Hepatitis Vaccination Pilot Project Launched
A new 1-year pilot project from SAMHSA's Center for
Substance Abuse Treatment (CSAT) will provide free vaccine
against hepatitis A and hepatitis B.
Programs that will distribute the vaccine include the
SAMHSA Minority AIDS Initiative Targeted Capacity Expansion
grantees, Opioid Treatment Programs regulated by SAMHSA,
and treatment sites using the medication buprenorphine
for opioid addiction.
The CSAT pilot project is part of an infection prevention
measure to reduce the risk of hepatitis A or B in persons
who are eligible for services.
Those individuals are either infected with HIV (human
immunodeficiency virus) or hepatitis C virus (HCV), or
they are at high risk for contracting these infections
as a consequence of injection drug use or other substance
use.
Vaccination against hepatitis A and B virus infections
can supplement care and improve treatment strategies
to prevent progression of liver disease.
Vaccine distribution began in January and will be completed
by September 2006. "The vaccine demand has been
higher than initial estimates among programs quick to
respond to the invitation letter," said Kenneth
Hoffman, M.D., M.P.H., Project Officer for the program.
"All available vaccine was committed by the end
of January."
About 30 sites have agreed to participate in the project.
To participate, programs must demonstrate that they have
an established immunization program as part of their
core treatment or outreach approach.
The project will assess the likelihood of reaching individuals
at risk for vaccine-preventable infectious hepatitis
in methadone and buprenorphine treatment facilities and
nontraditional substance abuse prevention and treatment
facilities.
Vaccination against hepatitis A and B virus infections can improve treatment strategies to
prevent progression of liver disease.
HCV, which spreads through contact with an infected
person's blood, and HIV are frequent co-occurring infectious
diseases in drug users, especially injection drug users.
And co-occurring infections complicate the medical management
of substance abuse treatment.
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Who Is Receiving the Vaccine?
For persons age 18 and older, the Centers for Disease
Control and Prevention (CDC) recommends immunization
for both hepatitis A and B for all susceptible persons
who are at risk for either exposure to both viruses,
or at risk for serious complications from infection with
these viruses. These individuals include residents of
drug and alcohol treatment centers and patients with
chronic liver disease.
The SAMHSA pilot project purchased Twinrix®, the
only combination vaccine for both hepatitis A and hepatitis
B. Use of the combined vaccine simplifies the dose schedule
by using one vaccine and decreases the number of shots
needed for full protection from five shots to three.
Even one shot of the combination vaccine can provide
significant protection against infection, with up to
50 percent of those vaccinated being protected against
hepatitis B for a short time.
Additional doses increase the percentage protected up
to 75 percent with a second dose, and 90 to 95 percent
with a third dose, and the length of protection is extended
to many years. Protection against hepatitis A is even
higher with a single dose, and 100 percent after all
three doses.
Side effects are minimal, the most common being transient
fatigue, headache, nausea, or aching following immunization.
SAMHSA, in collaboration with
the CDC, has educational materials available to all substance
abuse treatment programs and to patients beyond the pilot
period, whether or not the site is participating in the
demonstration project.
Because the vaccine is given in three separate injections,
the program will collect data on whether patients complete
the entire vaccination process. An evaluation team will
provide data that reflect the demographics and risk factors
of people receiving the immunization and the number of
immunizations received by those individuals.
The importance of preventing, identifying, and treating
hepatitis as part of comprehensive services in an opioid
treatment program is covered in detail in a SAMHSA monograph
on hepatitis, which will be available soon.
For more information about SAMHSA's pilot hepatitis
vaccination project, visit the SAMHSA Web site at http://dpt.samhsa.gov/twinrix.htm.
Or contact Dr. Kenneth Hoffman in the CSAT Division of
Pharmacologic Therapies at (240) 276-2701. 
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