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Hepatitis B C - The Silent Epidemics of the Homeless even in a Paradise

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Hepatitis B C - The Silent Epidemics of the Homeless even in a Paradise

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    2. Hepatitis B & C - The “Silent Epidemics” of the Homeless even in a Paradise

    3. Clouds gathering… “Despite over 20 years of knowledge, millions of dollars thrown into prevention and the distribution of countless condoms, many people in the U.S. are contracting HIV and Hepatitis at an alarming rate.” WHY?

    4. RG- I tried to use only chronic infection numbers (as opposed to anti HCV Ab) where these were available. Otherwise, I estimated 74% chronic infection. As children clear the virus at higher rates, I lowered the NHANES rate for Ab (0.3%) according to reported rates for chronic infection (0,1%). PEDS est is 240,000 via NIH stats from NIH HCV Meeting – This is the Anti-HCV number – chronic infections estimated at 68-100,000 (Jonas paper from the NIH meeting) I think this covers most of the populations you wanted. I did not find numbers for patients did not complete treatment. Let me know if you have alternate preferred sources for numbers. Austin. We need to tune of the prison numbers: Is the 255,000 the number of infected today? See my change in header: I would like this information to be be also intorduced step wise with the slide show NHANES 2) NEW ESTIMATE Then each sub group Neeed to add vets to this slides alsoe Could split to two slidesRG- I tried to use only chronic infection numbers (as opposed to anti HCV Ab) where these were available. Otherwise, I estimated 74% chronic infection. As children clear the virus at higher rates, I lowered the NHANES rate for Ab (0.3%) according to reported rates for chronic infection (0,1%). PEDS est is 240,000 via NIH stats from NIH HCV Meeting – This is the Anti-HCV number – chronic infections estimated at 68-100,000 (Jonas paper from the NIH meeting) I think this covers most of the populations you wanted. I did not find numbers for patients did not complete treatment. Let me know if you have alternate preferred sources for numbers. Austin. We need to tune of the prison numbers: Is the 255,000 the number of infected today? See my change in header: I would like this information to be be also intorduced step wise with the slide show NHANES2) NEW ESTIMATE Then each sub group Neeed to add vets to this slides alsoe Could split to two slides

    5. Sirens to Wail 60 Second Hepatitis C PSA from New Orleans

    6. Adults who are at the most risk for infection with Hepatitis C Homeless substance abusers Injection Drug Users Prisoners sharing injection drug using equipment or tattooing needles or ink People who snort drugs may be at risk Those with multiple sex partners and a history of sexually transmitted diseases Hemophiliacs Healthcare workers including EMT and others Military and others in other parts of the world who may exposed to blood

    7. Risk Factors for Transmission of Hepatitis Viruses and HIV in the USA This variability in the relative efficiency of transmission results in the same risk factor causing a different proportion of infections among persons with HBV, HCV and HIV infection. For example, in the United States illegal Injection drug use accounts for approximately 60% of new HCV infections, 31% of new HIV infections and only 14% of new HBV infections. Conversely, men who have sex with men account for only 1% of new HCV infections and 15% of HBV infections, but nearly half of new HIV infections. Interestingly, a similar proportion of persons with acute HCV and HIV have no identified risk factor at 10 and 9 percent respectively. This variability in the relative efficiency of transmission results in the same risk factor causing a different proportion of infections among persons with HBV, HCV and HIV infection. For example, in the United States illegal Injection drug use accounts for approximately 60% of new HCV infections, 31% of new HIV infections and only 14% of new HBV infections. Conversely, men who have sex with men account for only 1% of new HCV infections and 15% of HBV infections, but nearly half of new HIV infections. Interestingly, a similar proportion of persons with acute HCV and HIV have no identified risk factor at 10 and 9 percent respectively.

    8. Groups of High Rates Transmission of Hepatitis C Virus in the USA This variability in the relative efficiency of transmission results in the same risk factor causing a different proportion of infections among persons with HBV, HCV and HIV infection. For example, in the United States illegal Injection drug use accounts for approximately 60% of new HCV infections, 31% of new HIV infections and only 14% of new HBV infections. Conversely, men who have sex with men account for only 1% of new HCV infections and 15% of HBV infections, but nearly half of new HIV infections. Interestingly, a similar proportion of persons with acute HCV and HIV have no identified risk factor at 10 and 9 percent respectively. This variability in the relative efficiency of transmission results in the same risk factor causing a different proportion of infections among persons with HBV, HCV and HIV infection. For example, in the United States illegal Injection drug use accounts for approximately 60% of new HCV infections, 31% of new HIV infections and only 14% of new HBV infections. Conversely, men who have sex with men account for only 1% of new HCV infections and 15% of HBV infections, but nearly half of new HIV infections. Interestingly, a similar proportion of persons with acute HCV and HIV have no identified risk factor at 10 and 9 percent respectively.

    9. Other Groups with High Rates Transmission of Hepatitis C Virus in the USA This variability in the relative efficiency of transmission results in the same risk factor causing a different proportion of infections among persons with HBV, HCV and HIV infection. For example, in the United States illegal Injection drug use accounts for approximately 60% of new HCV infections, 31% of new HIV infections and only 14% of new HBV infections. Conversely, men who have sex with men account for only 1% of new HCV infections and 15% of HBV infections, but nearly half of new HIV infections. Interestingly, a similar proportion of persons with acute HCV and HIV have no identified risk factor at 10 and 9 percent respectively. This variability in the relative efficiency of transmission results in the same risk factor causing a different proportion of infections among persons with HBV, HCV and HIV infection. For example, in the United States illegal Injection drug use accounts for approximately 60% of new HCV infections, 31% of new HIV infections and only 14% of new HBV infections. Conversely, men who have sex with men account for only 1% of new HCV infections and 15% of HBV infections, but nearly half of new HIV infections. Interestingly, a similar proportion of persons with acute HCV and HIV have no identified risk factor at 10 and 9 percent respectively.

    10. The number of homeless is growing because of the exploding real estate market, the high costs of rent, and in Hawai`i because of the consistent pleasant weather and environment. In fiscal year 2004, emergency shelters in Chicago served 13,108 unduplicated clients, up from 11,050 in fiscal year 20031.

    11. Each day at least 800,000 persons are homeless in the USA. That includes 200,000 children. On any given night, almost 300,000 veterans experience homelessness nationwide, a number far greater than the roughly 58,000 U.S. soldiers who died during the Vietnam War.  As many as 18,000 veterans are estimated to experience homelessness every night in the six counties of the Chicago metropolitan area. Over the course of a year, between 2.3 and 3.5 million people experience homelessness nationwide and approximately 166,000 people experience homelessness in the Chicago Metropolitan area.

    13. Domiciliary for the Homeless Rehabilitation program Homelessness of any duration Ability for self-care Monthly income < $1,200 Willingness and ability to return to work

    19. What most people still do not know: The delay in signs and symptoms of HIV or chronic Hep infections can result in people who don’t feel sick and who disregard that possibility of spreading HIV or Hep infection.

    20. The face of the Hepatitis C (HCV) epidemic is also changing! The new infections are estimated at 25,000 (CDC) to 40,000 (HRSA) per year. Injection drug use and experimental injection drug use appear to be the greatest source of the spread of new infections. 44% of the Homeless with mental illness and substance abuse may have already been infected with hepatitis B and/or C.

    21. Other High risk groups that may continue to be a “Reservoir” of HCV infection unless they are tested, become aware of their infection, and are treated: 5.4% to 8% of Veterans appear to have been infected. Prisoners and people who have been incarcerated in the past appears to be about 15%. In many prisons it is 25% to 30%. It has been estimated that over 300,000 people may have HCV that had a blood transfusion before our blood supply was required to be tested for HCV in July 1992. Many of them still do not know it yet!

    22. The face of the HIV pandemic is changing, and it is younger. 25% of persons living with HIV in the world are 15 -24 years old. ˝ of all new infections of HIV occur in 15 to 24 year olds. 51% of the new infections occur in women and girls.

    23. What youth are the most at the most risk for HIV infection? Street youth (40% of homeless youth identify themselves as being gay or lesbian.) Runaways Teens having “survival sex” Those with a history of sexual abuse Teens with psychiatric diagnoses, such as mood disorder, substance abuse, and depression. Teens lacking resources – housing, safety Teens with older partners

    24. Contributing factors to risk:

    25. Developmental stages in adolescence Early teens (10 – 13) Sex drive begins Peer pressure, separation from parents Poor future orientation. Sexual interest usually exceeds activity Mid Teens (14 – 16) Sex drive surges Peak conflict with parents Peer group sets standards. Increasing sexual behavior and experimentation.

    26. Some quick numbers… 17% of 7th and 8th grade students report that they have had sexual intercourse. By the time teens turn 18, 56% of girls and 73% of boys report having had intercourse.

    27. Late adolescence developmental stage (17 – 21+) Maturation complete Close friendships formed. Intimacy. Focus on role in society. Future oriented. Refinement of values. Sexual orientation consolidates.

    28. Teen behavior and their risks to acquire HIV or Hepatitis B or C: Have multiple sex partners. Relationships are short-lived. Teens fall “in-and-out of love” and it can be dangerous. Teens tend to be “serially monogamous”…for a very short period of time! Some experiment with using Injectable drugs Some have Tattoos (or in Hawai`i Tatau or Polynesian Tattoos) or body piecing that is not done with new Needles or that uses shared ink.

    29. Challenges that predispose teens & adults to disregard HIV or Hepatitis risk The fear of HIV or Hepatitis has been lost. HIV & Hepatitis command less urgency that it once did, feeding the perception that HIV is no longer a threat. Infallibility, “HIV or Hep can’t happen to me.” A belief by teens and others that HIV can be cured. HIV medications are portrayed as being easy to take. Sexual risky behavior is back in vogue.

    30. Almost 50% of Students Have Had Sex Before Leaving High School1 54% of HBV infections in U.S. attributed to sexual contact2 Like HIV, HBV is spread by infected blood and body fluids, but can be 100 times more infectious than HIV3 Slide 59. Almost 50% of Students Have Had Sex Before Leaving High School1 Almost half of students have had sex before leaving high school.1 And, as we discussed before, VPH is often transmitted through sexual activity: Up to 14% of HAV cases in the U.S. are attributed to sexual/household contact 54% of HBV infections in the U.S. are attributed to sexual contact Like HIV, hepatitis B is spread by infected blood and body fluids, but can be 100 times more infectious than HIV. 1. CDC. Youth risk behavior surveillance—US 2001. MMWR 2002;51(SS04):1–64. 2. CDC. Epidemiology and Prevention of Vaccine-Preventable Diseases. 8th ed. 2004. 3. CDC. Prevention and control of infections with hepatitis viruses in correctional settings. MMWR 2003;52(RR-01):1–36.Slide 59. Almost 50% of Students Have Had Sex Before Leaving High School1 Almost half of students have had sex before leaving high school.1 And, as we discussed before, VPH is often transmitted through sexual activity: Up to 14% of HAV cases in the U.S. are attributed to sexual/household contact 54% of HBV infections in the U.S. are attributed to sexual contact Like HIV, hepatitis B is spread by infected blood and body fluids, but can be 100 times more infectious than HIV. 1. CDC. Youth risk behavior surveillance—US 2001. MMWR 2002;51(SS04):1–64. 2. CDC. Epidemiology and Prevention of Vaccine-Preventable Diseases. 8th ed. 2004. 3. CDC. Prevention and control of infections with hepatitis viruses in correctional settings. MMWR 2003;52(RR-01):1–36.

    32. STDs and Teens It is believed that at least 25% of sexually active American teens have contracted an STD. That’s 3 million teens a year. Bottom line, if teens are getting STDs, they either aren’t consistently using condoms or they aren’t using them right!

    33. A word on gay teens There are nearly 1 million gay teens in the U.S. There is a lack of information about safe-sex practices for gay teens. Sex education ignores gay youth…it renders them “invisible”. Experience emotional isolation. Experience widespread harassment. High suicide and dropout rates.

    34. Traces of Blood – A Hepatitis C Video Training Video for Staff and Injection Drug Users

    35. E Ho'omalu Kakoa I Ka Po'e Nele A Hune "Lets Shelter & Protect Those Who Are In Need" Save-A-Life Free Safety Kits Campaign Razors & Shaving Cream Tooth Brushes & Tooth Paste Nail Clippers Toe Nail Clippers Nail Files Band-Aids Antiseptic or Alcohol Wipes Soap &/or Anti-Bacterial Hand Gel Condoms

    36. Free Save-A-Life Safety Kit Campaign In May 2006, we informed a person with Hep B & a person with Hep C at the new 300 people Kakoa`ako Homeless Shelter that they were positive. They both stated that they had been sharing razors. In June 2006, we started our new free Save-A-Life Safety Kit Campaign!

    37. Can Razor Blades Transmit Hepatitis B? “Determination of Hepatitis B Virus at Used Razor Blade by PCR” 78 used razor blades were purchased from different barber’s shops in Turkey. HBV DNA was detected in 6 (7.7%) razor blade samples. CONCULSION: Reuse of razor blade that carry HBV will infect other people. Hence any HBV control & prevention program should educate barbers (and others) about the importance of contagious diseases, proper sterilization tech., and avoiding reuse and sharing of contaminated equipment and supplies like razor blade. ICAAC, Reported by Jules Levin, Sept. 27-30, 2006, San Francisco, CA.

    38. Hepatitis C – contamination of toothbrushes: myth or reality? 30 patients with chronic hepatitis C had their saliva and rinsing water tested. 40% of the toothbrush rinsing water specimens tested HCV-RNA-positive. CONCULSION: Study demonstrates a contamination with HCV-RNA of considerable portion toothbrushes used by hepatitis C patients Journal of Viral Hepatitis, Volume 13, No. 9, Sept. 2006, pp. 571-573(3)

    39. HCV may survive on environmental surfaces at room temp. at least 16 hrs. up to 4 days! This re-emphsizes the importance of: Cleaning and disinfection procedures, Safe therapeutic injection practices, and Harm reduction counseling and services for injection drug users.

    40. Get The Facts Video by Diana Slyvestre, MD, and Patients who have Hepatitis C at Oasis Clinic in Oakland, CA

    41. Hawai`i has the highest rate of Liver Cancer in the USA because of our high rates Hep B & C. Immigration from Pacific Island and Asian countries, which have extremely high rates of chronic hepatitis B is why we have the second highest rate of Hep B in the USA.

    42. Here are the rates of hepatitis B in these other Pacific Island countries as reported by the World Health Organization. Population HBsAg+ % Infected with Hepatitis B American Samoa 50,923 3,565 7% China 1,299,180,000 155,901,600 12% Fiji 883,000 97,130 11% Kiribati 72,000 22,320 31% S. Korea 46,403,000 5,568,360 12% Marshall Islands 190,000 22,800 12% Micronesia, FSM 190,000 22,800 12% to 15% New Zealand 3,662,000 29,296 0.8% (10% of Maori) Palau 16,386 1,966 12% to 15% Papua New Guinea 4,845,000 969,000 20% to 25% Philippines 77,473,000 7,747,300 10% Samoa (Western) 190,000 15,200 8% to 10% Tonga 92,000 18,400 20% Vietnam 82,427,000 9,891,240 12%

    43. The homeless are one of the highest at-risk groups that will continue spreading chronic viral hepatitis B and/or C unless we can start to effectively test & treat them for these hidden epidemics and vaccinate them for Hepatitis B. Most states do not have any special case management program to help the homeless populations that are infected with chronic hepatitis and that are at risk of spreading these infections to others.

    44. Many Homeless want to receive treatment for their Hepatitis C! Hepatitis C treatment study in 2005 by Alan D. Tice, MD, 32 of 150 methadone patients that thought they had active hepatitis C volunteered to be treated with pegylated interferon and ribavirin. An important new finding was that of those who were interested in treatment for their hepatitis C, 40% were homeless!

    45. These efforts will save lives, limit the spread of disease, and in the long run be cost-effective! Earlier testing and more housing, medical benefits, support, and case management are needed for effective treatment. Medical Costs of Cirrhosis or End Stage Liver Disease related complications (even before a Liver Transplants is needed) is very costly to our Healthcare Systems. Liver Transplants cost $250,000 to $350,000 apiece with about $10,000 of anti-rejection medications per year.

    46. Chronic liver disease due to hepatitis C causes between 10,000 and 12,000 deaths per year! It is the leading indication for liver transplantation each year in the United States. By the year 2010, the number of deaths from hepatitis C is expected to rise to 38,000 each year. It is also now the primary reason for death from HIV.

    47. A number of Homeless drink Alcohol. Should they be treated for their HCV? “Alcohol use and treatment of hepatitis C virus: results of a national multicenter study” A total of 4061 subjects were enrolled. The aim of study was to determine the impact of alcohol use on HCV tx outcomes. Recent alcohol use was associated with increased higher HCV tx discontinuation and lower SVR. However, patients who use alcohol and completed HCV tx had a response comparable to that of nondrinkers. CONCULSIONS: Patients with a history of alcohol use should not be excluded from HCV tx. Instead, additional support should be provided to ensure their ability to complete HCV tx. Gastroenterology. 2006 May;130(6):1912-4. Dept. of Medicine, Michael E. DeBakey VA Medical Center, Houston, Texas. PMID: 16697724 [PubMed – in process]

    48. Free Hepatitis B or C Tests for the Homeless & other at risk Groups We now give a Free T-Shirt to those who test at: Health Fairs Community & Organizational Talks Free for Homeless or people with risk factors who cannot afford special low cost tests $15 for HBV $25 for HCV $35 for Both Tests

    49. Where can they be tested for HCV if you do not have Health Insurance? Very limited resources in the USA Home Access Hepatitis C test Kits for $59.95 at http://www.homeaccess.com/02/ Through the State Department of Health in Hawai`i if you have been an injection drug user Check with your local Health Dept. if you do not have Health Insurance or cannot be tested by your physician or a local Community Health Clinic

    50. Another Important Health Concern! The Homeless as well as many otherwise Healthy People Need to Be Protected from Hepatitis A & B and need to be vaccinated! Slide 61. Otherwise Healthy Patients—Persons Who Wish to Be ProtectedSlide 61. Otherwise Healthy Patients—Persons Who Wish to Be Protected

    51. Reminder - Persons With HIV &/or Hepatitis C need to be Protected Against HBV HBV can survive at room temperature on environmental surfaces for at least one month 50% of infected adults are asymptomatic and can spread HBV without knowing it HBV is the leading cause of liver cancer in the U.S.1 2nd only to tobacco among known human carcinogens1 Slide 63. Persons Without Identifiable Risk Factors May Wish to Be Protected Against HBV Likewise, persons may wish to be protected against hepatitis B. Reasons a person may wish to be protected include: Nearly one-third or persons infected with acute HBV have no identifiable risk factors HBV can survive at room temperature on environmental surfaces for at least one month 50% of infected adults are asymptomatic and can spread HBV without knowing it HBV is the leading cause of liver cancer in the U.S., second only to tobacco among known human carcinogens Chronic HBV infection causes up to 80% of all liver cancer. CDC. Epidemiology and Prevention of Vaccine-Preventable Diseases. 8th ed. 2004.Slide 63. Persons Without Identifiable Risk Factors May Wish to Be Protected Against HBV Likewise, persons may wish to be protected against hepatitis B. Reasons a person may wish to be protected include: Nearly one-third or persons infected with acute HBV have no identifiable risk factors HBV can survive at room temperature on environmental surfaces for at least one month 50% of infected adults are asymptomatic and can spread HBV without knowing it HBV is the leading cause of liver cancer in the U.S., second only to tobacco among known human carcinogens Chronic HBV infection causes up to 80% of all liver cancer. CDC. Epidemiology and Prevention of Vaccine-Preventable Diseases. 8th ed. 2004.

    52. Persons Without Identifiable Risk Factors May Also Wish to Be Protected Against HAV Possible settings for hepatitis A transmission include: Restaurants—infected food handlers or contaminated food/water2 Daycare—poor hygiene among young children and diaper-changing activities among staff2 Healthcare institutions2 Schools2 Outdoor concerts/camping events3 (and Homeless settings) Slide 62. Persons Without Identifiable Risk Factors May Wish to Be Protected Against HAV Anyone who wishes to be protected against hepatitis A should be vaccinated. Nearly half of persons infected with HAV have no identifiable risk factors, so it’s easy to see why someone might wish to be protected. In addition to the definitive risk factors established by the CDC, the following settings have also been associated with HAV transmission: Restaurants (through infected foodhandlers or contiminated food or water) Daycare (due to poor hygiene among young children and diaper-changing activities among staff) Healthcare institutions Schools Outdoor concerts/camping events 1. CDC. Epidemiology and Prevention of Vaccine-Preventable Diseases. 8th ed. 2004. 2. CDC. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1999;48(RR-12):1–37. 3. CDC. Multistate outbreak of hepatitis A among young adult concert attendees—United States, 2003. MMWR 2003;52(35).844.Slide 62. Persons Without Identifiable Risk Factors May Wish to Be Protected Against HAV Anyone who wishes to be protected against hepatitis A should be vaccinated. Nearly half of persons infected with HAV have no identifiable risk factors, so it’s easy to see why someone might wish to be protected. In addition to the definitive risk factors established by the CDC, the following settings have also been associated with HAV transmission: Restaurants (through infected foodhandlers or contiminated food or water) Daycare (due to poor hygiene among young children and diaper-changing activities among staff) Healthcare institutions Schools Outdoor concerts/camping events 1. CDC. Epidemiology and Prevention of Vaccine-Preventable Diseases. 8th ed. 2004. 2. CDC. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1999;48(RR-12):1–37. 3. CDC. Multistate outbreak of hepatitis A among young adult concert attendees—United States, 2003. MMWR 2003;52(35).844.

    53. TWINRIX—Over 98% Effective After a 3-dose Series Slide 67. TWINRIX—Over 98% Effective After a 3-dose Series Here’s another chart that depicts the results of worldwide clinical trials with TWINRIX. One month after completion of a 3-dose series of TWINRIX, seroconversion for antibodies against HAV was elicited in 99.9% of vacinees, and protective antibodies against HBV were detected in 98.5%. In other words, TWINRIX elicited an effective immune response in over 98% of people after a 3-dose series. Complete TWINRIX safety summary to follow. TWINRIX prescribing information.Slide 67. TWINRIX—Over 98% Effective After a 3-dose Series Here’s another chart that depicts the results of worldwide clinical trials with TWINRIX. One month after completion of a 3-dose series of TWINRIX, seroconversion for antibodies against HAV was elicited in 99.9% of vacinees, and protective antibodies against HBV were detected in 98.5%. In other words, TWINRIX elicited an effective immune response in over 98% of people after a 3-dose series. Complete TWINRIX safety summary to follow. TWINRIX prescribing information.

    54. Are You at Risk for Vaccine-Preventable Hepatitis (VPH)? Page 2 I come from Asia or the Pacific Islands I take street drugs I am a man who has sex with men I have a blood-clotting disease with clotting factor infusions I had more than one sex partner during the last 6 months I have sex with or live with a person with hepatitis B I provide direct services to people with developmental disabilities Slide 81. Are You at Risk for Vaccine-Preventable Hepatitis (VPH)?—Page 2 Screening questionnaire for vaccine-preventable hepatitis, continued. Adapted from CDC Adult Vaccination Screening Form. Accessed at www.cdc.gov/nip/recs/adult_vac_scrn_hcp.pdf on 2/11/04. (Data on file, TWR404, GlaxoSmithKline.) Slide 81. Are You at Risk for Vaccine-Preventable Hepatitis (VPH)?—Page 2 Screening questionnaire for vaccine-preventable hepatitis, continued. Adapted from CDC Adult Vaccination Screening Form. Accessed at www.cdc.gov/nip/recs/adult_vac_scrn_hcp.pdf on 2/11/04. (Data on file, TWR404, GlaxoSmithKline.)

    55. 60,000 Adults Die Each Year From Vaccine-Preventable Diseases Medical visits are often missed opportunities to provide needed immunizations Add adult vaccination to your practice Identify adults at risk through pre-existing conditions and/or diagnosis codes Age Disease State Slide 86. 60,000 Adults Die Each Year From Vaccine-Preventable Diseases Adult vaccine-preventable disease causes significant morbidity and mortality, causing 60,000 deaths each year in the U.S. Medical visits are great opportunities to protect adults at risk from vaccine-preventable diseases. Use underlying conditions, diagnosis codes, and age to identify patients who need to be immunized. CDC. Epidemiology and Prevention of Vaccine-Preventable Diseases. 8th ed. 2004.Slide 86. 60,000 Adults Die Each Year From Vaccine-Preventable Diseases Adult vaccine-preventable disease causes significant morbidity and mortality, causing 60,000 deaths each year in the U.S. Medical visits are great opportunities to protect adults at risk from vaccine-preventable diseases. Use underlying conditions, diagnosis codes, and age to identify patients who need to be immunized. CDC. Epidemiology and Prevention of Vaccine-Preventable Diseases. 8th ed. 2004.

    56. Vaccinate Adults at Risk for Vaccine-Preventable Hepatitis (VPH) It’s Needed! Vaccine-preventable hepatitis (VPH) is a significant public health problem in the U.S. VPH causes 5,100 deaths per year HBV is the leading cause of liver cancer in the U.S. 2nd only to tobacco among known human carcinogens Slide 87. Vaccinate Adults at Risk for Vaccine-Preventable Hepatitis (VPH)—It’s Needed Vaccine-preventable hepatitis is a significant public health problem in the U.S., causing 5,100 deaths per year. Additionally, HBV is the leading cause of liver cancer in the country, second only to tobacco among known human carcinogens. CDC. Epidemiology and Prevention of Vaccine-Preventable Diseases. 8th ed. 2004.Slide 87. Vaccinate Adults at Risk for Vaccine-Preventable Hepatitis (VPH)—It’s Needed Vaccine-preventable hepatitis is a significant public health problem in the U.S., causing 5,100 deaths per year. Additionally, HBV is the leading cause of liver cancer in the country, second only to tobacco among known human carcinogens. CDC. Epidemiology and Prevention of Vaccine-Preventable Diseases. 8th ed. 2004.

    57. Vaccinate Adults at Risk for Vaccine-Preventable Hepatitis (VPH) It’s Recommended Slide 88. Vaccinate Adults at Risk for Vaccine-Preventable Hepatitis (VPH)—It’s Recommended Experts recommend vaccination of adults at high risk for VPH. This chart outlines CDC’s recommendations for immunization of persons with chronic liver disease, hepatitis C, sexually transmitted diseases, and HIV. 1. CDC. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR 1998;47(RR19):1–39. 2. CDC. Hepatitis B virus: a comprehensive strategy for eliminating transmission in the United States through universal childhood vaccination. MMWR 1991;40(RR-13):1–19. 3. CDC. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1999;48(RR-12):1–37. 4. CDC. Guidelines for preventing opportunistic infections among HIV-infected persons—2002. MMWR 2002;51(RR08):1–46.Slide 88. Vaccinate Adults at Risk for Vaccine-Preventable Hepatitis (VPH)—It’s Recommended Experts recommend vaccination of adults at high risk for VPH. This chart outlines CDC’s recommendations for immunization of persons with chronic liver disease, hepatitis C, sexually transmitted diseases, and HIV. 1. CDC. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR 1998;47(RR19):1–39. 2. CDC. Hepatitis B virus: a comprehensive strategy for eliminating transmission in the United States through universal childhood vaccination. MMWR 1991;40(RR-13):1–19. 3. CDC. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1999;48(RR-12):1–37. 4. CDC. Guidelines for preventing opportunistic infections among HIV-infected persons—2002. MMWR 2002;51(RR08):1–46.

    58. Vaccinate Adults at Risk for Vaccine-Preventable Hepatitis (VPH) It’s Reimbursed Vaccination routinely reimbursed for patients at risk Persons with chronic liver disease/hepatitis C Persons with sexually transmitted diseases Chlamydia, Gonorrhea, Herpes, HPV, Syphilis, etc. Men who have sex with men HIV-positive persons Slide 89. Vaccinate Adults at Risk for Vaccine-Preventable Hepatitis (VPH)—It’s Reimbursed Vaccination is routinely reimbursed for adults at high risk, such as persons with chronic liver disease, hepatitis C, sexually transmitted diseases, and HIV. Data on file, TWR1602, GlaxoSmithKline.Slide 89. Vaccinate Adults at Risk for Vaccine-Preventable Hepatitis (VPH)—It’s Reimbursed Vaccination is routinely reimbursed for adults at high risk, such as persons with chronic liver disease, hepatitis C, sexually transmitted diseases, and HIV. Data on file, TWR1602, GlaxoSmithKline.

    60. Merck will provide free vaccines to adults who are uninsured & unable to afford vaccines! Starting the third quarter of 2006, Merck vaccines will become available through their new Patient Assistance Program. All of Merck Vaccines are available in this program including Hep A, Hep B and Pneumococcal vaccines that are recommend for people with chronic viral Hepatitis. Uninsured people with incomes less than $19,600 are eligible (twice the Federal poverty level). Forms can be faxed to the patient’s physician’s office with a processing goal of less than ten minutes – so that qualifying patients can receive Merck vaccine during that visit! May 26, 2006, News Release Media Contacts: Maggie Kohn (908) 423-5655 & Mary Elizabeth Blake (215) 652-5558

    61. Please Remind people: “It’s not who you are but what you do that puts you at risk for HIV or Hepatitis B or C.”

    62. We need to help save lives before it is too late! HCV is often “CURABLE” if people do not wait until they feel ill to be tested and treated. Most people will not feel ill until it may be too late to be treated. Many homeless and substance abusers, who have been treated for Hepatitis C, are now helping to educate others in ways that outreach workers, who are not infected with Hepatitis C, cannot do! We can help stop the spread of Hepatitis C, save lives, and reduce the “Reservoir” of these viruses by educating the homeless and other at risk groups, vaccinating them for HAV and HBV, and treating them before it is too late!

    63. Many of the homeless will eventually find stable housing and become productive citizens again! However, chronic viral hepatitis B & C will continue to be “silent epidemics” that will infect and eventually kill many of them unless they are tested and treated.

    66. Resources Viral Hepatitis www.cdc.gov/hepatitis www.hcvadvocate.org www.hepcproject.org www.immunize.org www.hepb.org

    67. Hepatitis and the Homeless: “The Coming Storm”

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