potential to maximize the public health impact of immunization, while those opposed noted that HPV is not transmitted casually and were concerned about limited data on the long-term safety and efficacy of HPV vaccines. Pediatricians noted that specific strategies for effective vaccine delivery would be needed for an STI vaccine targeted toward adolescents, especially considering the poor public understanding of HPV. These included provision of HPV vaccines in alternative settings, guidance for pediatricians as to how to address parental concerns, and specific educational initiatives. CONCLUSIONS: The views of pediatricians, who have extensive experience administering vaccines to children and adolescents, will be valuable as HPV vaccine delivery strategies are designed.     

Prevention and control of infections with hepatitis viruses in correctional settings. Centers for Disease Control and Prevention.

This report consolidates previous recommendations and adds new ones for preventing and controlling infections with hepatitis viruses in correctional settings. These recommendations provide guidelines for juvenile and adult correctional systems regarding 1) identification and investigation of acute viral hepatitis; 2) preexposure and postexposure immunization for hepatitis A and hepatitis B; 3) prevention of hepatitis C virus infection and its consequences; 4) health education; and 5) release planning. Implementation of these recommendations can reduce transmission of infections with hepatitis viruses among adults at risk in both correctional facilities and the outside community. These recommendations were developed after consultation with other federal agencies and specialists in the fields of corrections, correctional health care, and public health at a meeting in Atlanta, March 5-7, 2001. This report can serve as a resource for those involved in planning and implementing health-care programs for incarcerated persons.     

Assessment of the hepatitis B birth dose vaccination program,Papua New Guinea, 2014

IntroductionPapua New Guinea (PNG) implemented hepatitis B birth dose (BD) vaccination in 2005 yet since that time coverage has remained low, allowing mother-to-child transmission to occur. We conducted a field assessment of the BD vaccination program to develop strategies for improving the BD coverage.MethodsWe selected five provinces with higher hepatitis B prevalence and five with lower prevalence based on the results of a 2013 hepatitis B serological survey. Within each province, we interviewed district and provincial health officers, health workers, village volunteers, and caregivers from ten randomly selected health facilities. Data were collected on knowledge, practice, vaccine management and data recording/reporting. To identify enabling factors and barriers, we compared health facilities with higher BD coverage with those with lower coverage, and compared caregivers whose children received BD with those whose children did not.ResultsOverall timely BD coverage was 31% and BD vaccination was taking place in 81% of sampled health facilities. Lack of cold chain and vaccine were the major reasons for not providing the BD. Insufficiencies in supervision, vaccine management, community outreach, and data management were identified as obstacles to achieving high timely hepatitis B BD coverage. Good supervision, knowledge of hepatitis B and hepatitis B vaccination, antenatal care including information about the hepatitis B BD, provision of vaccine refrigerators in maternity wards, and outreach vaccination for home deliveries were associated with higher timely BD coverage.DiscussionSeveral steps will likely be effective in improving BD coverage: strengthening training and supervision among health workers and officers, educating caregivers on the benefits of the BD and delivery in health facilities, improving vaccine management, and improving data quality. Considerable effort and leadership will be needed to achieve these steps.     

Limited awareness of vaccines recommended for adolescents and other results from two national consumer health surveys in the United States

PurposeThis study describes the vaccine-related knowledge and attitudes of adolescents aged 11–18 years and parents of adolescents aged 11–18 years.MethodsWe analyzed the 2007 HealthStyles and YouthStyles surveys related to vaccine knowledge and attitudes of parents (n = 1,208) and adolescents (n = 1,087).ResultsIn all, 21% of parents and 11% of adolescents correctly identified the three vaccines recommended at the time of the survey for adolescents. Regarding the hypothetical scenario that minor adolescents should be allowed to consent to vaccination without parental knowledge, 70% of parents and 72% of adolescents disagreed. The majority of parents and adolescents recognized the importance of vaccines in protecting an adolescent's health yet a substantial minority of both groups also reported concerns about vaccine safety.ConclusionsMany parents and adolescents surveyed were not aware of all vaccine recommendations for adolescents and did not support adolescents receiving vaccinations independent of parental knowledge and/or consent.     

预防接种知情告知专家共识（上）

《中华人民共和国疫苗管理法》和其他相关法律法规对受种者或其监护人的疫苗和预防接种工作知情提出了要求,对预防接种告知方式和内容作出了规定。本共识以该法和《预防接种工作规范》为基础,借鉴国内外经验,阐述了预防接种知情告知的发展和形式,制定了预防接种知情告知理论框架、标准流程和信息、非免疫规划疫苗知情告知原则以及各疫苗知情同...     

预防接种知情告知专家共识(上)

《中华人民共和国疫苗管理法》和其他相关法律法规对受种者或其监护人的疫苗和预防接种工作知情提出了要求,对预防接种告知方式和内容作出了规定。本共识以该法和《预防接种工作规范》为基础,借鉴国内外经验,阐述了预防接种知情告知的发展和形式,制定了预防接种知情告知理论框架、标准流程和信息、非免疫规划疫苗知情告知原则以及各疫苗知情同意书格式,为疾病控制和预防保健人员在预防接种服务中参考。本部分共识包括总则以及乙型肝炎疫苗、卡介苗、含脊髓灰质炎成分疫苗、含百日咳/白喉/破伤风成分疫苗、含麻疹/风疹/流行性腮腺炎成分疫苗、乙型脑炎疫苗、脑膜炎球菌疫苗、甲型肝炎疫苗预防接种知情告知内容。     

Factors influencing HPV vaccination status in a Latino population; and parental attitudes towards vaccine mandates

We performed a retrospective cohort study in a largely Latino population in Los Angeles, surveying 95 parents of 11–17 year old girls between May and June 2008 to examine factors associated with [1] parental consent for Human Papillomavirus (HPV) immunization one year after vaccine implementation and [2] parental support of an HPV vaccine mandate for adolescents prior to middle school entry. 73% of participants had heard of the HPV vaccine and 37% of daughters had already received the vaccine. Variables associated with vaccination included Latino ethnicity, the belief that vaccines are safe, and that HPV vaccine prevents cervical cancer. The most frequent reasons for refusing vaccination included parental request for more information and missed opportunities in clinic. Variables associated with parents agreeing with a law mandating HPV vaccination included: belief in vaccine safety, recent maternal Pap Smear, HPV vaccination of participant's daughter prior to survey, and Latino ethnicity. Our survey supports the work of previous studies recommending continued educational campaigns emphasizing the safety of HPV vaccine, and its efficacy in reducing cervical cancer.     

Universal hepatitis B vaccination: hospital factors influencing first-dose uptake for neonates in Darwin

Abstract: A universal neonatal hepatitis B vaccination program was introduced in the Northern Territory in 1990. We compared live births with vaccine usage to determine the uptake of the first dose of hepatitis B vaccine under this new policy and to identify hospital factors that influenced this rate. Attitudes and vaccine administration practices were determined through interviews, using standard questions with midwifery and paediatric nursing staff at both hospitals. Hepatitis B vaccines dispensed at Hospital A indicated a 96 per cent coverage of neonates in 1993 and 93 per cent in 1994. Vaccination at Hospital B indicated 71 per cent coverage in 1993 and 77 per cent in 1994. Differences in vaccine uptake appeared to be influenced by the use of standing drug orders, the nursing staff's attitudes and knowledge, and misinformation among health professionals. Education programs for health professionals and parents need to be established before the introduction of a universal hepatitis B vaccination policy for it to be well accepted. Standing orders for hepatitis B vaccine in postnatal wards allow nursing staff to promote it and thus maximise coverage rates     

Vaccination coverage among children entering school--United States, 2005-06 school year

One of the national health objectives for 2010 is to achieve and sustain > or =95% vaccination coverage among children in kindergarten through first grade for the following vaccines: hepatitis B vaccine; diphtheria and tetanus toxoids and pertussis vaccine, diphtheria and tetanus toxoids and acellular pertussis vaccine, or diphtheria and tetanus toxoids vaccine (DTP/DTaP/DT); poliovirus (polio) vaccine; measles, mumps, and rubella vaccines; and varicella vaccine. To determine vaccination coverage among children entering kindergarten, data were analyzed from reports submitted to CDC by states and the District of Columbia (DC) for the 2005-06 school year. This report summarizes the results of that analysis, which indicated that coverage for each vaccine was reported to have exceeded 95% in more than half of the states.     

The Impact of State Policies on Vaccine Coverage by Age 13 in an Insured Population

PurposeTo determine the impact of state policies on vaccine coverage among adolescents with managed care insurance.MethodsWe used the 2003 Health Plan Employer Data and Information Set to determine state-specific hepatitis B and varicella vaccine coverage among children with managed care insurance who turned 13 years in 2002. Our outcomes of interest were receipt of hepatitis B and varicella vaccines by age 13. Utilizing weighted least-squares methods, multiple linear regression models were developed to evaluate the relationship between hepatitis B and varicella vaccine coverage and state policies, while controlling for state sociodemographic variables.ResultsAcross 28 states, adolescent hepatitis B vaccine coverage ranged from 35.3% to 80.5% (mean = 55.3%) and varicella vaccine coverage ranged from 22.9% to 7.6% (mean = 42.3%). In separate multiple regression models, after adjusting for potentially confounding sociodemographic variables, middle school mandates were significantly associated with hepatitis B vaccine coverage (p = .002) and varicella vaccine coverage (p = .024). Other policies, including universal purchase of vaccines and availability of philosophic exemptions, were not associated with vaccine coverage in this insured population.ConclusionsIn this population of insured adolescents, middle school vaccine mandates were the only state policy associated with improved hepatitis B and varicella vaccine coverage. Mandates are an effective method for promoting adolescent immunization.     

Parental vaccine safety concerns: results from the National Immunization Survey, 2001-2002

BACKGROUND: According to the 2002 National Immunization Survey (NIS), vaccination coverage with recommended vaccines among U.S. children aged 19 to 35 months remained near all-time highs. Sustaining this high coverage requires significant effort, including consideration of parental vaccine safety concerns that have led to decreasing coverage in other countries. METHODS: The Parental Knowledge and Experiences module was administered to a random subset of NIS respondents from July 2001 to December 2002. The module included questions regarding attitudes toward vaccine safety and side effects, simultaneous vaccine administration, and acceptance of new vaccines. Multivariate logistic regression analyses examined associations between attitudes and up-to-date (UTD) vaccination coverage (four or more doses of diphtheria and tetanus toxoids and pertussis vaccine, three or more doses of poliovirus vaccine, one or more doses of any measles-containing vaccine, three or more doses of Haemophilus influenzae type b vaccine, and three or more doses of hepatitis B vaccine), while controlling for demographics. RESULTS: Ninety-three percent of parents rated vaccines as safe, 6% as neither safe nor unsafe, and 1% as unsafe. After adjusting for demographics, parental safety belief was significantly associated with the child's vaccination status. For children whose parents believed vaccines are safe, the odds of being UTD were 2.9 times the odds of being UTD for children of parents who believed vaccines are unsafe (75% vs 53%, respectively). Children whose parents were neutral about the safety of vaccines had vaccination coverage similar to children whose parents believed vaccines are unsafe. CONCLUSIONS: A significant association with vaccine coverage was found for a small group of parents with high vaccine safety concerns. Strategies focused on safety concerns may yield better protection for these children.     

Immunization of Adolescents: Recommendations of the Advisory Committee on Immunization Practices, the Amerii Academy of Pediatrics, the American Academy of Family Physicians, and the American Medical Association

SUMMARY: This report concerning the immunization of adolescents (ie, persons 11–21 years of age, as defined by the American Medical Association [AMA] and the American Academy of Pediatrics [AAP]) is a supplement to previous publications (ie, MMWR 1994;43[No. RR-1] 1–38; the AAP 1994 Red Book: Report of the Committee on Infectious Diseases; Summary of Policy Recommendations for Periodic Health Examination, August 1996 from the American Academy of Family Physicians [AAFP]; and AMA Guidelines for Adolescent Preventive Services [GAPS]: Recommendations and Rationale). This report presents a new strategy to improve the delivery of vaccination services to adolescents and to integrate recommendations for vaccination with other preventive services provided to adolescents. This new strategy emphasizes vaccination of adolescents 11–12 years of age by establishing a routine visit to their health-care providers. Specifically, the purposes of this visit are to a) vaccinate adolescents who have not been previously vaccinated with varicella virus vaccine, hepatitis B vaccine, or the second dose of the measles, mumps, and rubella (MMR) vaccine; b) provide a booster dose of tetanus and diphtheria toxoids; c) administer other vaccines that may be recommended for certain adolescents; and d) provide other recommended preventive services. The recommendations for vaccination of adolescents are based on new or current information for each vaccine. The most recent recommendations from AC1P, AAP, AAFP, and AMA concerning specific vaccines and delivery of preventive services should be consulted for details.     

Influenza vaccination in long-term-care facilities: structuring programs for success.

OBJECTIVES: To determine which influenza vaccination program characteristics were associated with high resident vaccination rates in Canadian long-term-care facilities (LTCFs). DESIGN: A cross-sectional survey consisting of a mailed questionnaire conducted in spring 1991. PARTICIPANTS: All 1,520 Canadian LTCFs for the elderly with at least 25 beds. RESULTS: The mean overall influenza vaccination rate in the 1,270 (84%) responding facilities was 79%. In multivariate analysis, the variables significantly associated with increased vaccination rates were: a single nonphysician staff person organizing the program, having more program aspects covered by written policies, the offering of vaccine to all residents, a policy of obtaining consent on admission that was durable for future years rather than repeating consent annually, and automatically administering vaccine to residents whose guardians could not be contacted for consent. Any encouragement to staff to be vaccinated had a significant impact on staff vaccination rates. CONCLUSION: Well-organized influenza vaccination programs increase the influenza vaccination rates of residents in Canadian LTCFs. Facilities need to develop resident vaccination programs further and to focus on vaccinating staff.