Presentation to the WA Joint Conference on Health 2010


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  • There are other hepatitis virus (D, E, G), but they are far less common in the U.S.
  • New treatments for HCV are expected to increase “cure” rates from 40% to up to 80%.
  • Section 317 (a.k.a. Immunization Grant Program) is available nationwide and provides vaccines to underinsured children and adolescents as well as to uninsured/underinsured adults “as funding permits.”
  • Persons living with HCV are one of the group sat greatest risk for complications related to super-infection of hepatitis A or B. As a result, the CDC recommends that all persons living with HCV, or at-risk for exposure to the virus, be vaccinated against HAV and HBV.
  • Currently working with 8 sites around Seattle. Currently have 13 active volunteer nurses/doctor (of 21 trained), including one nurse who does primarily street outreach.
  • 93 people are receiving the vaccine according to the accelerated dosing schedule, which means they need a 4 th booster dose one year from the 1 st dose; currently 74 of these people have 3 of the 4 doses.
  • Presentation to the WA Joint Conference on Health 2010

    1. 1. REACHING THE HARD-TO-REACH VACCINATING AT-RISK ADULTS AGAINST HEPATITIS A & B Maureen Oscadal, B.A. The Hepatitis Education Project Seattle, WA
    2. 2. Topics <ul><li>Introduction to the Hepatitis Education Project </li></ul><ul><li>Hepatitis 101 </li></ul><ul><li>CDC Vaccine Initiative </li></ul><ul><li>HEP’s Approach: Reaching the Hard-to-Reach </li></ul><ul><li>Challenges & Highlights </li></ul>
    3. 3. The Hepatitis Education Project <ul><li>The Hepatitis Education Project (HEP) is a non-profit organization based in Seattle, WA. </li></ul><ul><li>Since 1993 HEP has committed to providing support, education and advocacy for people affected by hepatitis and to helping raise hepatitis awareness among patients, medical providers and the general public. </li></ul>
    4. 4. The Liver & Hepatitis <ul><li>The Liver </li></ul><ul><ul><li>Performs over 500 different functions… </li></ul></ul><ul><ul><ul><li>Filter </li></ul></ul></ul><ul><ul><ul><li>Factory </li></ul></ul></ul><ul><ul><ul><li>Storage facility </li></ul></ul></ul><ul><ul><li>Regenerative </li></ul></ul><ul><ul><li>Non-complaining </li></ul></ul><ul><li>Hepatitis is a general term meaning liver inflammation… </li></ul><ul><ul><li>“ Hepa” refers to the liver </li></ul></ul><ul><ul><li>Any “itis” means inflammation </li></ul></ul>
    5. 5. Understanding Hepatitis <ul><li>Causes: </li></ul><ul><li>Viruses </li></ul><ul><li>Alcohol </li></ul><ul><li>Drugs/prescriptions </li></ul><ul><li>Herbs </li></ul><ul><li>Genetic disorders </li></ul><ul><li>Obesity </li></ul>
    6. 6. Hepatitis viruses <ul><li>Hepatitis A: fecal-oral transmission cycle; acute infection; contaminated food or water. </li></ul><ul><li>Hepatitis B: blood and body fluids; can occur as an acute or chronic infection; sexual, mother-to-child and injection drug use. </li></ul><ul><li>Hepatitis C: blood borne infection; direct blood-to-blood contact. </li></ul><ul><li>All 3 viruses can remain active/infectious outside of the body for several days. </li></ul>
    7. 7. Chronic Viral Hepatitis <ul><li>2 millions Americans HBV+. </li></ul><ul><li>In the United States most people get over this infection on their own (90-95%). </li></ul><ul><li>People infected for a long time have a higher risk of getting liver cancer. </li></ul><ul><li>People with chronic HBV can get liver cancer before cirrhosis. </li></ul><ul><li>Cancer screening is important. </li></ul><ul><li>Treatment is available for those who need it; there is no cure for HBV. </li></ul><ul><li>5 million Americans HCV+. </li></ul><ul><li>Approximately 75-80% of those exposed to HCV will develop the chronic infection. </li></ul><ul><li>At least 10,000 deaths from HCV annually in U.S. </li></ul><ul><li>Leading cause of liver transplantation in the U.S. </li></ul><ul><li>People with chronic HCV are at risk for cirrhosis, liver cancer and liver failure. </li></ul><ul><li>Treatment is available for those who need it; approximately 40% of patients attain Sustained Virological Response (SVR) on current treatment </li></ul><ul><li>Hepatitis B (HBV) </li></ul><ul><li>Hepatitis C (HCV) </li></ul>
    8. 8. Vaccine Preventable <ul><li>Hepatitis A </li></ul><ul><ul><li>2 shots over six months, lifelong protection </li></ul></ul><ul><li>Hepatitis B </li></ul><ul><ul><li>3 shots over six months, lifelong protection </li></ul></ul><ul><li>Combination hepatitis A/B shot available (Twinrix®) </li></ul><ul><ul><li>3 shots over six months OR 4 shots over 12 months, lifelong protection </li></ul></ul>
    9. 9. Adult Hepatitis B Vaccine Initiative <ul><li>According to the Centers for Disease Control (CDC), 42,000 adults in the United States die every year from vaccine-preventable diseases. </li></ul><ul><li>In 2007 the CDC made Section 317 funding available for the purchase of vaccine to protect at-risk adults against hepatitis A and B. </li></ul><ul><li>Since then Washington’s Department of Health has purchased hepatitis A/B combination vaccine (Twinrix®) with the funds. </li></ul>
    10. 10. Who is “at-risk”? <ul><li>Persons living with chronic hepatitis C. </li></ul><ul><li>Persons who have a history of drug use, either injection or non-injection. </li></ul><ul><li>Persons who have a history of high risk sexual practices or have been diagnosed with a sexually transmitted disease. </li></ul><ul><li>Persons who have sexual contact with someone infected with viral hepatitis. </li></ul><ul><li>Men who have sex with men. </li></ul>
    11. 11. HEP’s Role <ul><li>HEP seeks to provide relevant resources and services to people who are living with or at-risk for hepatitis B and C. </li></ul><ul><li>In February 2010 HEP partnered with Public Health Seattle-King County to offer free hepatitis A/B vaccinations as part of the CDC’s Adult Hepatitis B Vaccine Initiative. </li></ul>
    12. 12. HEP’s Model <ul><li>Vaccinations are provided during outreach to “non-traditional” settings. </li></ul><ul><li>Outreach includes: culinary arts training program, transitional housing locations, chemical dependency treatment centers, and street outreach. </li></ul><ul><li>Volunteer nurses administer vaccinations, other volunteers are available to test people for hepatitis C. </li></ul><ul><li>Utilizing both accelerated and standard dosing schedules. </li></ul>
    13. 13. As of February 2010… <ul><li>443 doses of vaccine have been administered. </li></ul><ul><li>222 people have received at least 1 dose. </li></ul><ul><li>127 people have received at least 2 doses. </li></ul><ul><li>84 people have received at least 3 doses; 10 of whom have completed the 3 dose series according to the standard schedule. </li></ul>
    14. 14. Who are we reaching? <ul><li>Approximately 21.5% of vaccine recipients report that they previously tested positive for hepatitis C. </li></ul><ul><li>Approximately 32% of vaccine recipients describe themselves as homeless. </li></ul><ul><li>Average income reported by vaccine recipients: $405/month. </li></ul><ul><li>Approximately 94% of vaccine recipients reside in King County; approximately 71% reside in Seattle. </li></ul>
    15. 15. Challenges <ul><li>Following up with clients who are homeless or marginally-housed (maximum immunity requires a series of 3 or 4* doses of the hepatitis A/B vaccine). </li></ul><ul><li>Identifying outreach sites that are appropriate but that can also accommodate the service. </li></ul><ul><li>Volunteer recruitment, scheduling and retainment. </li></ul><ul><li>Low-no cost hepatitis B testing services are limited; HEP does not offer this test. </li></ul><ul><li>Funding from CDC is expected to cease in 2011. </li></ul>* Accelerated schedule: 3 doses in1 month & a 4 th dose 1 year later.
    16. 16. Highlights <ul><li>Vaccination & testing services are entry points for educating people about disease transmission and prevention. </li></ul><ul><li>The service is made possible largely thanks to the service of HEP’s volunteer nurses who come from a number of local hospitals and clinics. </li></ul><ul><li>Offering services at “non-traditional” sites improves access to preventative health care for people who are marginally connected to the health care system. </li></ul><ul><li>Outreach is done in partnership with local organizations who have established relationships with the communities that HEP aims to serve. </li></ul>
    17. 17. The Hepatitis Education Project Maritime Building, Suite 302 911 Western Avenue Seattle, WA 98104 Ph. (206) 732-0311 Fax (206) 732-0312