CorrectCare

Georgia a Model for Juvenile Hepatitis B Vaccination

In about ten years, youths entering detention facilities will be part of the cohort that should have been vaccinated for hepatitis B as infants. However, many juvenile detention entrants who were not vaccinated as infants either need to initiate or complete the vaccine series. The greatest barrier to universal vaccination is cost. To overcome this obstacle, juvenile programs can take advantage of the federal Vaccine for Children program.

The VFC program provides free HB vaccine to youths who have yet to reach their 19th birthday. Juvenile facilities can access this vaccine, as well as a broad array of other vaccine materials, at no cost via their local public health departments.

At the Georgia Department of Juvenile Justice, medical director Michele Staples-Horne, MD, MPH, has collaborated with state and local health departments to maximize the number of detained youth who receive HB vaccine through the GDJJ.

Georgia provides universal HB vaccination for all infants and, for the past few years, catch-up vaccination for entrants to the 6th grade. Still, many youth entering the juvenile justice program have not been vaccinated. The GDJJ has 31 facilities spread out across the state. It admits about 60,000 youth per year, including both pretrial and sentenced juveniles. Reaching all of its unvaccinated juveniles is challenging.

Funding from the Centers for Disease Control and Prevention two years ago permitted hiring of a hepatitis coordinator who works closely with both the GDJJ and the Georgia Division of Public Health. At the GDPH, the federally funded state VFC program has partnered with the branches that address sexually transmitted diseases, adolescent health and epidemiology.

Prior to the initiation of this program, only two facilities in Georgia routinely vaccinated their charges, even though all incarcerated youth are eligible through the VFC program. Now, cooperative relationships have been set up between the GDJJ and the local health departments in all 159 Georgia counties.

Goals and Obstacles
The initial goals of the GDJJ program were to:
•  Enroll all 31 facilities in the VFC program.
•  Create a centralized tracking system, piggybacking on the institutional computer system.
•  Select and provide educational materials.

Various obstacles stood between the program’s planning and its implementation. For example, the requirement for parental consent for vaccinating youth was often cited as a barrier to administering vaccines in juvenile halls. However, HB is a sexually transmitted disease, and youth in Georgia can receive STD services, including HB vaccine, without parental consent. (For your state’s policy on minors’ access to STD services, see the Alan Guttmacher Institute Web site at www.agi-usa.org/pubs/spib_MASS.pdf.)

The fact that some youth are not detained long enough to complete a three-dose vaccination series should not deter initiation of vaccine. Completion of a three-dose series is optimal and provides greater than 95% protective immunity. However, if patients leave the facility before completion of vaccination, even one or two doses will provide an immunity for a smaller percent of individuals: One dose provides 30% to 50% protective immunity, and 2 doses provide approximately 75% of protective immunity. (See the January 2003 MMWR article on hepatitis in correctional facilities).

Initially, tracking of the vaccine administration was carried out through the facilities’ Juvenile Tracking System. However, in order to have access to the data after discharge, GDJJ is now working with public health to integrate its vaccine records with a statewide registry known as GRITS: Georgia Registry of Immunization Transactions and Services.

The numbers already vaccinated are evidence of the program’s great success. As of the end of 2003, program personnel had delivered 10,193 doses to 4,127 unique individuals.

How can your state replicate the success of Georgia? To obtain free vaccine for those less than 19 years of age who are incarcerated in juvenile and adult facilities, contact the VFC program in your state’s department of health. Your state’s immunization coordinator will be able to assist you in procuring the vaccine at no direct cost to your institutions.

— This article was reprinted in the Winter 2005 issue of CorrectCare with permission from the Winter 2005 issue of CorrDocs, the newsletter of the Society of Correctional Physicians. It has been edited slightly from the original. To learn about SCP or to obtain the newsletter online, visit the Web at www.corrdocs.org.