The Massachusetts Department of Youth Services is the single agency for all pre-trial detention and adjudicated youth. We work with approximately 5,500 pre-trial youth/year and about 1,500 adjudicated youth/year. We serve adolescents as young as 12, but most are15-21 years of age. Most are sexually active, some are involved in commercial sex or survival sex, and most are substance abusers.

We work closely with the Massachusetts Department of Public Health to provide hepatitis B vaccine to all adjudicated clients. We do not try to immunize the 5,500 pre-trial detainees that we receive each year as their average stay is only 20 days, however we will vaccinate any pre-trial detainee if a parent requests. We do offer HBV to all adjudicated clients unless excluded because of past history of the disease, prior immunization, or parental or client refusal.

We have an average daily population of about 3,400 kids. About half are in residential care. We assume responsibility for providing health care to the kids in residential care and parents assume responsibility when a client returns home. The residential facilities range from large secure multi-program clusters to community-based non-secure sites. Health care provision also varies from on-site staff to care from local community health providers.

We use the modified 0, 1, 4 month schedule for hepatitis B vaccination and track clients using software and tech support provided by SmithKline Beecham. We also receive much support from our state’s VFC staff. As of March 2001, we had 4,405 clients in our tracking data base; 4,191 received one dose of HBV; 3,098 received two doses; and 1,891 received three doses.

Some of our limitations have been: obtaining parental/guardian consent, obtaining vaccination records, and timely data entry and reporting to and from field. The third dose is often due when the client has returned home, and VFC funding does not include the two-dose series for adolescents.

Massachusetts has recommended (not required) HBV for all students entering grade 6 since 1998. Consequently, many newly committed kids have had some or all of the series, and just need completion of the series or no HBV at all. It appears that we may need to do less with HBV in five years than we did five years ago.