In 2002, hepatitis A rates increased dramatically in certain counties of the state. Rates doubled over previous years. The increase was largely attributable to MSM activity (men who have sex with men), especially in white males in the 25-44 age group. At the time, the CDC was interested in decreasing rates of HAV infection, so the state Immunization Branch applied for a grant. After receiving the grant, the Immunization Branch made the decision to purchase Twinrix® vaccine. Through a pilot project, adults at risk for hepatitis A and/or hepatitis B virus infections and those infected with hepatitis C virus were targeted for vaccination. 5,530 doses of vaccine were purchased in the fall of 2002. The expiration date of the vaccine was 7-5-04. By the end of the project period, over 2,600 adults had been vaccinated.

The Twinrix® project that started in 2003 by HIV/STD Branch staff in collaboration with the State Immunization Branch continues today. Twinrix® is now available to high risk adult clients at nearly all (96%) of the local health department STD clinics across the State. Use of Twinrix® vaccine at local health departments has increased each year since (see table below). Communicable disease nurses at the health departments have received verbal encouragement to use the vaccine and consistent education about the importance of offering/administering the vaccine from both the hepatitis B and C coordinators. The nurses are strongly encouraged to offer the vaccine to everyone over 18 years of age who is seen in their STD clinic. Targeted risk factors include HIV positive status, HCV positive status, current or past IDU, MSM, MSP, current or past STD, and past incarceration. Site assessments of local health department HIV/STD clinics are routinely conducted by Branch staff (Quality Assurance, Training, and Development Team) that actively assesses the use of Twinrix® by the health department.

Total doses ordered by local health departments
2004...........15,695 (includes pilot project period)
2005...........13,685
2006 ..........18,050
2007...........20,000 (projected)

Using the above numbers and assuming that all vaccine recipients received the required 3 doses *, it can be estimated that the following numbers were vaccinated:
2004............5,230
2005............4,529
2006...........6,014
2007...........6,664

DATA
Total doses administered: 67,430 doses to approximately 22,437 criteria-eligible clients.