Characteristics of persons with chronic hepatitis B--San Francisco, California, 2006

Chronic hepatitis B is the most common cause of cirrhosis and liver cancer worldwide. Approximately 45% of the world's population lives in regions where chronic hepatitis B virus (HBV) infection is endemic, including most of Asia and the Pacific Islands, Africa, and the Middle East. Nearly one fourth of the population of San Francisco was born in Asia and the Pacific Islands. In 2006, the San Francisco Department of Public Health (SFDPH) received reports consistent with probable chronic HBV infection for 2,238 persons. To characterize persons with reported confirmed chronic HBV infection in San Francisco in 2006, SFDPH collected additional data on a subset of 567 cases reported to the SFDPH chronic hepatitis B registry. Eighty-four percent of the persons were Asians/Pacific Islanders (A/PIs), 80% of whom were foreign born. Fewer than half had been referred to a gastroenterologist/hepatologist for evaluation at the time of reporting. Persons with chronic HBV infection can benefit from medical care by providers with expertise in viral hepatitis. In addition, close contacts of infected persons should be screened and offered vaccination if found to be susceptible to HBV infection. Culturally appropriate counseling for and follow-up of persons with chronic HBV infection and their contacts could help reduce the transmission of HBV infection.     

Preventing hepatitis B in people in close contact with hepatocellular carcinoma patients.

OBJECTIVE: To determine the prevalence of testing for hepatitis B virus (HBV) infection in the clinical management of primary liver cancer (hepatocellular carcinoma). METHODS: The authors reviewed the records of 78 patients treated for hepatocellular carcinoma in hospitals in the Puget Sound area in 1988 and early 1989 and reviewed all 1990 U.S. death certificates on which primary liver cancer was listed. RESULTS: The records of 50 (64%) of 78 hepatocellular carcinoma patients contained no evidence that the patient''s hepatitis B surface antigen (HBsAg) status had been determined. In addition, of 4353 people who died in 1990 for whom the diagnosis of primary liver cancer was listed on the death certificate, HBV infection was also listed for only 136 (3%), much less than expected based on case series. CONCLUSIONS: Many patients with hepatocellular carcinoma are not tested for HBV infection, suggesting that their close contacts are also not evaluated for HBV infection and the need for vaccination. Hepatitis B vaccination of close personal contacts of HBV-infected hepatocellular carcinoma patients is an important strategy for preventing HBV transmission.     

蓬莱市农村人群乙肝疫苗接种和乙肝病毒感染相关性

目的分析评价乙肝疫苗免疫接种对蓬莱市农村居民乙肝病毒(HBV)感染变化的影响。方法采用多阶段整群抽样方法,对蓬莱市农村1～59岁常住人口共629人进行乙肝血清流行病学调查和乙肝疫苗接种率调查,采用ELISA法检测HB-sAg、抗-HBs、抗-HBc等乙肝标志物。结果 629名调查对象HBV感染率为22.26%,HBsAg、抗-HBs、抗-HBc阳性率分别为2.70%、62.32%、18.44%。乙肝疫苗接种率由1992年以前出生人群的18.89%提高到2002-2006年出生人群的100.00%,HBV感染率由42.11%降为1.31%;有乙肝免疫史的人群HBV感染率和HBsAg、抗-HBc阳性率均低于无乙肝疫苗免疫史人群,抗-HBs阳性率明显高于无乙肝疫苗免疫史人群,乙肝疫苗保护率为85.63%。结论从1992年使用乙肝疫苗以来,不仅有效的减少了乙肝病毒携带状态,且乙肝疫苗保护率达到较好的效果,进一步说明接种乙肝疫苗可有效防止乙肝病毒的感染。     

Developing an evidence‐based guideline for the management of exposure to hepatitis B at a Victorian tertiary hospital

Objective: To develop a guideline for the management of potential exposures to hepatitis B virus (HBV) at The Alfred Hospital, based on results of clinical audit, database analysis and literature review. Methods: i) Retrospective record review of all histories of patients who received HBV immunoglobulin (HBIG) at The Alfred between 1/1/2007 and 30/9/2011. ii) Analysis of HBV serological results of men who have sex with men (MSM) on Victorian NPEP Service (VNPEPS) database between 10/8/2005 and 31/12/2011. iii) Literature review to determine risks of HBV transmission and best practice for prevention of HBV transmission. Results: A total of 48 patients were potentially exposed to HBV and given HBIG, with sexual exposure the most common indication (n=20). The source was reported to be HBsAg positive in one case only. Of the MSM on the VNPEPS database, 63% were immune to HBV, and only 0.5% of patients tested had evidence of chronic HBV infection. The recommendations for use of HBIG in The Australian Immunisation Guidelines are ambiguous and differ from other international guidelines. Conclusion: This audit at a tertiary referral hospital identified problems with the management of those potentially exposed to HBV. In those non‐immune patients exposed to HBV, the combination of HBIG plus vaccination provides the best protection against infection. The risk of transmission of HBV is highly variable; rates of chronic HBV in PWID and MSM in Australia are low and do not warrant use of HBIG unless the source is known to be HBsAg positive.     

慢性HBV感染患者血清自身抗体的检测与临床意义

目的：检测慢性HBV感染患者血清自身抗体,探讨其临床意义。方法：收集2009年4月-2011年3月贵阳医学院附属医院感染科住院部慢性HBV感染患者190例,其中45例慢性乙型肝炎（CHB）,18例慢性重型肝炎（CLF）,102例乙肝后肝硬化（LC）,25例原发性肝癌（HCC）,以30例健康体检者为正常对照组。采用间接免疫荧光法、免疫印迹法、速率散射比浊法分别检测血清ANA、ENA谱、RF。时间分辨荧光免疫分析法检测乙肝病毒标志物（HBV-M）,荧光定量PCR法检测HBVDNA,并常规测定ALT、AST、TBIL、ALB。结果：慢性HBV感染者自身抗体的总检出率32.1%明显高于正常对照组的3.3%,比较差异有统计学意义（P=0.001）;CHB、CLF、LC、HCC组的自身抗体检出率分别为24.4%、27.8%、33.3%、44.0%,与正常对照组比较差异均有统计学意义（P〈0.05）,但四组间比较差异无统计学意义（P〉0.05）;HBV DNA阳性与阴性组自身抗体检出率比较差异无统计学意义（P〉0.05）;慢性HBV感染者自身抗体阳性与性别无明显关系,与年龄、肝功能损害程度有密切关系（t年龄=2.37,P=0.019;tALT=4.33,P=0.000;tAST=2.60,P=0.01;tTBIL=3.53,P=0.001;tALB=-2.47,P=0.014）。结论：慢性HBV感染可诱发自身免疫性反应,导致多种自身抗体的产生。这种自身免疫性反应与感染者的性别、病毒复制无关,与年龄、肝功能损害程度有关。     

Surveillance for chronic hepatitis B virus infection - New York City, June 2008-November 2009

Chronic hepatitis B virus (HBV) infection is a leading cause of cirrhosis and liver cancer worldwide; the estimated prevalence in the United States is 0.3%-0.5%. Each year, approximately 11,500-13,000 persons are newly reported with a positive HBV test to the New York City (NYC) Department of Health and Mental Hygiene (DOHMH). To characterize chronic HBV patients, DOHMH began ongoing enhanced chronic HBV surveillance, selecting a random sample of newly reported cases and collecting more detailed information from the patients' clinicians. This report summarizes investigations of 180 randomly selected HBV cases reported during June 2008-November 2009. Approximately two thirds (67%) of patients were Asian, and the most commonly reported reason for HBV testing was the patient's birth country or race/ethnicity (27%). In 70% of cases, the clinician did not know of any patient risk factors. Sixty-nine percent of clinicians stated that they counseled their patients about notifying close contacts about their infection, and 75% counseled about transmission and prevention. Sixty-two percent did not know their patient's hepatitis A vaccination status despite recommendations. This surveillance effort provided quantitative data on health disparities useful for identifying opportunities for outreach and education, and it showed that not all patients received recommended prevention and treatment services. In response to these findings, DOHMH now routinely distributes HBV patient education materials to populations in need.     

Hepatitis B Virus Infection: Epidemiology and Vaccination

Worldwide, two billion people have been infected with hepatitisB virus (HBV), 360 million have chronic infection, and 600,000die each year from HBV-related liver disease or hepatocellularcarcinoma. This comprehensive review of hepatitis B epidemiologyand vaccines focuses on definitive and influential studies andhighlights current trends, policies, and directions. HBV canbe transmitted vertically, through sexual or household contact,or by unsafe injections, but chronic infections acquired duringinfancy or childhood account for a disproportionately largeshare of worldwide morbidity and mortality. Vaccination againstHBV infection can be started at birth and provides long-termprotection against infection in more than 90% of healthy people.In the 1990s, many industrialized countries and a few less-developedcountries implemented universal hepatitis B immunization andexperienced measurable reductions in HBV-related disease. Forexample, in Taiwan, the prevalence of chronic infection in childrendeclined by more than 90%. Many resource-poor nations have recentlyinitiated universal hepatitis B immunization programs with assistancefrom the Global Alliance for Vaccines and Immunization. Furtherprogress towards the elimination of HBV transmission will requiresustainable vaccination programs with improved vaccination coverage,practical methods of measuring the impact of vaccination programs,and targeted vaccination efforts for communities at high riskof infection. hepatitis B • hepatitis B vaccines • hepatitis B virus • immunization programs     

Impact of a targeted hepatitis B vaccination program in Amsterdam, The Netherlands

To evaluate hepatitis B virus (HBV) risk group vaccination in Amsterdam, which started in 1998, we examined 342 reported acute HBV-cases and sequenced 85 DNA isolates. The reported number of cases declined from 214 in 1992-1997 to 128 in 1998-2003, due to a decline in injecting drug users (IDU) and their heterosexual partners. Phylogenetic analyses showed that after 1998, the IDU cluster nearly disappeared, probably due to a decline in injecting. Acute HBV remained stable among men having sex with men; given their increased sexual risk behavior, vaccination has probably prevented an increase in their acute infections. Currently, 48-72% of the people who should be included in the program are still susceptible to HBV.     

成人乙肝疫苗主动接种影响因素分析

目的 研究成人接种乙肝疫苗影响因素.方法 在上海市闵行区随机抽取18～50岁成年居民613人,进行乙肝疫苗接种影响因素调查,用非条件Logistic回归分析影响因素.结果 613人中,接种过乙肝疫苗153人,接种率25.37%,其中父母带去接种27人,学校或单位组织接种59人,自己主动接种67人;影响主动接种乙肝疫苗的因素主要是年龄、家庭人均月收入、周围有乙肝病人、对不用安全套性交可传播乙肝、尚无治愈乙肝的特效药、我国居民乙肝病原携带率高等有正确认识(P<0.05);多因素分析表明,家庭人均月收入高,认为同桌吃饭(OR=1.97)、共用办公设备可传染乙肝(OR=8.67),正确认识尚无治愈乙肝的特效药者(OR=2.27)易主动接种乙肝疫苗.愿意接种乙肝疫苗的影响因素主要是文化程度,对乙肝是肝癌发病的重要病因、我国居民乙肝病原携带率高正确认识与否(P<0.05).结论 对乙肝相关知识了解不够、经济、成人接种服务不够便利等是闵行区成人乙肝疫苗主动接种的主要影响因素.     

Screening for Hepatitis B in partners and children of women positive for surface antigen,Burkina Faso

ObjectiveTo evaluate the implementation of a screening strategy for the partners and children of pregnant women with hepatitis B virus (HBV) attending antenatal care.MethodsWe identified pregnant women positive for HBV surface antigen (HBsAg) at antenatal consultation in Ouagadougou, Burkina Faso. At post-test counselling, women were advised to disclose their HBV status to partners and to encourage their partner and children to be screened for HBsAg. We used multivariable logistic regression to explore factors associated with uptake of screening and HBsAg positivity among family members.FindingsOf 1000 HBsAg-positive women, 436/1000 partners and 215/1281 children were screened. HBsAg was detected in 55 (12.6%) partners and 24 (11.2%) children. After adjusting for confounders, uptake of screening was higher in partners who were married, who attended the woman’s first post-test consultation and to whom the woman had disclosed her HBV status. In children, HBsAg positivity was associated with being born before the introduction of infant hepatitis B vaccination in Burkina Faso (not significant in the multivariable analysis), having a mother positive for HBV e-antigen (adjusted OR: 8.57; 95% CI: 2.49–29.48) or having a mother with HBV DNA level ≥ 200 000 IU/mL (OR: 6.83; 95% CI: 1.61–29.00).ConclusionIn low-income countries, the antenatal consultation provides a cost-effective opportunity to identify HBV-infected household contacts and link them to care. Children born before the introduction of infant hepatitis B vaccination and whose mother has higher viral load or infectivity should be a priority for testing and linkage to care.     

乙肝疫苗免疫规划对乙肝流行影响

目的了解乙型肝炎(HB)疫苗纳入免疫规划后,江苏省HB的流行病学特征及影响因素。方法根据《2006年全国人群乙肝等有关疾病血清学调查总体方案》,对3 906人进行现场和血清流行病学调查,并对结果进行描述流行病学分析。结果全省HBsAg、抗-HBs、抗-HBc阳性率和乙肝病毒(HBV)感染率分别为4.99%,58.70%,25.91%和25.93%。15岁人群乙肝疫苗(HepB)接种率达96.99%;HBsAg、抗-HBc阳性率及HBV感染率均比其他年龄组低,抗-HBs阳性率则较高,首针及时接种率为70.75%。城市HBsAg阳性率为5.19%,农村为4.80%。家庭中HBsAg阳性者关系中,夫妻占41.67%。结论HepB纳入免疫规划后,江苏省乙肝感染率大幅下降,15岁人群更为明显,感染高峰后移;15岁人群首针及时接种率仍处于较低水平。     

Updated CDC recommendations for the management of hepatitis B virus-infected health-care providers and students

This report updates the 1991 CDC recommendations for the management of hepatitis B virus (HBV)-infected health-care providers and students to reduce risk for transmitting HBV to patients during the conduct of exposure-prone invasive procedures (CDC. Recommendations for preventing transmission of human immunodeficiency virus and hepatitis B virus to patients during exposure-prone invasive procedures. MMWR 1991;40[No. RR-8]). This update reflects changes in the epidemiology of HBV infection in the United States and advances in the medical management of chronic HBV infection and policy directives issued by health authorities since 1991. The primary goal of this report is to promote patient safety while providing risk management and practice guidance to HBV-infected health-care providers and students, particularly those performing exposure-prone procedures such as certain types of surgery. Because percutaneous injuries sustained by health-care personnel during certain surgical, obstetrical, and dental procedures provide a potential route of HBV transmission to patients as well as providers, this report emphasizes prevention of operator injuries and blood exposures during exposure-prone surgical, obstetrical, and dental procedures. These updated recommendations reaffirm the 1991 CDC recommendation that HBV infection alone should not disqualify infected persons from the practice or study of surgery, dentistry, medicine, or allied health fields. The previous recommendations have been updated to include the following changes: no prenotification of patients of a health-care provider's or student's HBV status; use of HBV DNA serum levels rather than hepatitis B e-antigen status to monitor infectivity; and, for those health-care professionals requiring oversight, specific suggestions for composition of expert review panels and threshold value of serum HBV DNA considered "safe" for practice (<1,000 IU/ml). These recommendations also explicitly address the issue of medical and dental students who are discovered to have chronic HBV infection. For most chronically HBV-infected providers and students who conform to current standards for infection control, HBV infection status alone does not require any curtailing of their practices or supervised learning experiences. These updated recommendations outline the criteria for safe clinical practice of HBV-infected providers and students that can be used by the appropriate occupational or student health authorities to develop their own institutional policies. These recommendations also can be used by an institutional expert panel that monitors providers who perform exposure-prone procedures.     

Hepatitis B testing,care linkage,and vaccination coverage within a registry of hepatitis C infected patients

Background

Hepatitis B virus (HBV) infection testing among persons with hepatitis C virus (HCV) infection is necessary to appropriately care for these patients, yet uptake of HBV testing and vaccination in this population is suboptimal.

Hepatitis A virus immunity and seroconversion among contacts of acute hepatitis A patients in Amsterdam, 1996-2000: an evaluation of current prevention policy

OBJECTIVES: We evaluated the hepatitis A virus (HAV) control policy (hygienic precautions and passive immunization with immune globulin) for "household contacts" (defined as all people who lived in the same house and who shared the same toilet with the patient, people who took care of an HAV-infected child, and sexual partners of the patient) of acute hepatitis A patients between 1996 and 2000. METHODS: We examined the characteristics and the serological outcomes of household contacts. All susceptible contacts were invited for retesting 6 weeks after they received immune globulin. RESULTS: Of 1242 contacts of 569 HAV patients, more than 50% (n = 672) were found to be HAV immune. Among the remaining contacts, 161 (28.2%) had a concurrent infection, and 86 of these individuals were symptomatic. The remaining 409 susceptible contacts received immune globulin, with 186 (45%) returning for retesting 6 weeks later (64 [34%] were infected, but only 12 had symptoms). CONCLUSIONS: Immune globulin does not protect all household contacts from HAV infection; however, it attenuates symptoms and effectively reduces further HAV transmission.     

拉米夫定预防和治疗糖皮质激素诱导的慢性乙型肝炎急性发作

目的分析慢性乙型肝炎患者因其他疾病经糖皮质激素治疗后的病情活动和应用拉米夫定防治此病情活动的效果。方法选取126例乙型肝炎病毒（HBV）感染并应用糖皮质激素治疗的患者,根据拉米夫定治疗基线时的血清HBV DNA载量和血清丙氨酸转氨酶（ALT）水平,将患者分为3组：血清ALT 正常,HBV DNA 低于检测下限,39例（A组）;血清 ALT 正常,HBV DNA≥103拷贝/mL, 60例(B组); 血清ALT≥2倍正常值上限, HBV DNA≥104 拷贝/mL, 27例(C组)。每3~6个月观察患者血清HBV DNA载量和ALT水平一次,观察12~18个月。结果A组和B组中有47例慢性乙型肝炎患者未用拉米夫定治疗,在随访过程中发生HBV DNA明显升高者29例(61.70%),31例(65.96%) ALT升高,10 例(21.28%) 发生肝功能失代偿;而接受了拉米夫定治疗的52例患者,随访中仅4例 (7.69%) 发生病情再活动。C组患者拉米夫定治疗有效率为37.04% (10/27),显著低于在没有肝脏炎症活动时预防性应用拉米夫定的有效率（92.31%）（χ2=27.82,P＜0.01）。结论糖皮质激素治疗可诱导HBV感染的再激活和加重肝损害。拉米夫定能有效防治糖皮质激素诱导的慢性乙型肝炎急性发作,且预防应用的效果明显优于延期治疗。     

我国4个省份慢性乙型肝炎患者受到性与生育歧视现状调查

目的 了解中国当前慢性乙型肝炎(乙肝)患者遭受性与生育歧视的情况,为探究减少性与生育歧视策略提供依据。方法 从北京市、河南省、广东省和陕西省4个省份采用便利抽样选择5家医院乙肝患者采用自制问卷调查中国4个省份的慢性乙肝患者遭受性与生育歧视现状,使用方差分析和χ²检验比较不同人口学特征的性行为与生育歧视得分差异。结果 共调查797名慢性乙肝患者,4.15%(28/675)的患者被医生建议不要生育,4.67%(10/210)的女性患者被医务人员或计划生育服务机构建议终止怀孕。分别有3.62%(25/690)和3.48%(24/690)的患者因感染HBV被拒绝提供计划生育服务和生殖健康服务。男性患者中, ≤ 30岁组遭受性与生育歧视的程度低于31~岁组(P=0.011)和 ≥ 51岁组(P=0.009);女性患者中,31~岁组遭受性与生育歧视的程度低于 ≤ 30岁组(P=0.003)而高于41~岁组(P=0.001)和 ≥ 51岁组(P<0.001)。知晓HBV性传播途径的患者较不知晓的患者更可能有不发生性行为的想法(P=0.022)。而知晓安全套可以减小HBV感染风险知识的患者较不知晓的患者在发生性行为想法上差异无统计学意义(P=0.612)。结论 慢性乙肝患者存在遭受性与生育相关的歧视,尤其是处在31~40岁的女性。需要普及安全套阻断性传播的知识和实施母婴阻断策略,更好地保护乙肝患者性行为和生育的权利。     

Markers of hepatitis B virus infection and immunity in Victoria, Australia, 1995 to 2005

Objective: Estimating the prevalence of chronic hepatitis B virus (HBV) infection in generally low-prevalence populations containing communities with a higher disease burden is difficult. This study was conducted to estimate the prevalence of serological markers of infection with, and immunity to, HBV in the Victorian population and to analyse trends in these estimates over time.
Methods: A serological survey of 3,212 samples of convenience collected in the years 1995, 2000 and 2005 was conducted using a selection procedure designed to reduce selection bias. All samples were tested for hepatitis B surface and core antibodies; all core antibody positive samples (indicating previous infection) were then tested for the presence of hepatitis B surface antigen (HBsAg).
Results: HBsAg prevalence was 1.1% (95%CI 0.8-1.6%) with significant differences observed by area of residence, age, gender and test year. Serological evidence of immunisation in infants and adolescents were lower than established estimates following the introduction of universal vaccination for these groups.
Conclusions: This study emphasises the significant and growing problem of chronic HBV infection in Victoria and suggests lower than expected population immunity deriving from universal vaccination programs.
Implications: Greater efforts are needed to formulate a comprehensive public health response to address this relatively neglected blood borne viral infection, the burden of which is very significant in some marginalised sections of our community. Increased attention to improving the universality of our immunisation programs is also needed.     

A mathematical model to estimate global hepatitis B disease burden and vaccination impact

BACKGROUND: Limited data are available regarding global hepatitis B virus (HBV)-related morbidity and mortality and potential reduction in disease burden from hepatitis B vaccination. METHODS: A model was developed to calculate the age-specific risk of acquiring HBV infection, acute hepatitis B (illness and death), and progression to chronic HBV infection. HBV-related deaths among chronically infected persons were determined from HBV-related cirrhosis and hepatocellular carcinoma (HCC) mortality curves, adjusted for background mortality. The effect of hepatitis B vaccination was calculated from vaccine efficacy and vaccination series coverage, with and without administration of the first dose of vaccine within 24 h of birth (i.e. birth dose) to prevent perinatal HBV infection. RESULTS: For the year 2000, the model estimated 620,000 persons died worldwide from HBV-related causes: 580,000 (94%) from chronic infection-related cirrhosis and HCC and 40,000 (6%) from acute hepatitis B. In the surviving birth cohort for the year 2000, the model estimated that without vaccination, 64.8 million would become HBV-infected and 1.4 million would die from HBV-related disease. Infections acquired during the perinatal period, in early childhood (<5 years old), and > or = 5 years of age accounted for 21, 48, and 31% of deaths, respectively. Routine infant hepatitis B vaccination, with 90% coverage and the first dose administered at birth would prevent 84% of global HBV-related deaths. CONCLUSION: Globally, most HBV-related deaths result from the chronic sequelae of infection acquired in the perinatal and early childhood periods. Inclusion of hepatitis B vaccine into national infant immunization programs could prevent >80% of HBV-related deaths.     

Hepatitis B vaccination coverage among adults aged ≥ 18 years traveling to a country of high or intermediate endemicity,United States, 2015

BackgroundPersons from the United States who travel to developing countries are at substantial risk for hepatitis B virus (HBV) infection. Hepatitis B vaccine has been recommended for adults at increased risk for infection, including travelers to high or intermediate hepatitis B endemic countries.PurposeTo assess hepatitis B vaccination coverage among adults ≥ 18 years traveling to a country of high or intermediate endemicity from the United States.MethodsData from the 2015 National Health Interview Survey (NHIS) were analyzed to determine hepatitis B vaccination coverage (≥1 dose) and series completion (≥3 doses) among persons aged ≥ 18 years who reported traveling to a country of high or intermediate hepatitis B endemicity. Multivariable logistic regression and predictive marginal analyses were conducted to identify factors independently associated with hepatitis B vaccination.ResultsIn 2015, hepatitis B vaccination coverage (≥1 dose) among adults aged ≥ 18 years who reported traveling to high or intermediate hepatitis B endemic countries was 38.6%, significantly higher compared with 25.9% among non-travelers. Series completion (≥3 doses) was 31.7% and 21.2%, respectively (P < 0.05). On multivariable analysis among all respondents, travel status was significantly associated with hepatitis B vaccination coverage and series completion. Other characteristics independently associated with vaccination (≥1 dose, and ≥ 3 doses) among travelers included age, race/ethnicity, educational level, duration of U.S. residence, number of physician contacts in the past year, status of ever being tested for HIV, and healthcare personnel status.ConclusionsAlthough travel to a country of high or intermediate hepatitis B endemicity was associated with higher likelihood of hepatitis B vaccination, hepatitis B vaccination coverage was low among adult travelers to these areas. Healthcare providers should ask their patients about travel plans and recommend and offer travel related vaccinations to their patients or refer them to alternate sites for vaccination.     

Integrating hepatitis, STD, and HIV services into a drug rehabilitation program

BACKGROUND: Considering the difficulties in providing screening and vaccination services for inmates in short-stay incarceration facilities, an evaluation was conducted of the integration of prevention services in an alternative sentencing drug rehabilitation program (alternative to incarceration) in San Diego CA. METHODS: During the period April 1999 to December 2002, clients were asked to complete a brief risk-assessment questionnaire, and were offered hepatitis B virus (HBV) vaccination, HBV and hepatitis C virus (HCV) serologic testing, STD screening, and HIV counseling and testing. RESULTS: Of the estimated 1125 rehabilitation program enrollees, 930 (83%) participated in the integration program services. Most clients were male (64%), were aged >30 years (64%), and few (7%) reported previous HBV vaccination. Of the 854 clients eligible for hepatitis B vaccination, 98% received the first dose, 69% the second dose, and 42% completed the series. Eleven percent of clients had prior HBV infection, and 14.7% had HCV infection, with positivity rates being highest among those with a history of injection drug use-HBV, 19%, and HCV, 36%. HIV infection was rare (prevalence, 0.3%), and STDs were uncommon (chlamydia prevalence, 2%, and gonorrhea prevalence, 0.6%). Total annual cost of integration services (excluding HIV testing) was dollar 31,994 equating to dollar 122 per client served. CONCLUSIONS: Alternative sentencing drug rehabilitation programs provide a venue to efficiently deliver integrated hepatitis and other prevention services. Considering the vast number of high-risk persons in drug rehabilitation, probation, parole, and inmate release programs, an opportunity exists to greatly expand hepatitis services.