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Hep Express Issue 60

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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August 30, 2007
OFFICIAL CDC HEALTH ADVISORY: HEPATITIS A IN A FOOD HANDLER WHO SERVED PERSONS FROM MULTIPLE STATES

[The following is cross posted from the Immunization Action Coalition's "IAC EXPRESS" electronic newsletter, 8/27/07.]

On August 26, CDC's Health Alert Network issued an official CDC Health Advisory titled "Hepatitis A in a Food Handler Who Served Persons from Multiple States." It is reprinted below in its entirety.

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The Centers for Disease Control and Prevention (CDC) has recently been notified that an employee of a single Jamba Juice store in San Jose, California was recently diagnosed with hepatitis A. The food service worker also assisted with the preparation of fresh fruit smoothies for distribution at the booth of an exhibitor (JumpSport) at the 43rd Annual USA Gymnastics (USAG) National Congress and Trade Show held in conjunction with the 2007 Gymnastics National Championships, in San Jose, California. Attendees at the trade show and gymnastics competition were from a number of states and have since returned home.

Because it is likely the employee followed good hand hygiene and food safety practices, the risk of exposure is small. However, persons exposed in the last 14 days can reduce their risk. Persons who may have been exposed include:

  • Persons who ate or drank at the 1140 Lincoln Avenue San Jose, CA Jamba Juice on August 1-3, 6-9, 11, 13 and 15-16.
  • Persons who drank fruit smoothies distributed from the JumpSport booth at the USAG trade show on August 16 and 17.

People who have had a hepatitis A vaccine or have had the illness in the past, are protected from hepatitis A infection. CDC recommends that persons who are not protected and are within 14 days of exposure contact their medical provider or their state or local health department to receive a dose of single antigen hepatitis A vaccine or immune globulin (IG).

  • Healthy persons between the ages of 12 months and 40 years can receive single antigen hepatitis A vaccine or IG.
  • For persons over the age of 40 years, IG is preferred. Vaccine can be used if IG cannot be obtained.
  • IG should be used for children under the age of 12 months, immune compromised persons, persons who have been diagnosed with chronic liver disease, and persons for whom vaccine is contraindicated.

In persons exposed more than 14 days ago, vaccine or IG treatment will not prevent the illness. Those persons should watch for symptoms of hepatitis A and practice good hygiene, including frequent hand washing with soap and water.

Hepatitis A is a liver disease caused by the hepatitis A virus. Symptoms usually occur abruptly and include fatigue, abdominal pain, loss of appetite, nausea, jaundice (yellowing of the skin or eyes), and diarrhea. Symptoms usually last less than two months; but some people may be ill for as long as six months. The average time from exposure to symptoms is 28 days, but can range from 1550 days. Good personal hygiene, including frequent hand washing with soap and water is very important in preventing the spread of hepatitis A. If you experience symptoms, please contact your health care provider.

People seeking medical care related to possible exposure can contact Jamba Juice to learn about their reimbursement policy for related medical expenses and obtain a reimbursement form by calling (877) 217-4780.

More information about hepatitis A is available at http://www.cdc.gov/ncidod/diseases/hepatitis/ or by calling the CDC information line at (800) CDC-INFO ([800] 232-4636).

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To access the health advisory, go to:
http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00266
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August 30, 2007
NEW: SPANISH-LANGUAGE VERSION OF THE CURRENT RECOMMENDED ADULT IMMUNIZATION SCHEDULE NOW ONLINE

[The following is cross posted from the Immunization Action Coalition's "IAC EXPRESS" electronic newsletter, 8/27/07.]

The October 2006-September 2007, Recommended Adult Immunization Schedule is now available in Spanish and can be printed from the CDC website. The Recommended Adult Immunization Schedule--which was released in English in October 2006--has been approved by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Family Physicians (AAFP), the American College of Physicians (ACP), and the American College of Obstetricians and Gynecologists (ACOG).

To access the Spanish-language schedule directly, click here.

To view, download, or print the adult schedule in various
formats, visit http://www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm
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August 30, 2007
IAC UPDATES THREE OF ITS SPANISH-LANGUAGE VIRAL HEPATITIS SCREENING QUESTIONNAIRES

[The following is cross posted from the Immunization Action Coalition's "IAC EXPRESS" electronic newsletter, 8/20/07.]

IAC recently posted Spanish-language versions of three of its newly updated viral hepatitis screening questionnaires: (1) "Should You Be Vaccinated Against Hepatitis A?" (2) "Should You Be Vaccinated Against Hepatitis B?" and (3) "Should You Be Tested for Hepatitis C?" Following are links to the Spanish- and English-language versions of the three.

(1) To access "Se debe vacunar contra la hepatitis A? Un cuestionario para adultos para determinar si se deben vacunar," go to: http://www.immunize.org/catg.d/p2190-01.pdf

To access "Should You Be Vaccinated Against Hepatitis A? A questionnaire for adults," go to:
http://www.immunize.org/catg.d/2190hepa.pdf

(2) To access "Se debe vacunar contra la hepatitis B? Un cuestionario para adultos para determinar si se deben vacunar," go to: http://www.immunize.org/catg.d/p2191-01.pdf

To access "Should You Be Vaccinated Against Hepatitis B? A questionnaire for adults," go to:
http://www.immunize.org/catg.d/2191hepb.pd 

(3) To access "Le deben hacer la prueba de la hepatitis C? Un cuestionario para adultos para determinar si necesitan la prueba," go to: http://www.immunize.org/catg.d/p2192-01.pdf

To access "Should You Be Tested for Hepatitis C? A questionnaire for adults," go to: http://www.immunize.org/catg.d/2192hepc.pdf

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August 30, 2007
IAC POSTS NEW AND UPDATED IMMUNIZATION-EDUCATION PRINT MATERIALS, INCLUDING STANDING ORDERS FOR HEPATITIS B VACCINE

IAC recently updated several of its immunization-education materials and created one new piece. Details follow:

UPDATED VIRAL HEPATITIS MATERIALS
Changes were made to the following to reflect CDC's hepatitis B vaccination recommendations, which were revised in December 2005 (children and adolescents) and December 2006 (adults).

(1) To access the newly revised piece "Standing Orders for Administering Hepatitis B Vaccine to Children & Teens," go to: http://www.immunize.org/catg.d/p3076a.pdf

(2) To access the newly revised piece "Standing Orders for Administering Hepatitis B Vaccine to Adults," go to: http://www.immunize.org/catg.d/p3076.pdf

UPDATED GENERAL IMMUNIZATION MATERIALS
(1) Intended to help health professionals direct parents and patients to science-based immunization information, "Reliable Sources of Immunization Information: Where to go to find answers!" was updated with new information.

To access it, go to: http://www.immunize.org/catg.d/p4012.pdf

(2) The professional-education resource "It's Federal Law! You must give your patients current Vaccine Information Statements (VISs)" was updated to reflect the dates of the most current versions of VISs.

To access it, go to: http://www.immunize.org/catg.d/p2027.pdf

(3) The parent-education resource "When Do Children and Teens Need Vaccinations?" was revised to include updated information on hepatitis A, influenza, Tdap, HPV, and meningococcal vaccination.

To access it, go to: http://www.immunize.org/catg.d/p4050.pdf

NEW GENERAL IMMUNIZATION PIECE
IAC recently developed a new two-page chart titled "Guide to Contraindications and Precautions to Commonly Used Vaccines." It is adapted from information found in the CDC document "General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP)."

To access the new chart, go to: http://www.immunize.org/catg.d/p3072a.pdf

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August 30, 2007
HEPATITIS B FOUNDATION ADDS ANOTHER EXPERT SPEAKER PRESENTATION TO ITS WEBSITE

The Hepatitis B Foundation (HBF) recently added a presentation by Dr. Samuel So to its online Expert Speakers Forum. Each of the six available presentations is available in audio, video, and printer-friendly text formats.

The experts and their topics follow.

Samuel So, MD, FACS: "How Serious is Hepatitis B?"

Hillel Tobias, MD, FACS: "What is the impact of hepatitis B in the U.S?"

W. Thomas London, MD: "Why is hepatitis B important?"

Emmet Keeffe, MD: "Evolving Treatment Strategies for Chronic Hepatitis B"

Samuel So, MD, FACS: "Eliminating the Voodoo from Hepatitis B"

Harold Margolis, MD: "Viral Hepatitis--A National Perspective: Closing the Gaps"

To access the HBF Expert Speakers Forum, go to: http://www.hepb.org/expforum

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August 30, 2007
NOW IS A GREAT TIME TO PURCHASE IAC'S TOP-QUALITY PRODUCTS, ESPECIALLY IF YOU HAVE FISCAL YEAR-END-DOLLARS TO SPEND

Private practices, public clinics, corporations, and health departments find IAC's immunization products to be of great value in simplifying and improving the quality of vaccination delivery. August and September are a great time to stock up--as the influenza vaccination season is gearing up.

Also, if your fiscal year end is September 30, buying needed materials is a good way to spend "left-over" dollars. If you can make major purchases, please do--that way, you'll receive significant discounts.

Several months ago, IAC introduced a shopping cart to make it easy for you to buy any and all of our products with one simple transaction. Available products include

IMMUNIZATION RECORD CARDS
IAC offers three vaccination record cards: the popular adult card (more than 5 million sold) and two new cards--one for recording child and teen vaccinations and another for recording lifetime vaccinations. To learn more about IAC's cards and to view images of each, or to order online or download an order form, visit www.immunize.org/shop

In recent years, many states, health plans, and corporate partners have placed large orders for IAC's record cards and had them customized with special colors, logos, and text. For quotes on customizing or placing orders in excess of 200 boxes, or to request sample cards, call (651) 647-9009 or email admin@immunize.org

LAMINATED IMMUNIZATION SCHEDULES
IAC offers immunization schedules for two age groups: The child/teen immunization schedule is for people ages 0-18 years; it was updated for use in January 2007 and is approved by ACIP/AAP/AAFP. The adult schedule is for everyone else; it was approved by ACIP/AAFP/ACOG/ACP and updated for use from October 2006-September 2007. This schedule will expire soon. To order the new laminated adult schedule, please check back in November at www.immunize.org/shop Both schedules are laminated for heavy-duty use, complete with essential footnotes, and printed in color for easy reading.

"IMMUNIZATION TECHNIQUES" VIDEOTAPE AND DVD
Developed by the California Department of Health Services Immunization Branch in collaboration with a team of national experts, "Immunization Techniques: Safe, Effective, Caring" is considered a vital immunization tool. In a short 35 minutes, the video teaches best practices for administering intramuscular and subcutaneous vaccines to infants, children, and adults. It is designed for use as a "hands-on" instructional program for new staff and as a refresher course for experienced vaccinators.

The video is available in VHS tape and DVD formats. For information about the two formats and the print materials included with each, or to order online or to download an order form, visit www.immunize.org/shop

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August 30, 2007
CDC REPORTS ON U.S. KINDERGARTENERS' VACCINATION COVERAGE DURING THE 2006-07 SCHOOL YEAR

[The following is cross posted from the Immunization Action Coalition's "IAC EXPRESS" electronic newsletter, 8/20/07.]

CDC published "Vaccination Coverage Among Children in Kindergarten--United States, 2006-07 School Year" in the August 17 issue of MMWR. Portions of the article are reprinted below.

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Healthy People 2010 objectives include increasing vaccination coverage among children in kindergarten and first grade (objective 14-23). For these children, the target is >=95% vaccination coverage for the following: 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 vaccine; measles, mumps, and rubella (MMR) vaccine; and varicella vaccine. To assess progress toward national goals and determine vaccination coverage among children in kindergarten, data were analyzed from reports submitted to CDC by 49 states and the District of Columbia (DC) for the 2006-07 school year. This report summarizes findings from that analysis, which indicated that approximately 75% of states have reached the 2010 objective of at least 95% coverage for all of the vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) for children in kindergarten. These results underscore the effectiveness of school-entry requirements in increasing vaccination coverage but highlight a need for more standardized vaccination reporting among states. . . .

Among the reporting states, coverage ranged from 32 (74%) states with >=95% coverage for varicella vaccine to 35 (83%) states with >=95% coverage for hepatitis B vaccine. Although four states do not require or monitor mumps vaccination and one state does not require or monitor rubella vaccination, MMR usually is the vaccine of choice for protection against measles; therefore, children who receive this vaccine are protected against all three diseases. Thirty-five (70%) states reported >=95% coverage for MMR. Thirteen of the reporting states did not meet the 95% coverage target for one or more of the vaccines. . . .

EDITORIAL NOTE:
State laws requiring proof of vaccination at early school entry are key to the U.S. vaccination program and help ensure that no child is unvaccinated. The effectiveness of these laws depends on school nurses, teachers, health department staff members, and others identifying children whose vaccinations are not up to date. The findings from this analysis indicate that approximately 75% of states have reached the 2010 objective of at least 95% coverage for all vaccines recommended for children in kindergarten. The high nationwide coverage indicated in this analysis and other surveys in recent years underscore the success of school-entry requirements in boosting vaccination coverage. Childhood vaccination coverage also is measured nationally among children aged 19-35 months. Higher percentages of children are up to date at kindergarten entry than at younger ages, suggesting that early school-entry laws help maintain high coverage and ensure completion of the vaccine doses recommended for children by ages 4-6 years. . . .

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To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5632a3.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5632.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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August 30, 2007
JOURNAL ARTICLES YOU MAY HAVE MISSED

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

"Differences in Response to a Hepatitis B Vaccine Booster Dose among Alaskan Children and Adolescents Vaccinated During Infancy"
Authors: Samandari T, Fiore AE, Negus S, Williams JL, et al.
Source: Pediatrics, August 2, 2007, Vol. 120(2):e373-e381
http://pediatrics.aappublications.org/cgi/content/full/120/2/e373

"Why We Should Routinely Screen Asian American Adults for Hepatitis B: A Cross-Sectional Study of Asians in California"
Authors: Yin SY, Chang ET, So SK
Source: Hepatology, July 24, 2007, e-published ahead of print
Click here for article.

"Reducing Liver Cancer Disparities: A Community-Based Hepatitis B Prevention Program for Asian-American Communities, MD [Maryland]"
Authors: Hsu CE, Liu LCH, Juon HS, et al.
Source: Journal of the National Medical Association, August
2007, Vol. 99(8):900-7
http://www.nmanet.org/images/uploads/Journal/OC900.pdf

"Revisiting the Natural History of Chronic Hepatitis B: Impact of New Concepts on Clinical Management"
Author: Yuen MF
Source: J Gastroenterol Hepatol, July 2007, Vol. 22(7):973-6
Click here for article.

"Cancer Incidence, Mortality, and Associated Risk Factors among Asian Americans of Chinese, Filipino, Vietnamese, Korean, and Japanese Ethnicities"
Authors: McCracken M, Olsen M, Chen, et al.
Source: CA Cancer J Clin, July-August 2007, Vol. 57:190-205
http://caonline.amcancersoc.org/cgi/content/full/57/4/190

"Maternal Hepatitis B Infection and Gestational Diabetes Mellitus"
Authors: Lao Y, Chan B, Leung W, Ho L, Tse K
Source: J Hepatol, July 2007, Vol. 47(1):46-50
Click here for article.

"Occupational Risks of Blood Exposure in the Operating Room"
Author: Fry DE
Source: Am Surg, July 2007, Vol. 73(7):637-46
Click here for article.

"Rising Hepatitis A Immunity in U.S. Military Recruits"
Authors: Nevin RL, Niebuhr DW
Source: Military Medicine, July 2007, Vol. 172(7):787-93
Click here for article.

"Seroprevalence of Hepatitis C Virus and Hepatitis B Virus among
San Francisco Injection Drug Users"
Authors: Tseng FC, O'Brien TR, Zhang M, et al.
Source: Hepatology, July 26, 2007, epublished ahead of print
Click here for article.

"Needle Exchange and Injection-Related Risk Behaviors in
Chicago: A Longitudinal Study"
Authors: Huo D, Ouellet LJ
Source: J Acquir Immune Defic Syndr, May 1, 2007, Vol. 45(1):108-14
Click here for article.

"Development, Description, and Acceptability of a Small-Group,
Behavioral Intervention to Prevent HIV and Hepatitis C Virus
Infections among Young Adult Injection Drug Users"
Authors: Purcell DW, Garfein RS, Latka MH, et al.
Source: Drug Alcohol Depend, April 25, 2007
Click here for article.


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