The epidemiology of hepatitis B vaccination catch-up among AAPI children in the United States.

PURPOSE: The purpose of this paper is to report on progress in addressing a major health disparity. During the 1970s hepatitis B virus (HBV) infection rates in U.S. Asian American and Pacific Islander (AAPI) children were 20-30 times higher than among white children. These rates remained 17 times greater among AAPI children into the 1990s. Now, although almost 90% of AAPI children born after 1993 receive hepatitis B vaccine (HepB) in time to prevent HBV infection, many born before 1993 do not. Among this group, household HBV transmission remains relatively high--0.5%-1% annually. METHODS: In the mid-1980s household HBV transmission was studied among AAPI communities and by 1999 HepB coverage surveys, demonstration projects, and interventions in schools, communities, and provider offices were conducted followed by ethnic-specific controlled trials and cost-benefit research. The goal was established to reach 90% coverage by 2004. PRINCIPAL FINDINGS: Since 1995, catch-up efforts raised HepB coverage among AAPI children born 1983-1993 from 10% to 60%. Now, AAPI children targeted for catch-up are 9-19 years of age. Currently, most students entering middle school have not received their HepB series, but recently enacted middle school entry requirements in 26 states and Washington D.C. ensure at least 60% of AAPI students receive HepB by 12 years of age. High school students are less likely to have received HepB--no high school entry regulations are present to ensure vaccination. CONCLUSIONS: Much progress has been made toward eliminating this health disparity. More progress can be made if more health departments in the largest cities conduct high school HepB interventions, starting in schools with the highest numbers of AAPI. In addition, physicians and nurses can remove existing barriers to vaccination services and implement effective tracking/reminder/recall procedures to ensure the AAPI teenagers in their practice receive HepB.