The Community Immunization Services
is a division of Palm Beach County Health Department. This is the division that
deals with viral hepatitis and is located in a group of offices connected to the
county warehouse. There are 6 large stand-up clinics in different parts of the
county. The administrators of our division are focused on managing vaccine
inventory and flow to the whole county and teaching certification classes (not
only to new nurses coming into the system, but also fire rescue personnel who
assist with the large flu clinics in the fall & winter). We have two viral
hepatitis prevention programs that work out of this division.
(A) One is the Perinatal Hepatitis B
Program that Michael Patterson manages with the assistance of Laneishia Adderly
under the direction of Denise Chisholm. This program identifies infants born to
HBsAg-positive women. Once the information is received regarding the infants
born to HBsAg-positive women, case managers follow the infant to insure the
administration of HBIG and three doses of hepatitis B vaccine according to the
current ACIP Recommendations. The infant is then tested for HBsAg and Anti-HBs
no sooner than 12 weeks following the third dose or when the child is 15 months
of age. Successful immunization is indicated by a positive anti-HBs and a
negative HBsAg. Infants positive for HBsAg are referred for medical evaluation.
Infants negative for anti-HBs and HBsAg should be revaccinated following either
option A or B as shown below:
Option A: Give a fourth dose of
hepatitis B vaccine and retest in one month for HBsAg and anti-HBs. If anti-HBs
is negative, give dose 5 and 6 and retest for HBsAg and anti-HBs in one month.
Option B: Give a complete second series of hepatitis B vaccine. Retest for HBsAg
and anti-HBs one month after the last dose. If the infant continues to be
negative for anti-HBs, the infant is considered to be a non-responder.
(B) The other program is the Adult
Hepatitis Program (Community Outreach) which is actually a conglomerate of 2
main sub-programs. For 10 months out of the year, weekly hepatitis clinics are
held and vaccines are administered to high-risk individuals at substance abuse
centers, correctional re-entry programs, alternative lifestyle community
centers, & migrant vocational centers. The other two months out of the year are
devoted mainly to flu outreaches. This program consists of one full-time RN and
one full-time clerk. Slowly, but steadily, the program has acquired laboratory
services at many of these outreach sites. Two days a month, this program sees
only hepatitis patients (mostly referred from gastroenterologists in the area).
This program provides the needed hepatitis vaccines, dietary instruction and
information on support groups and other resources. Recently, the STD clinic,
which has hepatitis funding, has hired a coordinator for the hepatitis program.
The coordinator and adult outreach nurse, along with the Medical Director for
the STD clinic, are working together to develop a coalition. Hopefully, this
will attract community partners who will grow to be strong advocates and
teachers at the community level.