ABBREVIATIONS: ACIP, Advisory Committee on Immunization Practices; CDC, Centers for Disease Control and Prevention; DVH, Division of Viral Hepatitis; HAV, hepatitis A virus; HBV, hepatitis B virus; HCV, hepatitis C virus; IAC, Immunization Action Coalition; IDU, injection drug user; MMWR, Morbidity and Mortality Weekly Report; MSM, men who have sex with men; STD, sexually transmitted disease; VIS, Vaccine Information Statement; WHO, World Health Organization.
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(1 of 9)
August 13, 2004
VIS UPDATE: CDC ISSUES REVISED VIS FOR HEPATITIS A VACCINE

[The following is cross posted from the Immunization Action Coalition's "IAC EXPRESS" electronic newsletter, 8/9/04.]

On August 4, CDC issued a revised VIS for hepatitis A vaccine. The previous VIS for hepatitis A vaccine was issued on 8/25/98. If you have VISs with that date, discard them, and download and print the revised VIS from either the NIP website or the IAC website. Currently, only English-language versions of the revised VIS are available. IAC EXPRESS [and HEP EXPRESS] will alert readers as translations become available.

PLEASE NOTE: When hepatitis A vaccine is added to the Vaccine Injury Compensation Program's injury table, presumably later in 2004, another hepatitis A vaccine VIS will be issued. To avoid large printing expenses, print off only as many of the 8/4/04 VISs as you anticipate needing for the next several months.

To access a ready-to-copy (PDF) version of the 8/4/04 hepatitis A vaccine VIS from the NIP website, go to:
http://www.cdc.gov/nip/publications/VIS/vis-hep-a.pdf

To access it from the IAC website, go to:
http://www.immunize.org/vis/v-hepa.pdf
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(2 of 9)
August 13, 2004
CDC'S DIVISION OF VIRAL HEPATITIS REDESIGNS MSM WEB SECTION

CDC's Division of Viral Hepatitis recently launched a web section that provides information about preventing hepatitis A and hepatitis B among MSM (reported on in HEP EXPRESS #17). Even more recently, the page was redesigned to better meet the needs of gay and bisexual men themselves, rather than just health care professionals.

Now called the MSM Information Center, the page begins by asking, "Are you a man having sex with other men? Learn how to protect yourself from viral hepatitis, sexually transmitted diseases (STDs) and HIV." Visitors can access fact sheets, articles, recommendations, and other specialized publications such as the National Minority AIDS Council's full-color booklet "Protect Yourself from Hepatitis." Health care providers can also use the site to download posters and brochures for their MSM clients.

To visit the MSM Information Center, go to:
http://www.cdc.gov/ncidod/diseases/hepatitis/msm/
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(3 of 9)
August 13, 2004
CDC REPORTS ON TRANSMISSION OF HEPATITIS B VIRUS IN GEORGIA CORRECTIONAL FACILITIES

[The following is cross posted from the Immunization Action Coalition's "IAC EXPRESS" electronic newsletter, 8/9/04.]

CDC published "Transmission of Hepatitis B Virus in Correctional Facilities--Georgia, January 1999-June 2002" in the August 6 issue of MMWR. Reprinted below is a portion of the article, as well as the entire press summary.

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

[The article's opening paragraph]
Incarcerated persons have a disproportionate burden of infectious diseases, including hepatitis B virus (HBV) infection. Among U.S. adult prison inmates, the overall prevalence of current or previous HBV infection ranges from 13% to 47%. The prevalence of chronic HBV infection among inmates is approximately 1.0%-3.7%, two to six times the prevalence among adults in the general U.S. population. Incarcerated persons can acquire HBV infection in the community or in correctional settings. This report summarizes the results of (1) an analysis of hepatitis B cases among Georgia inmates reported to the Georgia Department of Human Resources, Division of Public Health (DPH) during January 1999-June 2002, including a retrospective investigation of cases reported during January 2001-June 2002; and (2) a prevalence survey conducted in prison intake centers during February-March 2003. These efforts identified cases of acute hepatitis B in multiple Georgia prisons and documented evidence of ongoing transmission of HBV in the state correctional system. The findings underscore the need for hepatitis B vaccination programs in correctional facilities. . .

[The complete press summary]
All inmates who receive a medical evaluation in a correctional facility should be administered hepatitis B vaccine to prevent ongoing hepatitis B virus transmission in correctional facilities and to reduce transmission in the community after incarceration.

Between January 2001-June 2002, 57 cases of acute hepatitis B virus infection (HBV) were identified among inmates at 31 long-term correctional facilities in Georgia. The majority of cases (72%) were acquired in prison, indicating ongoing HBV transmission occurred in correctional facilities. The extent of HBV transmission among inmates might be underestimated since most persons with acute HBV infection are asymptomatic and investigations of single cases are not routinely conducted. A survey at intake centers also showed most incoming inmates were susceptible to HBV and accepted hepatitis B vaccination (76% and 78% respectively). The ongoing transmission demonstrated in Georgia prisons might be occurring in other states, where similar conditions are likely to exist. Routine hepatitis B vaccination of inmates would interrupt HBV transmission among inmates during incarceration and reduce transmission in the community after incarceration.

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

To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5330a2.htm

To access a ready-to-copy (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5330.pdf

To receive a FREE electronic subscription to MMWR (which includes new ACIP statements), go to:
http://www.cdc.gov/mmwr/mmwrsubscribe.html
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(4 of 9)
August 13, 2004
CDC REPORTS ON HEPATITIS B VACCINATION OF INMATES IN TEXAS CORRECTIONAL FACILITIES

[The following is cross posted from the Immunization Action
Coalition's "IAC EXPRESS" electronic newsletter, 8/9/04.]

CDC published "Hepatitis B Vaccination of Inmates in Correctional Facilities--Texas, 2000-2002" in the August 6 issue of MMWR. Reprinted below is a portion of the article, as well as the entire press summary.

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

[The article's opening paragraph]
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; 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. . . .

[The complete press summary]
Vaccinating offenders in jails and prisons is feasible, and may prevent about 30% of new acute hepatitis B cases in the United States.

Hepatitis B vaccination in prison has the potential to prevent a substantial portion of hepatitis B cases in the United States, since approximately 30% of reported acute hepatitis B cases are among individuals who have been incarcerated. Although hepatitis B vaccination in correctional facilities has been recommended for over 20 years, only five states have implemented vaccination programs. The Texas Department of Criminal Justice implemented a hepatitis B vaccination program in its prisons and jails, and proved that vaccinating inmates was feasible and was well accepted by inmates and staff. The large majority of both prison and jail inmates accepted the first dose of vaccine when offered. Ninety-six percent of prison inmates incarcerated for 4 months or more received all three vaccine doses.

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

To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5330a3.htm

To access a ready-to-copy (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5330.pdf
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(5 of 9)
August 13, 2004
IF YOU VACCINATE ADULTS, YOU CAN'T AFFORD TO BE WITHOUT THE "ADULTS ONLY VACCINATION" KIT

[The following is cross posted from the Immunization Action Coalition's "IAC EXPRESS" electronic newsletter, 8/9/04.]

THE GOOD NEWS: More and more adults are being vaccinated, not only at doctors' offices but also at non-traditional sites, such as family planning clinics, college health services, STD clinics, pharmacies, and prisons.

THE BEST NEWS: IAC has collected ALL the information you need to vaccinate adults into one user-friendly kit--"Adults Only Vaccination: A Step-by-Step Guide" (the AOV kit).

WHAT IS THE AOV KIT? The kit pares down immunization delivery to its essential components and presents each component in manageable, easy-to-master steps. The steps progress in logical order, starting with setting up a vaccine service at your site and ending with billing for the vaccine services you've delivered.

WHAT'S IN THE KIT? The heart of the kit is the guide, which presents 157 pages of comprehensive, authoritative, CDC-reviewed information on ALL aspects of adult immunization. Organized into seven logically presented steps, the guide is designed to be useful and stay current for years: it has more than 45 patient and provider-education materials that will never go out of date because each is linked to the latest version on IAC's website.

Plus, the guide is tabbed for easy reference, spiral bound to lie flat, and plastic coated for durability. And, it has wide margins for jotting down practical information such as useful web and email addresses, ideas for improving certain aspects of vaccine delivery, etc. This allows you to customize your guide to suit your clinic or practice's unique needs.

In addition to the guide, the kit contains the following:

• Two "how-to" instructional videos--"Immunization Techniques: Safe, Effective, Caring" and "How to Protect Your Vaccine Supply"

• Standing orders protocols for administering eight vaccines commonly given to adults; these are indispensable for increasing your clinic or practice's adult immunization rates

• Vital information for responding to vaccine-related medical emergencies, such as anaphylaxis, or to power outages

• A pack of 25 adult immunization record cards

WHO SUPPORTS THE KIT? Immunization experts from NIP/CDC reviewed the kit. In addition, the following government agencies signed the guide's introductory letter: US Department of Health and Human Services (Women's Health); several divisions within CDC: the Division of HIV/AIDS Prevention, Division of Sexually Transmitted Diseases Prevention, and Division of Viral Hepatitis. The following professional organizations also signed the letter: the American College Health Association, American College of Obstetricians and Gynecologists, American Medical Association, National Medical Association, and Planned Parenthood Federation of America.

WHO NEEDS THE KIT? Designed to help integrate immunization services into sites new to vaccination, the AOV kit is equally valuable for settings experienced in vaccine delivery. Why? Because it puts ALL the information you need to vaccinate adults right at your fingertips. If you currently find any aspect of adult vaccination confusing, the kit will clarify the issue or give you resources for getting clarification. IF YOU VACCINATE ADULTS, YOU CAN'T AFFORD TO BE WITHOUT THE KIT.

WHAT'S THE PRICE: The kit costs $75. Special discount pricing is available for orders of 10 or more (see the link below).

CAN I GET MORE INFORMATION ABOUT THE KIT? You can get complete information--including a look at the guide's many worksheets, checklists, protocols, and educational materials--by visiting IAC's website at http://www.immunize.org/guide

HOW CAN I ORDER THE KIT? You can order online or by fax or mail, using a credit card, purchase order, or check. To order, go to: http://www.immunize.org/guide/index.htm#order Click on the appropriate link.
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(6 of 9)
August 13, 2004
AMERICAN GASTROENTEROLOGICAL ASSOCIATION OFFERS ONLINE EXPERT "CONVERSATIONS"

The American Gastroenterological Association (AGA) has added a section titled "AGA Conversations" to its website. Each 20-30 minute segment features experts discussing new research and providing insights into how emerging data affect their clinical practice.

One conversation is titled "Treatment and Management of Hepatitis B." Ira Jacobson, MD, professor of medicine at Weill Medical College of Cornell University, and Teresa Wright, MD, professor of medicine at UCSF School of Medicine, discuss the advantages and disadvantages of current approved therapies for hepatitis B.

A second conversation, "Epidemiology, Diagnosis and Evaluation of Hepatitis B," features discussion between Douglas T. Dieterich, MD, professor of medicine, Mount Sinai School of Medicine, and Paul Martin, MD, professor of medicine, David Geffen School of Medicine at UCLA.

Written transcripts and CME credit are available.

To access the "AGA Conversations" index page, go to:
http://www.healthology.biz/aga/conversations.asp
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(7 of 9)
August 13, 2004
IAC MAKES MINOR CHANGES TO ITS ENGLISH AND SPANISH PATIENT-EDUCATION PIECE "ALL KIDS NEED HEPATITIS B SHOTS!"

[The following is cross posted from the Immunization Action Coalition's "IAC EXPRESS" electronic newsletter, 8/9/04.]

IAC recently reviewed some of its older patient-education pieces and made minor revisions to the English and Spanish versions of one: "All kids need hepatitis B shots!"

To access a ready-to-copy (PDF) version of the updated "All kids need hepatitis B shots!" in English, go to:
http://www.immunize.org/catg.d/4055kidb.pdf

To access it in Spanish, go to:
http://www.immunize.org/catg.d/4055sp.pdf
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(8 of 9)
August 13, 2004
CORRECTION TO HEPX #19 ARTICLE

The third article in HEP EXPRESS #19 (July 28, 2004) stated that the Hepatitis B Foundation (HBF) was offering a CME course for physicians on their website. Although HBF promoted the course on their website, it was actually offered through Medscape. We apologize for the error, and thank HBF for pointing it out. All other information in the article is correct.
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(9 of 9)
August 13, 2004
JOURNAL ARTICLES YOU MIGHT HAVE MISSED

The following recent journal articles present research related to viral hepatitis prevention or treatment.

"Lack of Association Between Hepatitis B Birth Immunization and Neonatal Death: A Population-Based Study from the Vaccine Safety Datalink Project"
Authors: Eriksen EM, Perlman JA, Miller A, et al.
Source: Pediatric Infectious Diseases Journal, July 2004, Vol. 23(7):656-662
Click here for abstract

"Duration of Hepatitis B Immunity in Low Risk Children Receiving Hepatitis B Vaccinations from Birth"
Authors: Petersen KM, Bulkow LR, McMahon BJ, Zanis C, Getty M, Peters H, Parkinson AJ
Source: Pediatric Infectious Diseases Journal, July 2004, Vol. 23(7):650-5
Click here for abstract

"Prevalence and Incidence of HIV, Hepatitis B Virus, and Hepatitis C Virus Infections Among Males in Rhode Island Prisons"
Authors: Macalino GE, Vlahov D, Sanford-Colby S, Patel S, Sabin K, Salas C, Rich JD
Source: American Journal of Public Health, July 2004, Vol. 94(7):1218-23
Click here for abstract

"Predictors of Acceptance of Hepatitis B Vaccination in an Urban Sexually Transmitted Diseases Clinic"
Authors: Samoff E, Dunn A, VanDevanter N, Blank S, Weisfuse IB
Source: Sexually Transmitted Diseases, July 2004, Vol. 31(7):415-420
Click here for abstract

"Hepatitis A in Hispanic Children Who Live Along the United States-Mexico Border: The Role of International Travel and Food-Borne Exposures"
Authors: Weinberg M, Hopkins J, Farrington L, Gresham L, Ginsberg M, Bell BP
Source: Pediatrics, July 2004, Vol. 114(1):e68-73
Click here for abstract

"Ethnic and Cultural Determinants Influence Risk Assessment for Hepatitis C Acquisition"
Authors: Dev A, Sundararajan V, Sievert W
Source: Journal of Gastroenterolgy and Hepatology, July 2004, Vol. 19(7):792-8
Click here for abstract

"Sexually Transmitted Diseases in Men"
Authors: Phillips KD, Dudgeon WD, Becker J, Bopp CM
Source: Nursing Clinics of North America, June 2004, Vol. 39(2):357-377
Click here for abstract

"Prisoners' Attitudes Toward Hepatitis B Vaccination"
Authors: Vallabhaneni S, Macalino GE, Reinert SE, Schwartzapfel B, Wolf FA, Rich JD
Source: Preventive Medicine, June 2004, Vol. 38(6):828-833
Click here for abstract

"Hepatitis B Vaccination and Injecting Drug Users"
Authors: Budd J, Robertson R, Elton R
Source: British Journal of General Practice, June 2004, Vol. 54(503):444-7
Click here for abstract

"Immunogenicity of Inactivated Hepatitis A Vaccine in Children with Chronic Liver Disease"
Authors: Majda-Stanislawska E, Bednarek M, Kuydowicz J
Source: Pediatric Infectious Diseases Journal, June 2004, Vol. 23(6):571-4
Click here for abstract

"Hepatitis A Incidence and Hepatitis A Vaccination Among American Indians and Alaska Natives, 1990-2001"
Authors: Bialek SR, Thoroughman DA, Hu D, et al.
Source: American Journal of Public Health, June 2004, Vol. 94(6):996-1001
http://www.ajph.org/cgi/content/abstract/94/6/996

"Monitoring and Educational Feedback to Improve the Compliance of Tattooists and Body Piercers with Infection Control Standards: A Randomized Controlled Trial"
Authors: Oberdorfer A, Wiggers JH, Bowman J, Burrows S, Cockburn J, Considine RJ
Source: American Journal of Infection Control, May 2004, Vol. 32(3):147-154
Click here for abstract

"Treatment of Chronic Hepatitis C Virus in the Virginia Department of Corrections: Can Compliance Overcome Racial Differences to Response?"
Authors: Sterling RK, Hofmann CM, Luketic VA, Sanyal AJ, Contos MJ, Mills AS, Shiffman ML
Source: American Journal of Gastroenterology, May 2004, Vol. 99(5):866-872
Click here for abstract

"Honoring Tradition, Accepting New Ways: Development of a Hepatitis B Control Intervention for Vietnamese Immigrants"
Authors: Burke NJ, Jackson JC, Thai HC, Stackhouse F, Nguyen T, Chen A, Taylor VM
Source: Ethnicity and Health, May 2004, Vol. 9(2):153-169
Click here for abstract

"Impact of Thimerosal-Related Changes in Hepatitis B Vaccine Birth-Dose Recommendations on Childhood Vaccination Coverage"
Authors: Luman ET, Fiore AE, Strine TW, Barker LE
Source: JAMA, May 19, 2004, Vol. 291(19):2351-8
Click here for abstract

"The Natural History of Chronic Hepatitis B Virus Infection"
Author: McMahon BJ
Source: Seminars in Liver Disease, 2004, Vol.24(Suppl 1):17-21
Click here for abstract