National Hepatitis Coordinators’ Conference San Antonio 1/2003 Hepatitis A and Hepatitis B Vaccination in High Risk Adults: Florida’s Experience with Integrating Services Sandra W. Roush, MT, MPH National Hepatitis Coordinators’ Conference San Antonio 1/2003

Florida’s Hepatitis (A, B, C) Program Providing leadership, policy development, and technical assistance Development of a comprehensive prevention plan Counseling and testing services Vaccination for adults Patient care services Prevention initiatives Allocating state hepatitis resources

Florida’s Statewide High Risk Adult Hepatitis Immunization Program Initial purchase Dec. 2000: One-time carry over (lab and vaccine) 30,100 doses B ($ 699,825) 1,246 doses A ($ 20,160) Subsequent purchases: state and federal Eligibility: adult high risk Statewide memos March 2001, Dec. 2002 NO CHARGE TO CHD OR CLIENT

Florida Hepatitis and Liver Failure Prevention and Control Program Escambia Holmes Jackson Santa Rosa H o l m e s S a n t a R o s a J a c k s o n Okaloosa W Walton a l t o n W Washington Nassau a s h i n g o Gadsden G a d s d e n Leon Jefferson Hamilton N a s s a u Calhoun L e o n J e f f e r s o n M Madison a d i s o n H a m i l t o n Liberty Suwannee B a k Baker e r D u Duval v a l W Wakulla a k u l l a Taylor S u w a n n e e Columbia C o l u m b i a Bay T a y l o r Lafayette U Union Clay Gulf L a f a y e t t e n i o n Bradford C l a y St. John’s F r a Franklin n k l i n B r a d f o r d S t J o h n s i Gilchrist l c h r i s t Alachua Dixie A l a c h u a Putnam P u t n a m F l Flagler a g l e r Levy Florida Hepatitis and Liver Failure Prevention and Control Program Adult Hepatitis Vaccine Program County Participation – 10/10/2002 M a Marion r i o n V o Volusia l u s i a Citrus C i t r u s Sumter Lake L a k e Seminole Hernando u m t e r S e m i n o l e O r a Orange n g e B r e v a r d Pasco Osceola Hillsborough i l l s b o r o u g h Pinellas Polk O s c e o l a Brevard P o l k I n Indian River d i a n R i v e r Manatee Hardee Okeechobee M a n a t e e H a r d e e O k e e c h o b e e St. Lucie Highlands S t L u c i e Desoto H i g h l a n d s Sarasota r o t a D e S o t o Martin Charlotte C h a r l o t t e G l Glades a d e s Hepatitis A and hepatitis B vaccine available at no charge to county Hendry Lee P Palm Beach a l m B e a c h Collier B r Broward o w a r d Active programs using available hepatitis A and hepatitis B vaccine no charge to county Monroe Miami- Dade D a d e Comprehensive hepatitis and liver failure programs funded from State Health Office

Hepatitis Adult High Risk Vaccination Program Sites* Number of Counties STD 35 HIV 30 Immunization/ Epidemiology 26 Family Planning 23 General 29 * Participation sites are not mutually exclusive; number among 48 counties responding.

Florida’s Adult Hepatitis Vaccination Program: UNFUNDED COUNTIES 61 eligible counties (other 6 were funded) Received NO FUNDING No personnel No clinical supplies

Florida’s Adult Hepatitis Vaccination Program: FUNDED COUNTIES 6 counties (3 added Oct 2002) Comprehensive A, B, C programs Approximately 1/3 of the state population Budgets do not include vaccine starting July 2002 (rely on state supply, approx. 1/8 of their budget)

Vaccine Distribution: UNFUNDED COUNTIES Number of Doses Purchased by State (March 01 – October 02) Number (%) of Doses to CHD (October 01 – September 02) Hepatitis A 28,907 7,587 (26%) Hepatitis B 39,200 11,400 (29%)

Vaccine Used/Coded October 2001 to September 2002 UNFUNDED COUNTIES Hepatitis A No. (%) Hepatitis B Doses to Counties 7,587 11,400 Dose 1 4,436 (59%) 7,705 (68%) Dose 2 1,297 (29%) 3,779 (49%) Dose 3 N/A 1,878 (50%)* * 24 % hepatitis B series completion during this period

Vaccine Used/Coded October 2001 to September 2002 FUNDED COUNTIES Hepatitis A No. (%) Hepatitis B Dose 1 7,305 6,273 Dose 2 1,406 (19%) 3,469 (55 %) Dose 3 N/A 2,192 (63%)* * 35 % series completion during this time period

Selected* Hepatitis A Series Completion October 2001 – September 2002 Dose 1 Dose 2 % County E 606 287 47% County O 234 164 70% County A 318 121 38% County V 617 172 28% County P 735 75 10% County D 1,104 235 21% * Unfunded counties

Selected* Hepatitis B Series Completion October 2001 – September 2002 Dose 1 Dose 2 % Dose 3 County E 765 603 79% 395 52% County O 392 211 54% 169 43% County A 240 164 68% 82 34% County V 1,352 545 40% 352 26% County P 1,330 571 189 14% County D 3,796 1,972 1,053 28% * Unfunded counties

Number of Vaccine Doses Used: by County Size

Next Steps: Florida’s Adult Hepatitis A and B Immunization Program Vaccine accountability mechanisms Coverage assessment Evaluation Feasibility Cost effectiveness/efficiency Expand to additional clinics and other sites Ensure a reliable vaccine supply

Thanks to … HQ Hepatitis Staff, including: Jodi Baldy, Robbie Bouplon, Katrina Huffmaster, April Crowley, Sandy Teixeira County hepatitis and other programmatic staff HQ Bureaus of HIV/AIDS, Immunization, STD, TB/Refugee DOH Public Information Office NIP/CDC NCID/CDC