Hepatitis A, B, and C Prevention Programs
Information and Programs for Adults and Adolescents at Risk
 
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School-based programs for adolescents

 
North Carolina School-Site Hepatitis B Immunization Initiative
Program name: North Carolina School-Site Hepatitis B Immunization Initiative
Population served: Adolescents
Eligibility: All sixth-grade students in North Carolina
Region served: North Carolina
Funding: State and federal funds
Program started: 1995
Number of clients: We have vaccinated more than 521,961 students in the first nine years of the initiative, and 42,266 students participated in the 2003-2004 initiative.
Contact: Patricia Poole
Hepatitis B Coordinator
North Carolina Division of Public Health
Immunization Branch
1917 Mail Service Center
Raleigh, NC 27699-1917
Phone: (919) 707-5573
Fax: (919) 707-5594
Email: patricia.poole@ncmail.net
Website: http://www.immunizenc.com
IAC is not responsible for content found on other websites.
Description:
Hepatitis B virus (HBV) infection is a serious public health threat in the United States with approximately 79,000 new acute cases occurring each year. Transmission occurs through contact with blood and body fluids. Seventy percent of acute infections occur during adolescence and young adulthood. About 10% of newly infected adolescents and adults develop lifelong infections which result in complications such as chronic hepatitis, fibrosis, cirrhosis, and liver cancer. HBV infections can be prevented with vaccinations.

In 1994, the Centers for Disease Control and Prevention (CDC) added vaccination of adolescents to the national hepatitis B prevention strategy. Since July 1, 1994, North Carolina’s immunization law requires the hepatitis B vaccination series for all children. In 1995, the North Carolina Immunization Branch launched a statewide initiative to offer hepatitis B vaccinations to susceptible sixth-graders in school-site clinics. This strategy was designed to reach unvaccinated adolescents before the age of greatest risk of exposure to HBV. Since adolescents attend fewer than one health care visit each year, the school-site initiative offers an effective plan to vaccinate this high-risk population. School initiatives are convenient for parents and increase the likelihood adolescents will complete the recommended hepatitis B three-dose vaccination series.

North Carolina’s local health departments (LHD) conduct the Sixth-Grade School-Site Hepatitis B Immunization Initiative in collaborative relationships with schools with the goal of vaccinating 70 percent of North Carolina’s sixth-graders against hepatitis B. In the SY 2003-2004 initiative, students who received parental consent for vaccination were eligible to participate in the initiative. In the 99 participating counties, 42,466 of 109,774 total sixth-grade students received the first dose of vaccine during the initiative. This number represents 39 percent of the total number of students and 93 percent of the eligible students who had parental consent to participate in the initiative. Eighty six percent (36,439) of the 42,466 participating students completed the three-dose series during the school-site initiative.

Over the past four years, there have been fewer children participating in the initiative. Decreasing participation rates are likely due to children being vaccinated by providers outside the school-based clinics. Insufficient data prevents determination of overall county vaccination rates. However, the initiative continues to be worthwhile with the administration of 122,241 doses of hepatitis B vaccine and 17,592 routine Td booster vaccinations to 42,266 students during the SY 2003-2004 school-site initiative.

Recent state and national data reflect the effectiveness of hepatitis B vaccination. From 1982-1998, national data indicate a decline in new hepatitis B cases. The greatest decline in disease incidence is seen among persons 10-19 years of age (73 percent decline), followed by those 20-29 years of age (71 percent decline). In North Carolina, from 1991-2003, similar decline is seen with 96 percent fewer cases reported in persons 10-19 years of age and 68 percent fewer cases reported in persons 20 years of age and older. The decline in disease incidence in adolescents is thought to be related to immunization programs for infants, children, and adolescents.

Conclusion
The North Carolina Sixth-Grade School-Site Hepatitis B Immunization Initiative is fulfilling its role in the national hepatitis B prevention strategy by providing a unique opportunity to immunize susceptible adolescents before they reach the age of greatest risk of contracting disease. The initiative is slated to continue through SY 2005-2006, when students entering sixth grade should have been vaccinated, as mandated by state law, prior to school entry.

In recent years, increasing numbers of sixth graders have received hepatitis B vaccinations outside the school-site clinics. Inevitably, parents may give consent for previously vaccinated children to participate in the initiative. In these final two years of the initiative, it is important to note that collaboration among LHDs, schools and physicians is of utmost importance to review immunization histories and to avoid administration of unnecessary doses of vaccine.

Initiative data illustrate the success of vaccinating more than 521,861 of North Carolina’s adolescents in the past 10 years. While data indicate vaccination programs have been very successful, the reduction of hepatitis B related liver disease will not be fully realized until these vaccinated children reach adulthood. The public health benefit of this immunization program will bring immeasurable dividends for years to come.

To access a paper on this program, "Impact of Immunization Initiatives on Acute Hepatitis B Incidence in North Carolina (1991-2005)," click here.


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