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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