Hepatitis A, B, and C Prevention Programs
Information and Programs for Adults and Adolescents at Risk
Presented by the Immunization Action Coalition with dedicated funding from the
Division of Viral Hepatitis at the Centers for Disease Control and Prevention
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Programs for other populations at risk

Wenatchee Valley Medical Center
Program name: Wenatchee Valley Medical Center
Population served: Persons with hepatitis C infection
Eligibility: Individuals presenting for treatment at one of seven Wenatchee Valley Clinic locations
Region served: Washington state, Wenatchee Valley area
Funding: Patient insurance, Medicaid, and underwriting by clinic
Program started: 1991
Number of clients: 162 since 1991
Contact: Richard Tucker, MD
Medical Director of Quality and Education
Wenatchee Valley Medical Center
820 N. Chelan Street
Wenatchee, WA 98801
Phone: (509) 663-8711
Fax: (509) 667-7368
Email: rtucker@wvclinic.com
Website: None

The Wenatchee Valley Medical Center consists of seven clinics located in the interior of Washington state. The clinics have been diagnosing and treating a growing number of patients infected with hepatitis C who are at risk for serious sequelae from possible hepatitis A and/or B co-infections.

Since 1991, patients testing positive for hepatitis C infection at the Wenatchee Valley Medical Center (WVMC) have been enrolled in a Nursing Case Management (NCM) program that uses standing orders for diagnostic assessment, hepatitis C treatment, and hepatitis A and B vaccination. Our "Chronic Conditions Care Model" details guidelines and protocols, and helps our practice team be prepared and proactive and our patients be informed and activated.

It is the policy of WVMC to provide quality medical case management of hepatitis C patients with the use of standard baseline physician orders and follow-up physician orders. An infectious disease parallel chart is maintained in the Infectious Disease Department. The Medical Case Manager evaluates the database of enrolled patients for the purpose of obtaining demographics, response to therapy, and vaccination status.

A recent survey of 99 patients enrolled from 6/91-2/02 found the following:

52% were female, 48% were male
Age range: 24-89 years of age; median: 46
Known dead: 6/99
Status unknown: 11/99
Known alive: 82/99
Actively followed: 42/82
HIV co-infection: 19/99 (19%)
HBV serologies obtained: 93/99 (93%)
HBsAg+: 2/93 (2.2.%)
HBcAb+: 33/93 (35%)
HBsAb+: 28/93 (30%)
HBsAb+ and HBcAb+: 22/93 (24%)
Sero-susceptible: 41/99 (41%)
HAV serologies obtained: 93/99 (95%)
HAV Ab: 32/93 (41%)
Sero-susceptible: 58/99 (59%)

Prior vaccination:

Prior HAV vaccination: 3/99 (3%)
Prior HBV vaccination: 5/99 (5%)

Vaccination of sero-susceptibles:

Hepatitis B vaccination initiated: 39/41 (95%)
Hepatitis A vaccination initiated: 49/58 (84%)

Treatment statistics ("-IFN and ribavirin):

57/99 (60%) received treatment
14/57 (24%) remained on treatment
15/43 (35%) "cured" (ITT)

It has been our experience that Nursing Case Management: 1) enhances vaccination rates, 2) limits a significant amount of co-morbidity, 3) facilitates psychosocial management, 4) may improve adherence with treatment, 5) may improve response to treatment.

Immunization Action Coalition
          Hepatitis Prevention Programs

1573 Selby Ave, Ste 234   St Paul, MN 55104   Tel (651) 647-9009   Fax (651) 647-9131