Hepatitis Prevention: Feasibility of Implementing Hepatitis A/B Vaccine to Inmates in a Local Correctional Health Facility in California

Objectives:

To analyze the feasibility and acceptability of implementing a Hepatitis A/B vaccine program in a county jail system.

Background:

Funded by the California Department of Public Health, the San Mateo County (SMC) Department of Corrections began implementation of a Hepatitis A/B vaccine program in the County's jails in July 2007. The Maguire Correctional Facility for men, and the Women's Correctional Facility for women, book approximately 1,578 inmates per month, with an average stay of 27 days. A seroprevalence study by the Health Department in 2000 found HCV prevalence of 30% among a sample of incarcerated persons.

Methods:

All inmates housed in the facility 10 days after booking are routinely given a Tuberculosis Skin Test (TST) and offered a Hepatitis A/B combination vaccine (Twinrix^®) at a 0, 1 and 6 month schedule. Vaccination administration is incorporated into the existing 10-day and 6-month TST screening appointments, and an additional 1-month query for follow-up is scheduled (dose-2 of Twinrix^®) for any inmates still in the facility 30 days after booking.

Basic demographic, acceptance and dose data were collected on all eligible inmates from July 1, 2007 to December 31, 2008. These data were compared with all vaccine offers and booking data, and analyzed in Microsoft Excel.

Results:

During this period, 2,716 doses of Hepatitis A/B vaccine were administered to 7,782 eligible inmates, with 35% of inmates accepting at least one dose. The majority of vaccine acceptors were Hispanic (39%), followed by White (28%), African American (21%), Asian (9%) and Other/Unknown (4%) race/ethnicity. Of the doses administered, 57% of the inmates received the first dose of the three-dose series, 32% received the second, and 11% the third.

Conclusions:

Implementing a Hepatitis A/B vaccine program without pre-vaccination blood screening within SMC's jails is feasible with acceptability among 35% of the inmates. One third of acceptors received at least 2 doses of vaccine with serologic evidence of HBV immunity seen in >75% of persons after 2 doses of vaccine.

Given the average jail stay of 27 days, an accelerated dose schedule of 0, 7 and 21 days and 1 year rather than the traditional 0, 1 and 6 month schedule may improve vaccination acceptance.