An educational intervention was undertaken. Educational materials with information on hepatitis A virus transmission and prevention designed for MSM were distributed to area healthcare providers and to community locations familiar to the gay community. After a decrease in cases in 2000, the number of hepatitis A cases began to rise again. Wake County led the state in cases by 2002. A case of hepatitis A in a food service worker resulted in prophylaxis of more than 7,000 people at a cost of over $63,000. The burden of disease on the worker, the employer, and the healthcare system re-emphasized the need for education and increased vaccination coverage among high-risk groups.

The NC Office of Adult Immunizations made the combination hepatitis A/hepatitis B vaccine available. From March 2003 to April 2004, a task force of citizens, influential in the gay community, identified and implemented effective strategies to increase vaccination coverage in the MSM community.

The Task Force:

• Identified sites for hepatitis A/hepatitis B immunization outreach. Immunizations were given free at “MSM-friendly” community locations. Non-judgmental staff and volunteers provided immunizations at strategic times (example-at a local bar from 10:00 pm to 1:30 am).
• Developed positive, proactive sexual health messages that focused on taking action in protecting against hepatitis A and hepatitis B virus infections
• Developed informational postcards and posters promoting community vaccination sites.
• Distributed postcards and posters at bookstores, clubs, bars, community-based organizations, churches and other faith groups, local charity events, colleges, and universities.
• Promoted immunization sites in MSM-friendly media outlets and on e-mail listservs.

Eighty eight percent (88%) of those offered hepatitis A/hepatitis B vaccine chose to be vaccinated. The majority (90%) of participants ranged in age from 20-49 (20-29— 39%; 30-39— 35%; and 40-49— 16%). Ninety four percent (94%) of participants were male. Men having sex with men were identified as a risk factor for most participants (90%). Participants utilized community sites more as the project progressed and were more likely to report MSM as a risk factor. As of March 2004, 24% had completed the series while 76% of participants had received part of the series.

Buy-in, support and innovative strategies for vaccine delivery developed by the task force were instrumental to the success of this project. Offering vaccine at "gay-friendly" locations identified by the task force and providing staff and volunteers who were welcoming and non-judgmental were the keys to increased participation by the MSM community.

Currently the North Carolina Immunization Branch is offering the combination hepatitis A/hepatitis B vaccine at no charge to health department clients over age 18 who have the following risk factors:

• Men who have sex with men
• Injection drug users
• Persons with multiple sex partners
• Anyone who has been incarcerated
• Persons who are HIV positive or hepatitis C virus positive
• Persons with chronic liver disease, including persons with chronic HBV/HCV infection who have evidence of chronic liver disease or
• Persons seeking treatment for a sexually transmitted disease.

Those at risk can get this vaccine through the appropriate Wake County Human Services Clinics.