1. Florida Hepatitis and Liver Failure Prevention and Control Program
Tom Liberti
Bureau Chief, HIV/AIDS
January 27, 2003

2. Florida’s Comprehensive Hepatitis Prevention Program
Department of Health budget request, member projects, growing constituency
Comprehensive state-wide hepatitis prevention and control initiatives estimated at over $40 million annually ($2.66/capita)
$14 million request submitted, $2.5 million appropriated in 1999, $ 3.5 million each year since then

3. Florida: The Sunshine State
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
Hamilton N a s s a u
Calhoun
Jefferson 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
Duval
Liberty B a k
Baker e r D u v a l W
Wakulla
Suwannee 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
Clay
Gulf L a
Lafayette
Union f a y e t t e U 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
Florida: The Sunshine State
Levy 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 u m t e r S e m i n o l e
Hernando O r a
Orange n g e B r e v a r d
Pasco
Osceola i
Hillsborough l l s b o r o u g h
Pinellas
Polk O s c e o l a
Brevard P o l k
16 million population
67 counties
Hepatitis A rate for 2001 was 5.3/100,000
Hepatitis B rate for 2001 was 3.2/100,000
90,000 cumulative AIDS cases
28,000 cumulative HIV cases 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
Glades l a d e s
Hendry
Lee P
Palm Beach a l m B e a c h
Collier B r
Broward o w a r d
Monroe
Miami- Dade D a d e

4. Components of the Program
Enhanced surveillance including a hepatitis registry
Professional and public education
Immunization and testing
Comprehensive community hepatitis prevention and control projects
Epidemiologic research

5. Hepatitis Vaccine and Testing for High Risk Adults (since March 1, 2001)
• Hepatitis A and B vaccine for high risk adults free of charge
• Hepatitis B and C testing for high risk adults free of charge
• HBsAb, HBsAg, HBcAb (>12,000)
• HCV antibody: EIA and PCR/RIBA if needed
As of 12/11/02, over 24,000 doses of hepatitis A vaccine and 36,000 doses of hepatitis B vaccine were ordered by CHD
Counties integrating with HIV/AIDS, STDs, Epidemiology, Immunization, and other programs

6. 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

7. 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
Union
Clay
Gulf L a
Lafayette f a y e t t e U n i o n
Bradford C l a y
St. John’s F r
Franklin a 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 Laboratory Testing Program
County Participation – 10/10/2002 M
Marion a 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 u m t e r S e m i n o l e
Hernando 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 B and hepatitis C testing (HBsAg, HBsAb, HBcAb, HCV-antibody) 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 B and hepatitis C testing at no charge to county
Monroe
Miami-Dade D a d e
Comprehensive hepatitis and liver failure programs funded from State Health Office

8. County and Community-based Projects
9 county health department projects funded
6 (1/3 of FL population) with infrastructure funding
3 with nurse and clerk funded (Oct 2002)
Each includes hepatitis A, B, and C
Other counties integrating with HIV/AIDS, STDs, Epidemiology, and Immunization programs
Contract provider for outreach and testing in 5 counties
Contract provider for methadone clinic testing
Statewide action planning meeting

9. Professional and Public Education
3 Statewide Hepatitis Summits
Interactive CD-ROMs for hepatitis A, B, and C directed at public health work-force
Web-based hepatitis information clearinghouse (internet, intranet)
Hepatitis C Hotline
Outdoor media (placards, billboards)
Physician mailings (43,000 x 2)
TV and radio campaigns

10. Hepatitis C Hotline • Toll-free hotline established October 1, 2000
• FLA-HEPC
• Provides hepatitis C education
• Describes testing options
• Offers free home test kits to high risk callers
14,896 calls as of 12/1/02; 3,709 high risk;
1,475 tests; 403 positive

11. Corrections 7 jail link projects with HIV/AIDS and STD
96 of 303 tested (32 %) in one jail showed
evidence of prior viral hepatitis infection
In another jail, 44 of 163 tested (27 %) were
HCV positive
Vaccination for hepatitis A and B
Corrections infections workgroup (jails and prisons)
Seropositivity data from Department of Corrections
“Disease Lockdown” and education

12. Enhanced Surveillance
Web – based reporting
Decreased lag time for case review
Case investigations (acute)
Outbreak investigations and response
Chronic registry

13. Epidemiologic Research
Incidence of hepatitis in Florida
Epidemiology of hepatitis in Florida
Operations research
Evaluation

14. Additional Integration Opportunities
Corrections – jail and prison
HIV/AIDS and Community Planning Group
Immunization
STD
Drug treatment
TB/refugee health
Medicaid
Family Health

15. Challenges Three different diseases (confusion, priorities)
What to “integrate?” (C/T, education, prevention, surveillance, immunization, evaluation, clinical care, advocacy, etc.)
Other programs have categorical funding
Guidelines without financial backing
Capacity for care, treatment, and support
Public awareness

16. Next Steps
Increase networking and participation of the community and partners
Identify resources to fund implementation
Statewide action planning meeting (April 2002)
Prevent disease, disability and premature death due to hepatitis and liver disease