Hepatitis B Vaccination in Six STD Clinics in the United States Committed to Integrating Viral Hepatitis Prevention Services

Hepatitis B virus (HBV) infection is vaccine-preventable. An estimated 1.25 million Americans have chronic HBV infection, which can lead to lifelong infection, cirrhosis of the liver, liver failure, liver cancer, and death.1 The primary routes of HBV transmission in the U.S. are through sexual contact with an infected partner and percutaneously via contaminated needles or syringes (e.g., illicit injection drug use). Of the total number of people with acute HBV infection reported to the Centers for Disease Control and Prevention (CDC) from 1982 to 1998, 36% had been previously treated for a sexually transmitted disease (STD).2 Recognizing the public health importance of hepatitis B vaccination, CDC's 2002 STD treatment guidelines recommended for the first time that all unvaccinated adults being seen in STD clinics should be considered at high risk for HBV infection and receive hepatitis B vaccination.3 This recommendation was reinforced in CDC's 2006 STD treatment guidelines and 2006 strategy to eliminate transmission of hepatitis B virus in the United States.4,5 Furthermore, one of CDC's Healthy People 2010 objectives recommends that 90% of public STD clinics nationwide offer hepatitis B vaccination to all clients.6 Although there has been some progress in vaccinating clients of public STD clinics,7 as of 2001, only 26% of STD clinic program managers reported that all clients attending these clinics were eligible for vaccination—a notable increase from 9% in 1997, but far short of the 90% goal.8 This article examines trends in hepatitis B vaccination from as early as 1997 to 2005 in six STD clinics in the United States that were committed to integrating viral hepatitis prevention services—including hepatitis A and B vaccination and hepatitis C virus (HCV) counseling, testing, and referral—with existing clinical services. It also provides insights from senior STD clinic staff on hepatitis B vaccination efforts and trends.