Hepatitis A, B, and C Prevention Programs
Information and Programs for People at Risk
 
  Home
  Hep Express archives
    Search
 

Prevention Programs

  APIA programs
  Corrections, adult
  Corrections, juvenile
  Family planning
  Harm reduction
  Homeless programs
  MSM
  Perinatal related
  School programs
  STD/HIV
  Other programs
  Index of programs
    Support Group Info
  Hepatitis B
  Hepatitis C
  Listed by state
    Hepatitis B Info
  FAQ about hep B
  VISs
  Laws and mandates
  Case histories
  Photos
  Videos
    Hepatitis A Info
  FAQ about hep A
  VISs
  Laws and mandates
  Case histories
  Photos
    Hep-related Topics
  International adoption
  Tattooing and piercing
  Travel vaccination
  Healthcare workers
  Needle safety
  Dialysis
    Other Information
  CDC website
  Hep organizations
  NASTAD website
  Contact NASTAD
  About NASTAD
  Privacy policy
 

(click on the image)


Hep Express Issue 13

(1 of 8)
January 14, 2004
CDC REPORTS ON U.S. INCIDENCE OF ACUTE HEPATITIS B

[The following is cross posted from the Immunization Action Coalition's "IAC EXPRESS" electronic newsletter, 1/05/04.]

CDC published "Incidence of Acute Hepatitis B--United States, 1990-2002" in the January 2 issue of MMWR. The article is reprinted below in its entirety, excluding references and a figure.

***********************

Hepatitis B virus (HBV) is a bloodborne and sexually transmitted virus that is acquired by percutaneous and mucosal exposure to blood or other body fluids of an infected person. Clinical manifestations of acute hepatitis B can be severe, and serious complications (i.e., cirrhosis and liver cancer) are more likely to develop in chronically infected persons. In the United States, approximately 1.2 million persons have chronic hepatitis B virus (HBV) infection and are sources for HBV transmission to others. However, since the late 1980s, the incidence of acute hepatitis B has declined steadily, especially among vaccinated children. To characterize the epidemiology of acute hepatitis B in the United States, CDC analyzed national notifiable disease surveillance data for 1990-2002. This report summarizes the results of that analysis, which indicated that, during 1990-2002, the incidence of reported acute hepatitis B declined 67%. This decline was greatest among children and adolescents, indicating the effect of routine childhood vaccination. The decline was lowest among adults, who accounted for the majority of cases; incidence increased among adults in some age groups. To reduce HBV transmission further in the United States, hepatitis B vaccination programs are needed that target men who have sex with men (MSM), injection-drug users (IDUs), and other adults at high risk.

CDC analyzed surveillance data for acute hepatitis B cases reported weekly from state health departments and the District of Columbia during 1990-2002. Data included each patient's county of residence, sex, race/ethnicity, and age. Clinical and risk factor data were available for approximately 35% of cases reported since 1990, including death from acute hepatitis B, reported injection-drug use, sex and number of sex partners, and exposure to a household or sex contact during incubation period. Acute hepatitis B incidence was calculated by using population denominators from the U.S. Census Bureau.

Summary of Incidence

During 1990-2002, the incidence of acute hepatitis B declined 67%, from 8.5 per 100,000 population (21,102 total cases reported) to 2.8 per 100,000 population (8,064 total cases reported). By region, in 2002, incidence was highest in the South (3.6), followed by the Northeast (3.5), the West (2.3), and the Midwest (1.6). During 1990-2002, decreases in incidence were greatest in the West (78%), followed by the Midwest (72%), the South (59%), and the Northeast (52%); however, incidence in the Northeast has increased 41% since 1999.

The incidence of acute hepatitis B among men has been consistently higher than among women. In 1990, the incidence among men and women was 9.8 and 6.3, respectively; in 2002, the incidence was 3.7 and 2.2, respectively. Overall, incidence among women has declined more than among men; the male-to-female acute hepatitis B rate ratio was 1.5 in 1990, compared with 1.7 in 2002.

By age, the most significant decline (89%) in acute hepatitis B incidence during 1990-2002 occurred among persons aged 0-19 years, from 3.0 in 1990 to 0.3 in 2002. Among persons aged 20-39 and 40 years and older, acute hepatitis B incidence declined 67% and 39%, respectively; however, the majority of this decline occurred during 1990-1998. Since 1999, the incidence of acute hepatitis B has increased 5% among males aged 20-39 years and 20% and 31%, respectively, among males and females aged 40 years and older. Among 6,790 (32%) of the 21,102 cases reported in 1990 and 3,079 (38%) of the 8,064 cases reported in 2002 for which risk factor data were available, the proportion of persons who reported injection-drug use was similar (17% and 15%). However, the proportion of heterosexuals reporting multiple sex partners increased from 14% to 29%, as did the proportion of self-identified MSM, from 7% to 18%. During 1990-2002, the proportion of MSM reporting multiple sex partners was approximately 50%.

Examples of Local Trends

Data from two counties illustrate the changing epidemiology of acute hepatitis B in the United States. In both counties, overall incidence and incidence among children have declined. In Baltimore County (Baltimore, Maryland), acute hepatitis B incidence has been consistently higher than the national average. Since 1990, incidence has declined 26% overall; however, during 2000-2002, incidence increased 15%. In 2002, Baltimore County reported 50 acute hepatitis B cases (29 among men and 21 among women) for an overall incidence of 6.6; incidence for men and women was 8.1 and 5.3, respectively, with a male-to-female rate ratio of 1.5. Of the 38 persons with available risk factor data, 15 (40%) reported injection-drug use, eight (21%) reported having multiple heterosexual sex partners, and three (8%) reported both risk factors; six (16%) persons reported exposure to an HBV-infected household or sex contact, and three (8%) reported being an MSM.

Since 1990 in Mecklenburg County (Charlotte, North Carolina), reported acute hepatitis B incidence has been above the national average; however, during the same period, incidence has declined 82%. In 2002, Mecklenburg County reported 39 acute hepatitis B cases (28 among men and 11 among women) for an overall incidence of 5.6; incidence for men and women was 8.2 and 3.1, respectively, with a male-to-female rate ratio of 2.6. Risk factor data were available for all 39 cases; eight (21%) persons reported having multiple heterosexual sex partners, eight (21%) reported being MSM, and three (8%) reported both risk factors. Five (13%) persons reported exposure to an HBV-infected household or sex contact; no persons reported injection-drug use.

Editorial Note:

In 1991, a comprehensive strategy to eliminate HBV transmission was implemented in the United States and has reduced the incidence of acute hepatitis B among children. The strategy included universal infant vaccination, universal screening of pregnant women, and postexposure prophylaxis of infants born to infected mothers to prevent perinatal HBV infection; since 1982, adolescents and adults at high risk have been recommended to receive HBV vaccine. In 1995, the strategy was expanded to include routine vaccination of all adolescents aged 11-12 years and, in 1999, to include all persons aged 0-18 years who had not been vaccinated previously. The incidence of acute hepatitis B has declined steadily during the preceding decade, in part because of successful vaccination and other prevention programs. The observed decline in the incidence of acute hepatitis B among children occurred coincident with an increase in hepatitis B vaccination coverage among children aged 19-35 months, from 16% in 1992 to 90% in 2000.

Since 1999, after more than a decade of decline, hepatitis B incidence among men aged older than 19 years and women aged 40 years and older has increased. The most common risk factors reported among adults with acute hepatitis B continue to be multiple sex partners, MSM, and injection-drug use. Different high-risk behaviors accounted for the majority of transmissions in different locales.

Increases in sexually transmitted diseases (STD), including syphilis and human immunodeficiency virus (HIV) infection among MSM have been attributed to increases in high-risk sexual behavior (e.g., unprotected anal intercourse with more than one partner and unsafe sex while under the influence of alcohol or recreational drugs). Changes in patterns of sexual behavior also could be responsible for the increasing transmission of HBV among MSM.

In 1982, the Advisory Committee on Immunization Practices recommended hepatitis B vaccination for sexually active homosexual and bisexual men and IDUs and, in 1985, for heterosexuals with multiple sex partners or a recent STD. Trends in acute hepatitis B infection also reflect poor vaccination coverage among persons who engage in these behaviors. Of 3,432 young MSM in seven U.S. metropolitan areas, only 9% had received HBV vaccine. In a San Diego County, California, survey, only 6% of IDUs had completed the 3-dose HBV vaccine series.

Persons at high risk for HBV infection often seek health care in settings in which vaccination services could be provided. During 1996-1998, approximately half of persons reported with acute hepatitis B had been treated for an STD or incarcerated: 89% of IDUs, 35% of MSM, and 70% of persons with multiple sex partners. Both STD clinics and correctional facilities are settings in which hepatitis B vaccination services are recommended.

The findings in this report are subject to at least two limitations. First, the quality of surveillance data varies at local and state levels. Second, national viral hepatitis case-reporting is incomplete; only approximately 35% of all reported cases contain risk factor data.

The decline in acute hepatitis B among children indicates that successful hepatitis B vaccination programs are possible. These programs must consider the local epidemiology of hepatitis B and identify ways to reach populations at high risk. Integration of hepatitis B vaccination into health-care programs that target persons at high risk is feasible and cost effective. Hepatitis B vaccination programs have been implemented in STD clinics, juvenile and adult detention facilities, HIV-counseling and -testing centers, and other sites.

No national adult hepatitis B program exists that is similar to those that have proven successful for children and adolescents. Components of a national adult vaccination program must include policies for vaccination, including methods for achieving higher vaccination rates among adults at greatest risk and appropriate resources to support implementation.

***********************

To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5251a3.htm

To access a ready-to-copy (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5251.pdf

Receive a FREE electronic subscription to MMWR (which includes new ACIP statements) by going to
http://www.cdc.gov/mmwr/mmwrsubscribe.html

---------------------------------------------------------------
Return to top

(2 of 8)
January 14, 2004
CDC ADDS TRAINING AND COUNSELING RESOURCES TO ITS HEPATITIS WEBSITE
 
The Division of Viral Hepatitis, Centers for Disease Control and Prevention (CDC), recently added resources for training and counseling to its website.
 
Training and counseling curricula include web-based courses, print manuals, PowerPoint presentations, educational games, and more. Most are intended for training of the clinician or outreach worker, but a few are designed for the patient/client.
 
Curricula developers include CDC's Division of Viral Hepatitis, the New York City Department of Health and Mental Hygiene, the Danya Institute and Danya International, Inc., the American Liver Foundation, the National Commission on Correctional Health Care, the Texas Department of Health, and the Veteran's Administration.
 
To access these resources, go to the Viral Hepatitis Resource Center at
http://www.cdc.gov/ncidod/diseases/hepatitis/resource/index.htm and scroll down to "Training and Counseling Resources."

----------------------------------------------------------------
Return to top

(3 of 8)
January 14, 2004
HBF ADDS NEW RESOURCES TO ITS WEBSITE
 
The Hepatitis B Foundation (HBF) continues to expand and improve its website to provide accurate hepatitis B information to those who need it most.
 
HBF recently added Spanish and Simplified Chinese language chapters to the already existing Traditional Chinese, Korean, and Vietnamese chapters. These chapters include a companion version in English and are available in ready-to-print (PDF) format on the home page of HBF's website.
 
A Frequently Asked Question section has also been added to provide quick, easy-to-understand answers to the most common hepatitis B questions from patients, families, and health care providers. Click on "What is Hepatitis B?" on the home page to find this section.
 
HBF's website can be accessed at http://www.hepb.org

----------------------------------------------------------------
Return to top

(4 of 8)
January 14, 2004
HBF OFFERS FREE PARENT PACKET
 
The Hepatitis B Foundation (HBF) has developed a free parent packet titled "Information for Parents of Young Children with Hepatitis B." This resource contains information on issues surrounding children and hepatitis B including international and domestic adoption, treatment, education, and social issues.
 
To request this free information packet online, go to: www.hepb.org/resources and click on "Order Our Information." You can also order this packet by phone at (215) 489-4900.

----------------------------------------------------------------
Return to top

(5 of 8)
January 14, 2004
GLMA SURVEY INDICATES MORE THAN HALF OF MSM NOT PROTECTED AGAINST HEPATITIS A AND B
 
A survey conducted by the Gay and Lesbian Medical Association (GLMA) at Gay Pride events around the nation indicates that more than half of the nation's gay and bisexual men may not be protected against hepatitis A and hepatitis B.
 
Of the 1,430 respondents, 33% were immune to hepatitis A and 39% were immune to hepatitis B (based on history of prior infection or immunization). The survey also revealed health care disparities, with Latino, African American, and lower-income men who have sex with men (MSM) less likely than other MSM surveyed to be protected against hepatitis A and B.
 
Respondents who were "out" to their provider were 65% more likely to be immune to hepatitis A and 52% more likely to be immune to hepatitis B than respondents who were not. Ken Haller, MD, President of the Board of the GLMA, said, "Gay and bisexual men need to ask their providers about hepatitis vaccination, and providers need to be trained to make sure their gay and bisexual male patients are protected against these diseases."
 
The article can be accessed directly by clicking here.

----------------------------------------------------------------
Return to top

(6 of 8)
January 14, 2004
NIDA REQUESTS PROPOSALS FOR PREVENTING HIV AND OTHER INFECTIONS AMONG DRUG USERS IN CRIMINAL JUSTICE SYSTEM

The National Institute on Drug Abuse (NIDA), National Institutes of Health, seeks innovative research to advance knowledge and understanding of the epidemiology, prevention, and treatment service needs of drug users in the criminal justice system who are at high risk for HIV and other bloodborne and sexually transmitted diseases. The target population includes adult and juvenile drug users in the criminal justice system receiving legal supervision in community-based settings, such as drug courts, diversion initiatives, or community re-entry programs.

A letter of intent is encouraged, although not required, and is due February 23, 2004. Applications are due March 23, 2004.

To read more about this Request for Applications (RFA), go to
http://grants2.nih.gov/grants/guide/rfa-files/RFA-DA-04-015.html or contact Gary Fleming by email (gfleming@mail.nih.gov) or phone (301) 443-6710. The RFA number is RFA-DA-04-015.

----------------------------------------------------------------
Return to top

(7 of 8)
January 14, 2004
CDC DISTRIBUTES HEPATITIS C TOOLKIT TO 143,000 PHYSICIANS

The Division of Viral Hepatitis, Centers for Disease Control and Prevention (CDC), mailed a Hepatitis C Physician/Patient Toolkit to 143,000 physicians in December 2003.

The objectives for the distribution of the Toolkit are

  1. To educate physicians and patients about hepatitis C and HCV testing of at-risk patients in primary clinical settings;
  2. To assess the process of materials dissemination and impact on physician education; and
  3. To identify whether the physicians' receipt of the Toolkit resulted in an increase in anti-HCV laboratory testing within the state.

Hepatitis C testing data will be collected in eight states including Alabama, Idaho, Indiana, Utah, Ohio, West Virginia, Nebraska, and Vermont. In addition, testing data will be collected in Georgia, Michigan, New Hampshire, Nevada, Washington, and South Dakota. However, Toolkits will not be distributed in these states at this time. Testing data from these six states will be compared with the testing data from the eight states that received the Toolkits.

The physician study population comprises approximately 43,000 members of the American Medical Association (AMA) in the eight intervention states. Toolkits have also been sent to AMA members in 18 additional states. These physicians' specialties include internal medicine, family practice, substance abuse/addiction medicine, surgery, obstetrics and gynecology, pediatrics, and general practice.

The total initial mailing included 143,000 physicians in 26 states. Due to funding restrictions, CDC is unable to distribute the Toolkit more widely at this time.

----------------------------------------------------------------
Return to top

(8 of 8)
January 14, 2004
CDC ISSUES GUIDELINES FOR INFECTION CONTROL IN DENTAL HEALTH-CARE SETTINGS
 
[The following is cross posted from the Immunization Action Coalition's "IAC EXPRESS" electronic newsletter, 12/22/03.]
 
The Centers for Disease Control and Prevention (CDC) published "Guidelines for Infection Control in Dental Health-Care Settings--2003" in the December 19 issue of "MMWR Recommendations and Reports" (MMWR). The guidelines have a section on preventing transmission of bloodborne pathogens, which includes information about hepatitis B virus, hepatitis C virus, hepatitis D virus, and human immunodeficiency virus. The section also outlines exposure prevention methods and postexposure management and prophylaxis.
 
To access a web-text (HTML) version of the guidelines, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm
 
To access a ready-to-copy (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/rr/rr5217.pdf


Nastad
www.nastad.org
nastad@nastad.org
          Hepatitis Prevention Programs
www.hepprograms.org
nastad@nastad.org

444 North Capitol Street, NW Suite 339 Washington D.C. 20001 (202) 434-8090