ADULT HEPATITIS 317 VACCINE EXPERIENCE Florida National Immunization

ADULT HEPATITIS 317 VACCINE EXPERIENCE Florida National Immunization Conference April 2, 2009 Philip E. Reichert, MPH Program Administrator Florida Hepatitis Prevention Program

FLORIDA Geography • Population (2008 mid-year): 18, 851, 975 • Area: 58, 560 Square Miles (4308 swamp, lakes, etc) • Pensacola to Key West: 829 miles (by car) • Coastline: 1197 miles • Highest Point: 345 feet • 67 Counties • Five Largest Counties (Population): 43% of Citizens • Multi-Cultural: Several Latino Cultures (Cuban, Puerto Rican, Central & South American), Several Black Cultures (A-A, Caribbean, Central & South American)

Sunshine State Naples Beach

Hepatitis Program Staff Tallahassee April Crowley – Health Education Coordinator (850) 245 -4444 ext. 2580 Nosipho Beaufort – Field Services Coordinator (850) 245 -4444 ext. 2589 Jessi Embleton – Office Manager (850) 245 -4444 ext. 2430 Carl Mc. Kissick – Data Coordinator (850) 245 -4444 ext. 2513 Cyndena Hall - Surveillance & Research Coordinator (850) 245 -4444 ext. 2589 Phil Reichert – Program Administrator (850) 245 -4426 E-MAILS are: first_last@doh. state. fl. us

Funding • CDC: $86, 000 in 2009 (AVHPC Grant: Adult Viral Hepatitis Prevention Coordinator) • General Revenue: $3. 1 Million (– 4%) • Budget Cuts in 2009 -2010 (15+%? ) • 317 Vaccine 2009 - $1. 1 million

General Revenue From State Legislature • 6 County Programs (buy their own vaccine): $1, 528, 000 • 5 County Programs (Medium funding): $382, 000 • 4 County Programs (Minimum Funding): $240, 000 • Laboratory, Vaccine, 5 FTEs, Educational Materials, Other Program Expenses: $950, 000

Ft. Walton Beach

Hepatitis 09 Program County Health Departments (CHD) -Hepatitis A, B & C Testing -Adult Hep A & B Vaccine -Risk Assessment of Clients

Testing • Hepatitis A, B & C antibody panels through the 5 State Labs • Home Access Hepatitis C Kits

Hepatitis Panel Tests* State Laboratory 2005 - 2008 2005 # Tests 13, 647 # Diff Prev Yr % Dif Prev Yr - 2006 14, 230 +583 +4. 3% 2007 24, 842 +10, 612 +74. 6% 2008 34, 608 +9766 +39. 3% 2005 – 2008 # Difference: +20, 961 2005 – 2008 % Difference: +153. 6% *The hepatitis panels include: Hep A antibody, hep B core antibody, hep B surface antigen & hep C antibody

Possible Reasons for Increase in Testing _________________________ • 317 Vaccine Initiative—offer testing before starting vaccine • Health depts already drawing blood for syphilis and HIV; clients consent to hep testing at same time • Testing is easier than providing vaccine for health care givers • Some health care givers fundamentally opposed to providing vaccine before they know if client will benefit

Risk Assessments • CHDs routinely risk assess clients • Risk assessments from 10 sentinel counties analyzed to determine where prevention interventions need to be (Populations at risk, demographics, best interventions…)

Case Reporting and Investigation ________________________________ • Acute A & B and Acute and Chronic C • Reported through Merlin at CHDs • Bureau of Epidemiology follows up on outbreaks

Education & Information • Brochures, Posters & Other Written Materials • Videos, CD-ROMs (In the past: PSAs) • Educational Conference • Hepatitis 101 via Conference Call & e-mailed Slides

Surveillance • Reported Cases are compiled monthly • The Division of Disease Control MONTHLY SURVEILLANCE REPORT • Includes: Acute A, B & C and Chronic C (And HIV/AIDS, STD, TB)

Hollywood (Not California)

Vaccine Program • Hepatitis A and B Vaccine available through Hepatitis Prevention Program • Vaccine Accountability by Field Services Coordinator

317 Vaccine Initiative 2007: $400, 000 -16, 175 doses of hep B -Enhanced vaccine delivery via STD 2008: $785, 823 -25, 871 doses of hep B vaccine -3866 doses of combination A/B -9 county jails & continue in STD

317 Vaccine Initiative 2009: $1, 097, 172 -24, 200 doses of hep B vaccine -12, 800 doses of combo hep A/B -TOTAL: 37, 000 doses -Health dept STD and HIV clients -8 county jails -Fla Dept of Corrections -6 Substance abuse treatment facilities -2 CBOs -1 University health facility

Key West

Hepatitis A Vaccine 2006 # Vaccines Given # Diff from Prev Year 2007 2008 9873 11, 895 12, 315 -- +2022 +420 +20. 5% +3. 5% % Diff from Prev Year --

Hepatitis B Vaccine 2006 2007 2008 18, 552 20, 295 18, 439 # Diff from Prev Year -- +1742 -1856 % Diff from Prev Year -- +9. 4% -9. 1% # Vaccines Given

Hepatitis A/B Combo 2006 2007 2008 2796 4836 10, 677 -- +2040 +5841 % Diff from Prev Year -- +73% +120. 8% # Vaccines Given # Diff from Prev Year

TOTAL A, B & A/B Vaccines 2006 31, 221 2007 37, 026 2008 41, 431 # Diff from Prev Year -- +5805 +4405 % Diff from Prev Year -- +18. 6% +11. 9% # Vaccines Given

South Beach (Miami)

How did we Promote 317? For 2007: -Letter to 67 County Health Depts (CHD) -Tied to CDC MMWR Elimination of Hepatitis B in Adults (Dec 2006) -Survey in Oct 2007 (47 of 67 counties responded) -46 of 47 (98%) implemented hep B For 2008: -Memo of Agreement (9 county jails) -Updated letter to CHDs

How Did We Promote 317? For 2009: -6 MOAs -Technical Assistance calls -TA e-mails -No travel this year unless an agency requests on-site TA or training -Regular collaboration with STD, HIV & county health depts -Contact person at each agency

Daytona Beach

Fla Viral Hepatitis Council • • Established 2004 Partnership between state & community Meets twice a year Provides advice & guidance to the state Hepatitis Prevention Program • Charged with writing a comprehensive hepatitis prevention plan • 6 Goals, 28 Objectives

Sunset over Tampa Bay

Thank You for Listening And thanks for all of your hard work helping others Contact Information Philip E. Reichert (850) 245 -4426 phil_reichert@doh. state. fl. us www. Fla. Hepatitis. org