A Modern Take on Hepatitis Immunization: Overcoming Today's Hurdles With Recent Guidelines and Practical Strategies
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Aug 16, 2024
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About This Presentation
Co-Chairs, Robert G Gish, MD, and Stacey B. Trooskin, MD, PhD, discuss hepatitis in this CME/NCPD/CPE/AAPA/IPCE activity titled “A Modern Take on Hepatitis Immunization: Overcoming Today's Hurdles With Recent Guidelines and Practical Strategies.” For the full presentation, downloadable Pract...
Slide Content
A Modern Take on Hepatitis Immunization
Overcoming Today's Hurdles With Recent Guidelines
and Practical Strategies
Robert G Gish, MD Stacey B. Trooskin, MD, PhD
Medical Director Executive Medical Officer
Hepatitis B Foundation Mazzoni Center
Adjunct Professor of Medicine, Faculty, Perelman School of Medicine
University of Nevada, Reno & Las Vegas at the University of Pennsylvania
Principal, Robert G Gish Consultants LLC Philadelphia, Pennsylvania
San Diego, California
Copyright ©
Overcoming Today's Hurdles With Recent Guidelines
and Practical Strategies
Robert G Gish, MD Stacey B. Trooskin, MD, PhD
Medical Director Executive Medical Officer
Hepatitis B Foundation Mazzoni Center
Adjunct Professor of Medicine, Faculty, Perelman School of Medicine
University of Nevada, Reno & Las Vegas at the University of Pennsylvania
Principal, Robert G Gish Consultants LLC Philadelphia, Pennsylvania
San Diego, California
Copyright ©
Overview of the Epidemiology and
Burden of Hepatitis A and B
Robert G Gish, MD
Medical Director
Hepatitis B Foundation
Adjunct Professor of Medicine,
University of Nevada, Reno & Las Vegas
Principal, Robert G Gish Consultants LLC
San Diego, California
Copyright © 2000-2024, PeerView
Burden of Hepatitis A and B
Robert G Gish, MD
Medical Director
Hepatitis B Foundation
Adjunct Professor of Medicine,
University of Nevada, Reno & Las Vegas
Principal, Robert G Gish Consultants LLC
San Diego, California
Copyright © 2000-2024, PeerView
Our Goals for Today
Expand your understanding of the impact of HAV and HBV infection,
including transmission rates, clinical features, and risk factors for severe
disease and poor outcomes
Provide you with ACIP updated guidelines for HAV and HBV vaccination
Improve your ability to use professional-patient dialogue regarding HAV
and HBV vaccine recommendations to address disparities and barriers
in diverse adult populations
Equip you with multidisciplinary, interprofessional strategies for optimal
prevention of HAV and HBV infection in accordance with updated guidelines
Copyright O 2000
Expand your understanding of the impact of HAV and HBV infection,
including transmission rates, clinical features, and risk factors for severe
disease and poor outcomes
Provide you with ACIP updated guidelines for HAV and HBV vaccination
Improve your ability to use professional-patient dialogue regarding HAV
and HBV vaccine recommendations to address disparities and barriers
in diverse adult populations
Equip you with multidisciplinary, interprofessional strategies for optimal
prevention of HAV and HBV infection in accordance with updated guidelines
Copyright O 2000
Burden of Hepatitis A in the United States: Health
Outcomes, Economic Costs, and Management Strategies!
34 studies reported on
‘outbreak management
4 N 33 studies reported on 10 studies reported on
In the United States, health outcomes ‘economic burden
HepA vaccination
error adverse health ‘The estimated national
en from HepA disease v average cost per HepA-related
virus infection; however, comes from Hepa disease were
many US adults remain
ae a =
liver Liver 9 Ay $16,000/person in
e tengais @7 the United States
There have been ongoing | aise
outbreaks of HepA disease
in the United States since |
2016, mostly spread through
close personal contact
A2017 outbreak resulted in
an estimated cost of
2
$253 spent per employee
| Y evaluated for HepA by a city
BM nospiaizaon rate case fatality rate alth department
‘The US HepA outbreaks have had considerable health and economic impact since 2016
Increasing HepA vaccination coverage is needed to reduce the impact of HepA in the United States and prevent future outbreaks
These outbreak management |
1. Hom EX et al. J Info Dis. 2024: 20087 (Epub online ahead o prin
Pee!
m/SHN827 Copyright © 2000-2024, PeerView
Outcomes, Economic Costs, and Management Strategies!
34 studies reported on
‘outbreak management
4 N 33 studies reported on 10 studies reported on
In the United States, health outcomes ‘economic burden
HepA vaccination
error adverse health ‘The estimated national
en from HepA disease v average cost per HepA-related
virus infection; however, comes from Hepa disease were
many US adults remain
ae a =
liver Liver 9 Ay $16,000/person in
e tengais @7 the United States
There have been ongoing | aise
outbreaks of HepA disease
in the United States since |
2016, mostly spread through
close personal contact
A2017 outbreak resulted in
an estimated cost of
2
$253 spent per employee
| Y evaluated for HepA by a city
BM nospiaizaon rate case fatality rate alth department
‘The US HepA outbreaks have had considerable health and economic impact since 2016
Increasing HepA vaccination coverage is needed to reduce the impact of HepA in the United States and prevent future outbreaks
These outbreak management |
1. Hom EX et al. J Info Dis. 2024: 20087 (Epub online ahead o prin
Pee!
m/SHN827 Copyright © 2000-2024, PeerView
Epidemiologic Patterns: Hepatitis A
Lower Socioeconomic Status
Acquisition by age 5
High seroprevalence
Mild clinical course
Pacific Islands
Waves of epidemics
Varying severity by generation
Developed Regions
Higher socioeconomic status
Low rate of childhood exposure
Food-bome outbreaks
San Diego outbreak 2016-2018
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Lower Socioeconomic Status
Acquisition by age 5
High seroprevalence
Mild clinical course
Pacific Islands
Waves of epidemics
Varying severity by generation
Developed Regions
Higher socioeconomic status
Low rate of childhood exposure
Food-bome outbreaks
San Diego outbreak 2016-2018
PeerView.com
Copyright © 2000-2024, PeerView
Number of Reported Cases of Hepatitis A Virus Infection and
Estimated Infections—United States, 2014-2021 (n = 5,728)!
40,000
— Reported cases
IM Estimated infections
Cases, n
8
3
15,000
10,000
5,000
2014 2015 2016 2017 2018 2019 2020 2021
| pa de govmepatisstatisis/202 survetanceimepattc- hm. Year PeerView.com
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Estimated Infections—United States, 2014-2021 (n = 5,728)!
40,000
— Reported cases
IM Estimated infections
Cases, n
8
3
15,000
10,000
5,000
2014 2015 2016 2017 2018 2019 2020 2021
| pa de govmepatisstatisis/202 survetanceimepattc- hm. Year PeerView.com
PeerView.com/SHN827 Copyright © 2000-2024, PeerView
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Sources of Hepatitis A Infection
Intemational travel
Outbreak
3%
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Sources of Hepatitis A Infection
Intemational travel
Outbreak
3%
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Copyright © 2000-2024, PeerView
At-Risk Populations
oO
Travelers to endemic areas without prior immunization
Family members/caregivers of infected patients
Family members/caregivers of recent adoptee from a country where HAV is common
MSM
Sexual partners of people with acute HAV
People with HIV
People with clotting disorders
IDU
People with chronic liver disease
oo
a
Q
a
Q
Q
Q
a
Homeless, people with unstable housing
PeerView.com
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oO
Travelers to endemic areas without prior immunization
Family members/caregivers of infected patients
Family members/caregivers of recent adoptee from a country where HAV is common
MSM
Sexual partners of people with acute HAV
People with HIV
People with clotting disorders
IDU
People with chronic liver disease
oo
a
Q
a
Q
Q
Q
a
Homeless, people with unstable housing
PeerView.com
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Clinical Presentations
Asymptomatic disease without jaundice ©
Symptomatic, self-limiting disease with jaundice for less than 8 weeks
Cholestatic jaundice lasting more than 10 weeks
Relapsing acute hepatitis, with two or more instances over a 10-week period
Acute hepatic failure
PeerVie
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Asymptomatic disease without jaundice ©
Symptomatic, self-limiting disease with jaundice for less than 8 weeks
Cholestatic jaundice lasting more than 10 weeks
Relapsing acute hepatitis, with two or more instances over a 10-week period
Acute hepatic failure
PeerVie
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Who Should Get Vaccinated?"
People who use
‘substances
ing and
únoninjecting
substanc People anticipating
close personal
‘contact with
International
adoptees
Men who have
sex with men
International travelers} People at
(from low to high increased risk occupational risk
or Intermediate
¡demicty count of infection of exposure
People at
risk of
severe disease
People with chronic liver disease
CB infection
(any etiology
: Fatty ive People with HIV
+ Autoimmune hepatitis
1. Migueres Metal. Vues, 2021:13:1900 PeerView.com
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People who use
‘substances
ing and
únoninjecting
substanc People anticipating
close personal
‘contact with
International
adoptees
Men who have
sex with men
International travelers} People at
(from low to high increased risk occupational risk
or Intermediate
¡demicty count of infection of exposure
People at
risk of
severe disease
People with chronic liver disease
CB infection
(any etiology
: Fatty ive People with HIV
+ Autoimmune hepatitis
1. Migueres Metal. Vues, 2021:13:1900 PeerView.com
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Hepatitis A Surveillance’
Decrease in hepatitis A cases in 20:
+ 43% decrease from numb
+ Remains 4 times number of cases in 2015, before person-to-person outbreaks were first reported
Overall rate of 1.7 per 100,000 persons, highest rates among persons
+ 30-39 years and 40-49 years of age
+ White people who are not Hispanic
+ States in Eastern and Southern regions
ional states declared end to outbreaks among people who use drugs and people
experiencing homelessness
1. ps: cd govinepattslstatistes/202tsurvellanceinepatis-a him. rView.com
>m/SHN827 Copyright © 2000-2024, PeerView
Decrease in hepatitis A cases in 20:
+ 43% decrease from numb
+ Remains 4 times number of cases in 2015, before person-to-person outbreaks were first reported
Overall rate of 1.7 per 100,000 persons, highest rates among persons
+ 30-39 years and 40-49 years of age
+ White people who are not Hispanic
+ States in Eastern and Southern regions
ional states declared end to outbreaks among people who use drugs and people
experiencing homelessness
1. ps: cd govinepattslstatistes/202tsurvellanceinepatis-a him. rView.com
>m/SHN827 Copyright © 2000-2024, PeerView
National Progress Report 2025 Goal:
Reduce Estimated New Hepatitis A Virus Infections by 240%!'
Estimated New Hepatitis A Virus Infections and
di ‘Annual Targets for the United States by Year Key Findings
+ 2021 is the second year hepatitis A
30.000 has decreased, after 5 years
of consecutive increase
30,000
E + Consistent with resolving hepatitis A
é
É 25000 outbreaks in several states
3 + A 65% reduction from the 2024
& 20,000 estimate is needed to meet 2025 goal
= of 4,000 estimated infections
15.000
oo National Progress Report 2025 Goal
BER Status: Moving toward annual target,
d but annual target was not met
o
2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023
Time, y
| tps wr ode govepatts poly NPR/2020sonaiProgreszReport Hepk-Reduseintechons.him PeerView.com
PeerView.com/SHN827 Copyright © 2000-2024, PeerView
Reduce Estimated New Hepatitis A Virus Infections by 240%!'
Estimated New Hepatitis A Virus Infections and
di ‘Annual Targets for the United States by Year Key Findings
+ 2021 is the second year hepatitis A
30.000 has decreased, after 5 years
of consecutive increase
30,000
E + Consistent with resolving hepatitis A
é
É 25000 outbreaks in several states
3 + A 65% reduction from the 2024
& 20,000 estimate is needed to meet 2025 goal
= of 4,000 estimated infections
15.000
oo National Progress Report 2025 Goal
BER Status: Moving toward annual target,
d but annual target was not met
o
2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023
Time, y
| tps wr ode govepatts poly NPR/2020sonaiProgreszReport Hepk-Reduseintechons.him PeerView.com
PeerView.com/SHN827 Copyright © 2000-2024, PeerView
Epidemiology and Burden of Hepatitis B in the United States!
Up to 2.4 million people are chronically infected
Rates of acute hepatitis B infection have risen 50%-450% in states impacted by the opioid crisis
For many countries, chronic hepatitis B rates are higher in men than women and have declined over
the past 3 decades, but no consistent pattern is seen between rates for US immigrants and residents
More than 50% of people living with chronic hepatitis B are of Asian, Pacific Islander, or African descent;
hepatitis B and the resulting liver cancer are among the largest health disparities for these groups
The weighted average chronic hepatitis B prevalence for all foreign-born people in the United States
in 2018 was about 3%
= About 59% of those US residents with chronic hepatitis B in the United States in 2018 emigrated
from Asia, 19% from the Americas, and 15% from Africa
Only 25% of infected individuals are diagnosed
Thousands of people die each year from hepatitis B
1. ps: hepb ergwhatis-hepatis-bhvhatishepbiacts-and-figures. PeerView.com
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Up to 2.4 million people are chronically infected
Rates of acute hepatitis B infection have risen 50%-450% in states impacted by the opioid crisis
For many countries, chronic hepatitis B rates are higher in men than women and have declined over
the past 3 decades, but no consistent pattern is seen between rates for US immigrants and residents
More than 50% of people living with chronic hepatitis B are of Asian, Pacific Islander, or African descent;
hepatitis B and the resulting liver cancer are among the largest health disparities for these groups
The weighted average chronic hepatitis B prevalence for all foreign-born people in the United States
in 2018 was about 3%
= About 59% of those US residents with chronic hepatitis B in the United States in 2018 emigrated
from Asia, 19% from the Americas, and 15% from Africa
Only 25% of infected individuals are diagnosed
Thousands of people die each year from hepatitis B
1. ps: hepb ergwhatis-hepatis-bhvhatishepbiacts-and-figures. PeerView.com
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Transmission of HBV Infection’
+ Most common route of transmission is from mother to neonate (vertical transmission) or
from mother to child or child to child (horizontal transmission)
+ HBV is transmitted through percutaneous or mucosal contact with blood or body fluids
Others routes include
+ Sex with a partner who has HBV infection
+ Injection drug use that involves sharing needles, syringes, or drug preparation equipment
+ Accidental exposures to needle sticks or sharp instruments
+ Contact with blood from, or open sores on, a person who has HBV infection
+ Administration of contaminated blood products, especially in resource-restricted countries
Atos wera oho innews-toomiact-sheetsidetaitnepattisb PeerView.com
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+ Most common route of transmission is from mother to neonate (vertical transmission) or
from mother to child or child to child (horizontal transmission)
+ HBV is transmitted through percutaneous or mucosal contact with blood or body fluids
Others routes include
+ Sex with a partner who has HBV infection
+ Injection drug use that involves sharing needles, syringes, or drug preparation equipment
+ Accidental exposures to needle sticks or sharp instruments
+ Contact with blood from, or open sores on, a person who has HBV infection
+ Administration of contaminated blood products, especially in resource-restricted countries
Atos wera oho innews-toomiact-sheetsidetaitnepattisb PeerView.com
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Hepatitis B Disease Progression and Impact’
‘Spontaneous
/ clearance
OBI
+ Up to 40% of persons with CHB
develop significant clinical
si consequences, including cirrhosis,
Decompensated liver failure, and HCC
ciunosis; + 25% of persons with CHB will die
moor prematurely from complications
lifetime risk Death
+ Faiure to clear HB4Ag 6 ments after acute infection
1. The eiminaton of hepatiis 8. In: Buckey Gi etal. Elminatng the Pubic Heat Problem of Hepatitis Band C in th United States: Phase One Report. 2016
2. Huang YT etal. J Cin Oncol 2011:28:3643-3650. 3. Lok ASF. Eng! Med. 2002:348:1682-1085. 4 Has AM et al MW Mor Mortal WAY Rep, ñ
2010.67 541-546, PeerView.com
PeerView.com/SHN827 Copyright © 2000-2024, PeerView
‘Spontaneous
/ clearance
OBI
+ Up to 40% of persons with CHB
develop significant clinical
si consequences, including cirrhosis,
Decompensated liver failure, and HCC
ciunosis; + 25% of persons with CHB will die
moor prematurely from complications
lifetime risk Death
+ Faiure to clear HB4Ag 6 ments after acute infection
1. The eiminaton of hepatiis 8. In: Buckey Gi etal. Elminatng the Pubic Heat Problem of Hepatitis Band C in th United States: Phase One Report. 2016
2. Huang YT etal. J Cin Oncol 2011:28:3643-3650. 3. Lok ASF. Eng! Med. 2002:348:1682-1085. 4 Has AM et al MW Mor Mortal WAY Rep, ñ
2010.67 541-546, PeerView.com
PeerView.com/SHN827 Copyright © 2000-2024, PeerView
Number of Reported Cases of Acute HBV Infection and
Estimated Infections—United States, 2014-2021 (n = 2,045)!
30,000
— Reported acute cases.
25,000 À Ml Estimated acute infections
8
3
Acute Cases, n
10,000
5,000
2014 2015 2016 2017 2018 2019 2020 2021
1. os: ode qovnepattalsttetce/202survellanceiepatie-biigure2.1.ntm. Year PeerView.com
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Estimated Infections—United States, 2014-2021 (n = 2,045)!
30,000
— Reported acute cases.
25,000 À Ml Estimated acute infections
8
3
Acute Cases, n
10,000
5,000
2014 2015 2016 2017 2018 2019 2020 2021
1. os: ode qovnepattalsttetce/202survellanceiepatie-biigure2.1.ntm. Year PeerView.com
PeerView.com/SHN827 Copyright © 2000-2024, PeerView
Hepatitis B Surveillance’
Decrease in acute hepatitis B in 2021
— 5% decrease in number of cases reported from 2020
- Declines in 2020 and 2021 following 10-years of stable rates ~1.0 per 100,000
- Combination of prevention efforts and COVID-19 pandemic impact
Overall acute hepatitis B rate of 0.7 per 100,000 persons, highest rates among persons
— 40-49 years of age
— States located in Eastern and Southern regions
Risk data missing in 45% of reported acute hepatitis B cases
— Increase from 37% in 2019
- When data present, injection drug use most common risk reported
Rate of newly reported chronic hepatitis B among Asian/Pacific Islander persons 14 times the rate
among White people who are not Hispanic
Rate of hepatitis B deaths among Asian/Pacific Islander persons 10 times the rate among White
people who are not Hispanic
tps wer ode govmepatisistatisis/202suveitancemepatis- him. PeerView.com
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Decrease in acute hepatitis B in 2021
— 5% decrease in number of cases reported from 2020
- Declines in 2020 and 2021 following 10-years of stable rates ~1.0 per 100,000
- Combination of prevention efforts and COVID-19 pandemic impact
Overall acute hepatitis B rate of 0.7 per 100,000 persons, highest rates among persons
— 40-49 years of age
— States located in Eastern and Southern regions
Risk data missing in 45% of reported acute hepatitis B cases
— Increase from 37% in 2019
- When data present, injection drug use most common risk reported
Rate of newly reported chronic hepatitis B among Asian/Pacific Islander persons 14 times the rate
among White people who are not Hispanic
Rate of hepatitis B deaths among Asian/Pacific Islander persons 10 times the rate among White
people who are not Hispanic
tps wer ode govmepatisistatisis/202suveitancemepatis- him. PeerView.com
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National Progress Report 2025 Goal:
Reduce Estimated New Hepatitis B Virus Infections by 220%!
Estimated New Hepatitis A Virus Infections and
Key Findings
‘Annual Targets for the United States by Year
+ Estimated new infections continued to
decrease in 2021 25,000
= Attributable, in part, to the impact of
COVID-19 response strategies 20.000
+ In 2021, the number of estimated a
infections is 26% below the 2025 goal 2
of 18,000 estimated infections q.
= 10000
National Progress Report 2025 Goal 5,000
Status: Met or exceeded current
target 0
2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023
Time, y
|. tps rode goumepattsipoteyNNPR/2020NatonalProgressReport-Hep8-Reducelntection hin, PeerView.com
PeerView.com/SHN827 Copyright © 2000-2024, PeerView
Reduce Estimated New Hepatitis B Virus Infections by 220%!
Estimated New Hepatitis A Virus Infections and
Key Findings
‘Annual Targets for the United States by Year
+ Estimated new infections continued to
decrease in 2021 25,000
= Attributable, in part, to the impact of
COVID-19 response strategies 20.000
+ In 2021, the number of estimated a
infections is 26% below the 2025 goal 2
of 18,000 estimated infections q.
= 10000
National Progress Report 2025 Goal 5,000
Status: Met or exceeded current
target 0
2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023
Time, y
|. tps rode goumepattsipoteyNNPR/2020NatonalProgressReport-Hep8-Reducelntection hin, PeerView.com
PeerView.com/SHN827 Copyright © 2000-2024, PeerView
National Progress Report 2025 Goal: Reduce Estimated New
HBV Infections Among Persons Who Inject Drugs by 225%!
Key Findings Incidence Rate of Reported New Hepatitis B Cases Among Persons
‘Aged 18-40 Years and Annual Targets for the United States by Year
+ The rate of acute hepatitis B among
persons who inject drugs (persons aged
18-40 years) continued to decrease
+ The observed rate in 2021 is below
the 2025 goal of 1.0 case per
100,000 population 3
3
National Progress Report 2025 Goal
target
2 2019 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023
Time, y
1. ip hen. ede gouepattisipolyinpr2021/NationaiProgressReport-HepB-ReduceinfectionsPWID htm. PeerView.com
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HBV Infections Among Persons Who Inject Drugs by 225%!
Key Findings Incidence Rate of Reported New Hepatitis B Cases Among Persons
‘Aged 18-40 Years and Annual Targets for the United States by Year
+ The rate of acute hepatitis B among
persons who inject drugs (persons aged
18-40 years) continued to decrease
+ The observed rate in 2021 is below
the 2025 goal of 1.0 case per
100,000 population 3
3
National Progress Report 2025 Goal
target
2 2019 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023
Time, y
1. ip hen. ede gouepattisipolyinpr2021/NationaiProgressReport-HepB-ReduceinfectionsPWID htm. PeerView.com
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National Progress Report 2025 Goal: Reduce Reported Rate
of Hepatitis B-Related Deaths by 220%!
Ney Findings Age-Adjusted Rate of Hepatitis B-Related Deaths and
+ B-related deaths are slightly decreased ‘Annual Targets for the United States by Year
from the 2020 rate ee
+ Increase above the target may reflect, in
part, the impact of COVID-19 on the 0.50
overall US death rate
+ A 16% reduction from the 2021 rate is E 040 os
needed lo meet the 2025 goal of 0.37 3 toe)
deaths per 100,000 population $ 030
3
© 020
National Progress Report 2025 Goal
0.10
‘Status: Moving toward annual target,
but annual target was not fully met 0
2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023
Time, y
tps rr ode goVepattspolyInp2021/NatcnaProgressñeport-HepB-ReduceDests htm PeerView.com
PeerView.com/SHN827 Copyright © 2000-2024, PeerView
of Hepatitis B-Related Deaths by 220%!
Ney Findings Age-Adjusted Rate of Hepatitis B-Related Deaths and
+ B-related deaths are slightly decreased ‘Annual Targets for the United States by Year
from the 2020 rate ee
+ Increase above the target may reflect, in
part, the impact of COVID-19 on the 0.50
overall US death rate
+ A 16% reduction from the 2021 rate is E 040 os
needed lo meet the 2025 goal of 0.37 3 toe)
deaths per 100,000 population $ 030
3
© 020
National Progress Report 2025 Goal
0.10
‘Status: Moving toward annual target,
but annual target was not fully met 0
2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023
Time, y
tps rr ode goVepattspolyInp2021/NatcnaProgressñeport-HepB-ReduceDests htm PeerView.com
PeerView.com/SHN827 Copyright © 2000-2024, PeerView
National Progress Report 2025 Goal: Reduce Reported Rate of
HBV-Related Deaths Among Asian and Pacific Islander Persons by 225%!
Key Findings Age-Adjusted Rate of Hepatitis B-Related Deaths Among Non-Hispanic Asi
+ The 2021 observed hepatitis B-related and Pacific Islander Persons and Annual Targets for the United States by Year
death rate among Asian and Pacific
Islander persons was substantially higher
than the overall national rate (0.44)
3.00
250
+ Increase in 2021 may, in part, be
attributable to the COVID-19 pandemic
£ 200
+ A 28% reduction from the 2021 rate is E
needed to meet the 2025 goal of 1.84 cd
‘deaths per 100,000 population 3 150
E10
National Progress Report 2025 Goal
Status: Annual target was not met se
“and has not changed or moved away
from annual target o
2013" 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023
Time, y
1. ip ws. ede gouepattiaipolyinpr2020/NationaiProgressReport-HepB-ReduceDeainsAPI him, PeerView.com
PeerView.com/SHN827 Copyright © 2000-2024, PeerView
HBV-Related Deaths Among Asian and Pacific Islander Persons by 225%!
Key Findings Age-Adjusted Rate of Hepatitis B-Related Deaths Among Non-Hispanic Asi
+ The 2021 observed hepatitis B-related and Pacific Islander Persons and Annual Targets for the United States by Year
death rate among Asian and Pacific
Islander persons was substantially higher
than the overall national rate (0.44)
3.00
250
+ Increase in 2021 may, in part, be
attributable to the COVID-19 pandemic
£ 200
+ A 28% reduction from the 2021 rate is E
needed to meet the 2025 goal of 1.84 cd
‘deaths per 100,000 population 3 150
E10
National Progress Report 2025 Goal
Status: Annual target was not met se
“and has not changed or moved away
from annual target o
2013" 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023
Time, y
1. ip ws. ede gouepattiaipolyinpr2020/NationaiProgressReport-HepB-ReduceDeainsAPI him, PeerView.com
PeerView.com/SHN827 Copyright © 2000-2024, PeerView
Faculty
Discussion
Discussion
Faculty
Discussion
Discussion
Updated Vaccination Recommendations
for Hepatitis A and B
Stacey B. Trooskin, MD, PhD
Executive Medical Officer
Mazzoni Center
Faculty, Perelman School of Medicine
at the University of Pennsylvania
Philadelphia, Pennsylvania
Copyright
for Hepatitis A and B
Stacey B. Trooskin, MD, PhD
Executive Medical Officer
Mazzoni Center
Faculty, Perelman School of Medicine
at the University of Pennsylvania
Philadelphia, Pennsylvania
Copyright
HAV Vaccines’
Vaccines Used to Prevent Hepatitis A Virus Infection
Vaccine Trade Name je Group, y Dosage, mL. Route Schedule Booster
HepA, inactivated Bun 118 0.5 (720 ELISA units inactivated HAV) m None
doses) = 1 (1,440 ELISA units inactivated HAV) ™ None
rent = 148 05 (25 unis HAV antigen) m None
doses) 219 1 (60 units HAV antigen) m None
Ce entres 2. 218 (primary) 1(720 ELISA unis inactivated HAV + 20 pg HBsAg) IM None
E 218 (accelerated) 1 (720 ELISA units inactivated HAV + 20 jig HBsAg) IM 12mo
Dosage Recommendations for GamaSTAN Human Immunoglobulin
for Pre-Exposure and Postexposure Prophylaxis Against Hepatitis A Infection
ion Time Dose, mLikg Route
Pre-exposure prophylaxis Up to 1 mo duration of travel 04 m
Pre-exposure prophylaxis Up to 2 mo duration of travel 02 m
Pre-exposure prophylanis, 22 mo duration oftravel 02 (repeat every 2mo) m
Postexposure prophya Within 2 weeks of exposure 01 m
Combined HepA and HepB vaccine (Twins) shoul nt be used for postexposure prophyiaxs. > The dosage af mmunogiobuin is based on weight or all ages and
‘oes net ave a maximum dose fr prtecion agaist hepatitis A A
Y hos inode. govlmmortvolames/6einipdainGS0Sa-H pt. PeerView.com
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Vaccines Used to Prevent Hepatitis A Virus Infection
Vaccine Trade Name je Group, y Dosage, mL. Route Schedule Booster
HepA, inactivated Bun 118 0.5 (720 ELISA units inactivated HAV) m None
doses) = 1 (1,440 ELISA units inactivated HAV) ™ None
rent = 148 05 (25 unis HAV antigen) m None
doses) 219 1 (60 units HAV antigen) m None
Ce entres 2. 218 (primary) 1(720 ELISA unis inactivated HAV + 20 pg HBsAg) IM None
E 218 (accelerated) 1 (720 ELISA units inactivated HAV + 20 jig HBsAg) IM 12mo
Dosage Recommendations for GamaSTAN Human Immunoglobulin
for Pre-Exposure and Postexposure Prophylaxis Against Hepatitis A Infection
ion Time Dose, mLikg Route
Pre-exposure prophylaxis Up to 1 mo duration of travel 04 m
Pre-exposure prophylaxis Up to 2 mo duration of travel 02 m
Pre-exposure prophylanis, 22 mo duration oftravel 02 (repeat every 2mo) m
Postexposure prophya Within 2 weeks of exposure 01 m
Combined HepA and HepB vaccine (Twins) shoul nt be used for postexposure prophyiaxs. > The dosage af mmunogiobuin is based on weight or all ages and
‘oes net ave a maximum dose fr prtecion agaist hepatitis A A
Y hos inode. govlmmortvolames/6einipdainGS0Sa-H pt. PeerView.com
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HAV Vaccine Efficacy’
Highly immunogenic
More than 95% of adults develop protective antibody
within 4 weeks of a single dose
More than 97% of children and adolescents will be
seropositive within 1 month of the first dose
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Highly immunogenic
More than 95% of adults develop protective antibody
within 4 weeks of a single dose
More than 97% of children and adolescents will be
seropositive within 1 month of the first dose
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Tremendous Success With Hepatitis A!
EEE Cases — Incidence rate
8
8
ES
However, recent
outbreaks have
threatened
3
Cases, n
Cases per 100,000
Population
progress in
hepatitis A
elimination
1. Hotmelster MG et al. Pubic Heth Rep. 2023:339548291184007. PeerView.com
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EEE Cases — Incidence rate
8
8
ES
However, recent
outbreaks have
threatened
3
Cases, n
Cases per 100,000
Population
progress in
hepatitis A
elimination
1. Hotmelster MG et al. Pubic Heth Rep. 2023:339548291184007. PeerView.com
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ACIP HAV Vaccine Recommendations (2020)!
Children
+ All children aged 12-23 mo
+ Unvaceinated children and adolescents aged 2-18 y
Persons at increased risk for HAV infection
+ International travelers
+ Men who have sex with men
+ Persons who use injection or noninjection drugs
(ie, all those who use illegal drugs)
+ Persons with occupational risk for exposure
+ Persons who anticipate close personal contact with
an international adoptee
+ Persons experiencing homelessness.
Persons at increased risk for severe disease from
HAV infection
+ Persons with chronic liver disease
+ Persons with human immunodeficiency virus infection
Other persons recommended for vaccination
+ Pregnant women at risk for HAV infection or
severe outcome from HAV infection
+ Any person who requests vaccination
Vaccination during outbreaks
+ Unvaccinated persons in outbreak settings who
are at risk for HAV infection or at risk for severe
disease from HAV
Implementation strategies for settings providing
services to adults
+ Persons in settings that provide services to adults
in which a high proportion of those persons have
risk factors for HAV infection
Hepatitis A vaccination is no longer
recommended by ACIP
+ Persons who receive blood products for clotting
disorders (eg, hemophilia)
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A. Nelson NP etal, MMWR Recomm Rep. 2020;68:1-28,
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Children
+ All children aged 12-23 mo
+ Unvaceinated children and adolescents aged 2-18 y
Persons at increased risk for HAV infection
+ International travelers
+ Men who have sex with men
+ Persons who use injection or noninjection drugs
(ie, all those who use illegal drugs)
+ Persons with occupational risk for exposure
+ Persons who anticipate close personal contact with
an international adoptee
+ Persons experiencing homelessness.
Persons at increased risk for severe disease from
HAV infection
+ Persons with chronic liver disease
+ Persons with human immunodeficiency virus infection
Other persons recommended for vaccination
+ Pregnant women at risk for HAV infection or
severe outcome from HAV infection
+ Any person who requests vaccination
Vaccination during outbreaks
+ Unvaccinated persons in outbreak settings who
are at risk for HAV infection or at risk for severe
disease from HAV
Implementation strategies for settings providing
services to adults
+ Persons in settings that provide services to adults
in which a high proportion of those persons have
risk factors for HAV infection
Hepatitis A vaccination is no longer
recommended by ACIP
+ Persons who receive blood products for clotting
disorders (eg, hemophilia)
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A. Nelson NP etal, MMWR Recomm Rep. 2020;68:1-28,
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HBV Vaccines
Three-dose recombinant May be given to all ages, and safe for pregnancy
(Engerix-B, Recombivax-HB) Three doses given over 6 months (at 0, 1, and 6 months)
Two-dose recombivant adjuvanted For 18 and older, nonpregnant adults
(Heplisav-B) Two doses given 1 month apart
Given in pediatrics protects against five or six diseases,
including DTaP-IPV-HepB+/- HiB
Three doses given following birth dose HBV vaccine
Combo pentavalent and hexavalent
(Pediarix, Vaxelis)
Three-dose combo HAV/HBV vaccine May be given to all ages
(Twinrix) Three doses given over 6 months (at 0, 1, and 6 months)
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Three-dose recombinant May be given to all ages, and safe for pregnancy
(Engerix-B, Recombivax-HB) Three doses given over 6 months (at 0, 1, and 6 months)
Two-dose recombivant adjuvanted For 18 and older, nonpregnant adults
(Heplisav-B) Two doses given 1 month apart
Given in pediatrics protects against five or six diseases,
including DTaP-IPV-HepB+/- HiB
Three doses given following birth dose HBV vaccine
Combo pentavalent and hexavalent
(Pediarix, Vaxelis)
Three-dose combo HAV/HBV vaccine May be given to all ages
(Twinrix) Three doses given over 6 months (at 0, 1, and 6 months)
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ACIP Policy Statement for PreHevbrio, Added February 20221
PreHevbrio may be used as a HepB vaccine
Recommendation in persons aged 218 years recommended
for vaccination against HBV infection.
Persons on hemodialysis, pregnant persons,
and persons who are breastfeeding are not discussed
in this Evidence to Recommendations Framework.
The safety and effectiveness of PreHevbrio have not been established in adults
on hemodialysis. There are no adequate and well-controlled studies of
PreHevbrio in pregnant women. Available human data on PreHevbrio
administered to pregnant women are insufficient to inform vaccine-associated
tisks in pregnancy. Data are not available to assess the effects of PreHevbrio
on the breastfed infant or on milk production/excretion.
Additional
Considerations
1. Weng MK et a. MMWR More Mortal Wily Rep. 2022:71:477-483, PeerView.com
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PreHevbrio may be used as a HepB vaccine
Recommendation in persons aged 218 years recommended
for vaccination against HBV infection.
Persons on hemodialysis, pregnant persons,
and persons who are breastfeeding are not discussed
in this Evidence to Recommendations Framework.
The safety and effectiveness of PreHevbrio have not been established in adults
on hemodialysis. There are no adequate and well-controlled studies of
PreHevbrio in pregnant women. Available human data on PreHevbrio
administered to pregnant women are insufficient to inform vaccine-associated
tisks in pregnancy. Data are not available to assess the effects of PreHevbrio
on the breastfed infant or on milk production/excretion.
Additional
Considerations
1. Weng MK et a. MMWR More Mortal Wily Rep. 2022:71:477-483, PeerView.com
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HBV Vaccine Efficacy’
Outcomes Averted Over Cohort Lifetime?
+ >90% protection among healthy Number averted (% additional averted)
i $
ope, one tneithreerdoee: Acute HBV infections 428,485 (24.8%)
+ Estimated 290% of persons had Chronic HBV infections 34,200 (24.2%)
evidence of protection 30 years m
aflor receiving the primary series Hepatitis B-related deaths 78,808 (22.8%)
Hepatocellular carcinoma 59,477 (28.8%)
“Assumes a tie dose strategy base cas, averting adtinal hepatts B-rlated outcomes compared wih baseine current risk-based strategy
Anal horizon 1 Ihe ete ofthe cohort (on average, -35 years per person) aaa
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Outcomes Averted Over Cohort Lifetime?
+ >90% protection among healthy Number averted (% additional averted)
i $
ope, one tneithreerdoee: Acute HBV infections 428,485 (24.8%)
+ Estimated 290% of persons had Chronic HBV infections 34,200 (24.2%)
evidence of protection 30 years m
aflor receiving the primary series Hepatitis B-related deaths 78,808 (22.8%)
Hepatocellular carcinoma 59,477 (28.8%)
“Assumes a tie dose strategy base cas, averting adtinal hepatts B-rlated outcomes compared wih baseine current risk-based strategy
Anal horizon 1 Ihe ete ofthe cohort (on average, -35 years per person) aaa
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Hepatitis B: Progress and Unfinished Business!
25,000
202
Le) Universal
prorat hepatitis B
20,000 catar
El A vaccination
> vacenaton ae $
Pa 1990 Universal aged 250 years
E Universal ehichood Infant hepatts
8 15.000 (618 years) hepatitis 8 © vaccination
ö Vaccination within 24 hours
1062 1007 oti
Risk-based Hepatitis Band
10,000 | MpatisB BIC vaccination
vaccination ae bith for infants
born to HBsAg
‘itn parents
5000
o
1980 1982 1984 1986 1988 1990 1992 1904
1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020 2022
Year
1. Bider D et al. Publ Heath Rep, 2023:333548231175548. PeerView.com
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25,000
202
Le) Universal
prorat hepatitis B
20,000 catar
El A vaccination
> vacenaton ae $
Pa 1990 Universal aged 250 years
E Universal ehichood Infant hepatts
8 15.000 (618 years) hepatitis 8 © vaccination
ö Vaccination within 24 hours
1062 1007 oti
Risk-based Hepatitis Band
10,000 | MpatisB BIC vaccination
vaccination ae bith for infants
born to HBsAg
‘itn parents
5000
o
1980 1982 1984 1986 1988 1990 1992 1904
1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020 2022
Year
1. Bider D et al. Publ Heath Rep, 2023:333548231175548. PeerView.com
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2023 Updated Hepatitis B Screening
and Testing Recommendations!
New Unchanged
Screening is recommended
Screening is recommended for all
For all adults aged >18 years pregnant persons during each pregnancy,
at least once in a lifetime preferably in the first trimester, regardless
of vaccination status or history of testing
Testing is recommended for anyone
with a history of risk (all ages)
For anyone who requests it
Susceptible during the period of risk
Using a three-test panel Periodic testing for susceptible persons
(HBsAg, anti-HBs, total anti-HBc) with ongoing risk (all ages)
1. Conners EE etal. MMWR Recomm Rep, 202372125, PeerView.com
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and Testing Recommendations!
New Unchanged
Screening is recommended
Screening is recommended for all
For all adults aged >18 years pregnant persons during each pregnancy,
at least once in a lifetime preferably in the first trimester, regardless
of vaccination status or history of testing
Testing is recommended for anyone
with a history of risk (all ages)
For anyone who requests it
Susceptible during the period of risk
Using a three-test panel Periodic testing for susceptible persons
(HBsAg, anti-HBs, total anti-HBc) with ongoing risk (all ages)
1. Conners EE etal. MMWR Recomm Rep, 202372125, PeerView.com
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ACIP Vaccination Recommendations??
May receive HBV vaccine
Should receive HBV vaccine
All infants + Adults 260 years of age without risk factors |
for HBV infection
Persons <19 years of age
Adults 19 to 59 years of age
Adults 260 years of age with risk factors
for HBV infection
All patients with chronic liver disease
should be vaccinated for hepatitis A and B
1. Sehlie $ et al MMWA Recomm Rep. 2018:87:1-31. 2. Weng MK et al. MMWR Morb Mortal Wkly Rep. 2022:71:477-483 PeerView.com
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May receive HBV vaccine
Should receive HBV vaccine
All infants + Adults 260 years of age without risk factors |
for HBV infection
Persons <19 years of age
Adults 19 to 59 years of age
Adults 260 years of age with risk factors
for HBV infection
All patients with chronic liver disease
should be vaccinated for hepatitis A and B
1. Sehlie $ et al MMWA Recomm Rep. 2018:87:1-31. 2. Weng MK et al. MMWR Morb Mortal Wkly Rep. 2022:71:477-483 PeerView.com
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Incidence, Hepatitis B
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Hepatitis B Immunization Strategy Evolves’
350,000
1999
Age 0-18 years
250,000 — New hepatitis B infections
1984
Infants born
to HBSAg* women
2005
Birth dose
1982
= 201
Vaccine for groups
Adults 550 years
100.000 | at increased risk with diabetes
1991
90,000. A US infants
35333338588 S5NS388388 SSSSSSSHSS Szsezeenee
SRSSSSSSSS BISSSSSISS FARRRRRRRR RRRRRRARAR
1980s 19908 Year 20008 20108
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Hepatitis B Immunization Strategy Evolves’
350,000
1999
Age 0-18 years
250,000 — New hepatitis B infections
1984
Infants born
to HBSAg* women
2005
Birth dose
1982
= 201
Vaccine for groups
Adults 550 years
100.000 | at increased risk with diabetes
1991
90,000. A US infants
35333338588 S5NS388388 SSSSSSSHSS Szsezeenee
SRSSSSSSSS BISSSSSISS FARRRRRRRR RRRRRRARAR
1980s 19908 Year 20008 20108
Copyright © 2000-2024, PeerView
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Risk-Based Hepatitis B Immunization Among Adults:
A Partial Success!
+ Initial decreases in new hep B infections plateaued 10 years ago
+ Rates are now highest among adults
+ Rates have increased among adults >40 years of age
6 Rates of Reported Acute Hepatitis B Virus Infection
by Age Group—United States, 2004-2019
Reported Cases per
100,000 Popul
m A ee 0-19y
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Year
1. tps wer cds goumepatisistatisis/201Ssurveitarceipdl/201¢HepSurveilanceRpt pct PeerView.com
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A Partial Success!
+ Initial decreases in new hep B infections plateaued 10 years ago
+ Rates are now highest among adults
+ Rates have increased among adults >40 years of age
6 Rates of Reported Acute Hepatitis B Virus Infection
by Age Group—United States, 2004-2019
Reported Cases per
100,000 Popul
m A ee 0-19y
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Year
1. tps wer cds goumepatisistatisis/201Ssurveitarceipdl/201¢HepSurveilanceRpt pct PeerView.com
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Limitations of a Risk-Based Approach’
Availability of information regarding risk behaviors or exposures" associated
with reported cases of acute hepatitis B virus infection—United States, 2019
2/3 of reported
1,183 cases were either
= Risk identified (37.1%) missing risk data
No risk identified
or reported no
‘= Risk data missing identified risk
Case reports with atleast one of he flowing risk behavorslexposures reported wk 1 8 mo pio o symplom onset or documented seroconversion asymplomatic: (1) injection drug use
(2) mulipl sexual partners; (3) underwent surgery: (4) man who have sex wil men; (S) sexual conta wih suspacteciconfemad hepatts E ease (6) sustained a percutaneous Uy,
(7) household contact with suspectecicorirmed hepabis 8 case; (8) occupational exposure 1 blood: (0) alysis: and (10) transusion. Reportes cases may include more Pan one risk
behaviorexoosure. "Risk behaviersiexposures data trom one state was classified as "missing" because of erors in reporto
Tips: cds. govinepattsistalstes/201surveilancelFigure2 7 him.
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Availability of information regarding risk behaviors or exposures" associated
with reported cases of acute hepatitis B virus infection—United States, 2019
2/3 of reported
1,183 cases were either
= Risk identified (37.1%) missing risk data
No risk identified
or reported no
‘= Risk data missing identified risk
Case reports with atleast one of he flowing risk behavorslexposures reported wk 1 8 mo pio o symplom onset or documented seroconversion asymplomatic: (1) injection drug use
(2) mulipl sexual partners; (3) underwent surgery: (4) man who have sex wil men; (S) sexual conta wih suspacteciconfemad hepatts E ease (6) sustained a percutaneous Uy,
(7) household contact with suspectecicorirmed hepabis 8 case; (8) occupational exposure 1 blood: (0) alysis: and (10) transusion. Reportes cases may include more Pan one risk
behaviorexoosure. "Risk behaviersiexposures data trom one state was classified as "missing" because of erors in reporto
Tips: cds. govinepattsistalstes/201surveilancelFigure2 7 him.
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What Does HBV Elimination Look Like?
Test all adults
Vaccinate all newborns
HBV susceptible
Vaccinate
Universal precautions
Suppressive
antiviral
Chronic HBV
Cirrhosis/HCC
HBV is vaccine-preventative but not curable
Suppressive treatment lowers risk of liver cancer and cirrhosis
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Test all adults
Vaccinate all newborns
HBV susceptible
Vaccinate
Universal precautions
Suppressive
antiviral
Chronic HBV
Cirrhosis/HCC
HBV is vaccine-preventative but not curable
Suppressive treatment lowers risk of liver cancer and cirrhosis
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Faculty
Discussion
Discussion
Assessing and Addressing
Health Disparities With Vaccination
Stacey B. Trooskin, MD, PhD
Executive Medical Officer
Mazzoni Center
Faculty, Perelman School of Medicine
at the University of Pennsylvania
Philadelphia, Pennsylvania
Health Disparities With Vaccination
Stacey B. Trooskin, MD, PhD
Executive Medical Officer
Mazzoni Center
Faculty, Perelman School of Medicine
at the University of Pennsylvania
Philadelphia, Pennsylvania
Viral Hepatitis: National Strategic Plan!
A Roadmap to Elimination for the United States, 2021-2025
The Need to Address Social Determinants of Health and Priority Populations
Many populations
disproportionately impacted by
viral hepatitis have faced
disparities in health status related
to the social determinants of
health, such as low-paying or
inconsistent employment, unstable
housing or homelessness, race,
ethnicity, and geographic location,
or other characteristics linked to
discrimination, stigma, or exclusion
4. peu govstes/defaultfles/Virat Hepatitis National-Stategle-Plan-2021-2025 pal.
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Negative interactions with the
healthcare or social services
system may decrease the
likelihood of care-seeking
behavior, making viral hepatitis
risk assessment and linkage
to care, prevention, and treatment
more difficult; this difficulty poses
additional and unique challenges
to the development
of broad-based solutions
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A Roadmap to Elimination for the United States, 2021-2025
The Need to Address Social Determinants of Health and Priority Populations
Many populations
disproportionately impacted by
viral hepatitis have faced
disparities in health status related
to the social determinants of
health, such as low-paying or
inconsistent employment, unstable
housing or homelessness, race,
ethnicity, and geographic location,
or other characteristics linked to
discrimination, stigma, or exclusion
4. peu govstes/defaultfles/Virat Hepatitis National-Stategle-Plan-2021-2025 pal.
PeerView.com/SHN827
Negative interactions with the
healthcare or social services
system may decrease the
likelihood of care-seeking
behavior, making viral hepatitis
risk assessment and linkage
to care, prevention, and treatment
more difficult; this difficulty poses
additional and unique challenges
to the development
of broad-based solutions
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Who Is Receiving the Hepatitis A Vaccine?"
« Among adults aged 219 years, hepatitis A vaccination coverage was
higher in 2021 than in 2018 overall (24.8%)
* Coverage was higher among travelers (33.8%) than nontravelers
(19.3%)
» Among all adults 219 years, coverage among White adults (24.8%)
was higher than Black (19.4%) but lower than Asian (33.1%) adults
+ Among adults aged 19-49 years, White adults had higher coverage
(37.5%) than Black (25.5%) and Hispanic (29.5%) adults
|. nos wr ode govvaccinesiima-managerslcoverageladultanviewipubsesoutcesivaccinaton-coverage-adutt-2021 hin. PeerView.com
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« Among adults aged 219 years, hepatitis A vaccination coverage was
higher in 2021 than in 2018 overall (24.8%)
* Coverage was higher among travelers (33.8%) than nontravelers
(19.3%)
» Among all adults 219 years, coverage among White adults (24.8%)
was higher than Black (19.4%) but lower than Asian (33.1%) adults
+ Among adults aged 19-49 years, White adults had higher coverage
(37.5%) than Black (25.5%) and Hispanic (29.5%) adults
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Likelihood of Receiving HAV Vaccination!
+ Results of a retrospective study from both rural and urban populations found that overall only
15% of people had received HAV vaccine despite appropriate indication
+ Among HAV vaccine receivers White (88%), non-Hispanic (92.5%), and native English
speakers (98.1%) had the highest percentage
More Likelihood
of HAV Vaccination (%) of HAV Vaccination (%)
Private insurance (19) Medicare (10.3) <.01
Age <35 y (26.4) Age 235 y (11.8) <.01
No history of incarceration (19.4) History of incarceration (12.2) <.01
Not Hispanic (15.2) Hispanic (13.2) .038
Asian (23.5) Not Asian (14.9) <.01
1. Baloch Letal. Am J Gastroonterl 202:116:5548, PeerView.com
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+ Results of a retrospective study from both rural and urban populations found that overall only
15% of people had received HAV vaccine despite appropriate indication
+ Among HAV vaccine receivers White (88%), non-Hispanic (92.5%), and native English
speakers (98.1%) had the highest percentage
More Likelihood
of HAV Vaccination (%) of HAV Vaccination (%)
Private insurance (19) Medicare (10.3) <.01
Age <35 y (26.4) Age 235 y (11.8) <.01
No history of incarceration (19.4) History of incarceration (12.2) <.01
Not Hispanic (15.2) Hispanic (13.2) .038
Asian (23.5) Not Asian (14.9) <.01
1. Baloch Letal. Am J Gastroonterl 202:116:5548, PeerView.com
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Rates of Reported Cases of Acute Hepatitis B Virus Infection
in the United States, 2006-20211
Age Race and Ethnicity
—e- American incian/Aaska Native, not Hispanic
© AsianvPactc Islander, not span
> Black, not Hispanic
‘ Vie. ten
Sa ee pe
35 as
83 gs
y LE
3 SE
38 38
ES 3
ES ae
a o
EEE DERG DOE DS DTD 3 ‘ere Be OO eve ZO 2
Year Year
JP te gormapattsen 20 uretncaepans pue um. .
2. lps./hvun.ode.‚govinepati'talisics/2021surveilanoeihepatiis-bfgur-2.6.hm. PeerView.com
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in the United States, 2006-20211
Age Race and Ethnicity
—e- American incian/Aaska Native, not Hispanic
© AsianvPactc Islander, not span
> Black, not Hispanic
‘ Vie. ten
Sa ee pe
35 as
83 gs
y LE
3 SE
38 38
ES 3
ES ae
a o
EEE DERG DOE DS DTD 3 ‘ere Be OO eve ZO 2
Year Year
JP te gormapattsen 20 uretncaepans pue um. .
2. lps./hvun.ode.‚govinepati'talisics/2021surveilanoeihepatiis-bfgur-2.6.hm. PeerView.com
PeerView.com/SHN827 Copyright © 2000-2024, PeerView
Rates of Newly Reported Cases of Chronic Hepatitis B,
by Demographic Characteristic, 2021 (n = 14,229)!
By Age Group
Overall
0-19 years
20-29 years
30-39 years
40-49 years
50-59 years
60+ years
0 5 10 15
Rate per 100,000 Population
1. ps: cd govnepattsistatstes/202{survellarce/hepatis-btable-26.nim
PeerView.com/SHN827
By Race and Ethnicity
Overall 59
Asian/Pacific Islander, 5,
not Hispanic
Black, not Hispanic 77
White, not Hispanic | 1.9
Hispanic
American Indian/Alaska
Native, not Hispanic
24
26
5
10 15 20 25 30
Rate per 100,000 Population
PeerView.com
Copyright © 2000-2024, Peerview
by Demographic Characteristic, 2021 (n = 14,229)!
By Age Group
Overall
0-19 years
20-29 years
30-39 years
40-49 years
50-59 years
60+ years
0 5 10 15
Rate per 100,000 Population
1. ps: cd govnepattsistatstes/202{survellarce/hepatis-btable-26.nim
PeerView.com/SHN827
By Race and Ethnicity
Overall 59
Asian/Pacific Islander, 5,
not Hispanic
Black, not Hispanic 77
White, not Hispanic | 1.9
Hispanic
American Indian/Alaska
Native, not Hispanic
24
26
5
10 15 20 25 30
Rate per 100,000 Population
PeerView.com
Copyright © 2000-2024, Peerview
Rates of Death With Hepatitis B Listed as a Cause of Death Among
US Residents, by Demographic Characteristic, 2021 (n
By Age Group
Overall
0-34 years
35-44 years
45-54 years
55-64 years
65-74 years
75+ years
0 02 04 06 08 1 12 14 16
Death Rate per 100,000 Population
1. ps: ede. qovhepattsistatstes 202 surveilance/hepatis-btable-28.him
PeerView.com/SHN827
1,748)!
By Race and Ethnicity
Overall
Muttirace, not Hispanic
Asian/Pacific Islander,
not Hispanic
Black, not Hispanic.
White, not Hispanic
Hispanic
American Indian/Alaska
Native, not Hispanic
0 04 08 12 16 2
24 28
Age-Adjusted Death Rate per 100,000 Population
PeerView.com
Copyright © 2000-2024, PeerView
US Residents, by Demographic Characteristic, 2021 (n
By Age Group
Overall
0-34 years
35-44 years
45-54 years
55-64 years
65-74 years
75+ years
0 02 04 06 08 1 12 14 16
Death Rate per 100,000 Population
1. ps: ede. qovhepattsistatstes 202 surveilance/hepatis-btable-28.him
PeerView.com/SHN827
1,748)!
By Race and Ethnicity
Overall
Muttirace, not Hispanic
Asian/Pacific Islander,
not Hispanic
Black, not Hispanic.
White, not Hispanic
Hispanic
American Indian/Alaska
Native, not Hispanic
0 04 08 12 16 2
24 28
Age-Adjusted Death Rate per 100,000 Population
PeerView.com
Copyright © 2000-2024, PeerView
HBV Vaccine Coverage by Race/Ethnicity in Ages 30-49
Years!
50
45
40
a 8
2
¿os
3
g 2
5 2
15
10
5
o
Mexican Whites Alrican Asians Other race
amerears spares Americans
Race/Ethnicity
1. Bhuiyan AR et al. Diseases. 2020.8:10, PeerView.com
PeerView.com/SHN827 Copyright © 2000-2024, PeerView
Years!
50
45
40
a 8
2
¿os
3
g 2
5 2
15
10
5
o
Mexican Whites Alrican Asians Other race
amerears spares Americans
Race/Ethnicity
1. Bhuiyan AR et al. Diseases. 2020.8:10, PeerView.com
PeerView.com/SHN827 Copyright © 2000-2024, PeerView
HBV Vaccine Prevalence Among Other At-Risk Groups:
MSM!
« Among MSM traveling internationally, self-reported HBV
vaccination prevalence was 77% overall (highest for men ages
18-40 years) and less prevalent among men older than 50 years
and those with HIV infection (one-third of HIV+ men reported not
being vaccinated)
— HBV infection prevalence was 25% overall and associated
with Black men, older age, and HIV infection
1. Truong HH etal
Transm Dis, 2018;45 425426, PeerView.com
PeerView.com/SHN827 Copyright © 2000-2024, PeerView
MSM!
« Among MSM traveling internationally, self-reported HBV
vaccination prevalence was 77% overall (highest for men ages
18-40 years) and less prevalent among men older than 50 years
and those with HIV infection (one-third of HIV+ men reported not
being vaccinated)
— HBV infection prevalence was 25% overall and associated
with Black men, older age, and HIV infection
1. Truong HH etal
Transm Dis, 2018;45 425426, PeerView.com
PeerView.com/SHN827 Copyright © 2000-2024, PeerView
HAV and HBV Vaccine Prevalence Among Other At-Risk Groups:
People Who Inject Drugs and Have Evidence of Hepatitis C*
Hepatitis A vaccine 21 dose Ceres
2029y —6-E
30-39 y (P <.001) ——
4o49y(P<.001) MI _——
Hepatitis A vaccine 2 doses
20-29y ——66-
30-39y(P<.001) E—®—
40-49y(P<.001) [EN —o——
Hepatitis B vaccine 2 doses
2029 —oa
30-39 y —o—-
40-49 m=—eo——
E © 70 60 0 100
Vaccinated, %
1. Koepke Ret al Pubs Heath Rep. 2018 104:651-650, PeerView.com
PeerView.com/SHN827 Copyright © 2000-2024, PeerView
People Who Inject Drugs and Have Evidence of Hepatitis C*
Hepatitis A vaccine 21 dose Ceres
2029y —6-E
30-39 y (P <.001) ——
4o49y(P<.001) MI _——
Hepatitis A vaccine 2 doses
20-29y ——66-
30-39y(P<.001) E—®—
40-49y(P<.001) [EN —o——
Hepatitis B vaccine 2 doses
2029 —oa
30-39 y —o—-
40-49 m=—eo——
E © 70 60 0 100
Vaccinated, %
1. Koepke Ret al Pubs Heath Rep. 2018 104:651-650, PeerView.com
PeerView.com/SHN827 Copyright © 2000-2024, PeerView
Barriers to Vaccination in At-Risk Populations’
1. Kolobova et al. Hum Vacein Immunother, 2022:18:2056422.
PeerView.com/SHN827
Access to healthcare and educational attainment level were
identified as key barriers to vaccination among LatinX
and Asian migrants and immigrants
Fewer foreign-born women were insured than US-born women
(68.2% vs 86.4%) and fewer foreign-born women had visited a
healthcare provider in the past year (74.4% vs 85.3%)
Limited English fluency and not knowing where to go for
vaccination were identified as barriers
Copyright
PeerView.com
> 2000-2024, Pee
1. Kolobova et al. Hum Vacein Immunother, 2022:18:2056422.
PeerView.com/SHN827
Access to healthcare and educational attainment level were
identified as key barriers to vaccination among LatinX
and Asian migrants and immigrants
Fewer foreign-born women were insured than US-born women
(68.2% vs 86.4%) and fewer foreign-born women had visited a
healthcare provider in the past year (74.4% vs 85.3%)
Limited English fluency and not knowing where to go for
vaccination were identified as barriers
Copyright
PeerView.com
> 2000-2024, Pee
Health Equity: Disparities Could Be Reduced
With a Universal Adult HBV Vaccine Recommendation‘?
s converged to a lower rate when a universal
+ Rates of HBV infection for children and adolescents of all races/ethni
vaccination strategy was implemented for children $18 years
+ Current rates among Black American adults are now up to 3x those of Asian/Pacific Islander and Hispanic groups
+ Raciallethnic disparities remain in hepatitis B virus infections
Rates of Reported Acute HBV Infections,
Wie, not Hispanic
lack, not span
So Amencan nlrílasta Natve
o pane
A ‘slanPacie lander
2004 2005 2008 2007 2008 2009 2010 2011 2012 2013 2014 2018 2016 2017 2018 2019
Year
100,000 Population
Reported Cases per
1. ps: ode. govinepattsistatistes/201@survellancelMep® him. 2. Wasley At al, MMWR Survol Summ. 2008:57:1-24, PeerView.com
PeerView.com/SHN827 Copyright © 2000-2024, PeerView
With a Universal Adult HBV Vaccine Recommendation‘?
s converged to a lower rate when a universal
+ Rates of HBV infection for children and adolescents of all races/ethni
vaccination strategy was implemented for children $18 years
+ Current rates among Black American adults are now up to 3x those of Asian/Pacific Islander and Hispanic groups
+ Raciallethnic disparities remain in hepatitis B virus infections
Rates of Reported Acute HBV Infections,
Wie, not Hispanic
lack, not span
So Amencan nlrílasta Natve
o pane
A ‘slanPacie lander
2004 2005 2008 2007 2008 2009 2010 2011 2012 2013 2014 2018 2016 2017 2018 2019
Year
100,000 Population
Reported Cases per
1. ps: ode. govinepattsistatistes/201@survellancelMep® him. 2. Wasley At al, MMWR Survol Summ. 2008:57:1-24, PeerView.com
PeerView.com/SHN827 Copyright © 2000-2024, PeerView
Faculty
Discussion
Discussion
Interprofessional Approach to Vaccination
Best Practices and Practical Solutions
Robert G Gish, MD
Medical Director
Hepatitis B Foundation
Adjunct Professor of Medicine,
University of Nevada, Reno & Las Vegas
Principal, Robert G Gish Consultants LLC
San Diego, California
Best Practices and Practical Solutions
Robert G Gish, MD
Medical Director
Hepatitis B Foundation
Adjunct Professor of Medicine,
University of Nevada, Reno & Las Vegas
Principal, Robert G Gish Consultants LLC
San Diego, California
Reasons for Vaccine Hesitancy!
Concerns about vaccine safety, adverse effects, toxicity, or poor quality of vaccine components
Previous experiences with vaccines and interactions with healthcare providers
Mistrust of doctors, health authorities, government sources, pharmaceutical companies and scientific
research, and doubts about the technology used to produce the vaccine
Perceptions of low risk of contracting illness, low illness severity, and low vaccine efficacy
Lack of information, information sources, and influence of antivaccine proponents
Religious beliefs,
Desire for a “natural” and “organic” lifestyle
How a person’s peer group perceives vaccines
Belief in a person's right to make their own healthcare decisions
Fear of needles
Inconvenience
Vaccine cost
1. htps:lipharmaceutes!joumal coma éonrto-sdéress-vacaine-hezitancy. PeerView.com
PeerView.com/SHN827 Copyright © 2000-2
Concerns about vaccine safety, adverse effects, toxicity, or poor quality of vaccine components
Previous experiences with vaccines and interactions with healthcare providers
Mistrust of doctors, health authorities, government sources, pharmaceutical companies and scientific
research, and doubts about the technology used to produce the vaccine
Perceptions of low risk of contracting illness, low illness severity, and low vaccine efficacy
Lack of information, information sources, and influence of antivaccine proponents
Religious beliefs,
Desire for a “natural” and “organic” lifestyle
How a person’s peer group perceives vaccines
Belief in a person's right to make their own healthcare decisions
Fear of needles
Inconvenience
Vaccine cost
1. htps:lipharmaceutes!joumal coma éonrto-sdéress-vacaine-hezitancy. PeerView.com
PeerView.com/SHN827 Copyright © 2000-2
Strategies for Addressing Vaccine Hesitancy!
Listen to the patient and acknowledge their
concems without judgment
Engage the patient in a dialogue; frame the
conversation beyond a binary yes/no
vaccination decision
Tailor your response to the patient's
concems
Keep messages clear and easy
to understand
Avoid jargon
Avoid using statements such as “no risk,” as
people mistrust strong statements and may
conversely believe the opposite
Help patients to weigh up the risks versus
benefits
Remind patients of the benefits
of vaccinations, the mildness of vaccine
adverse effects, and the very low risk
of serious adverse effects
Highlight the risks of not immunizing
Do
Correct misinformation, accept questions,
and explain
Provide personal examples
(e, pharmacist's own vaccination,
fact sheets, and other resources)
‘Communicate the high level
of endorsement of vaccines by various
‘communities
Refer patient to other providers or schedule
another appointment to discuss remaining,
vaccination concerns
Guide patient along the vaccine hesitancy
continuum toward acceptance, and
recognize the value of the conversation,
even if patient does not get vaccinated
at that appointment
D
Question an individual's sacred values:
or group identity
Griicize a particular group, such as
vaccine-hesitant parents
Get into an argumentidebate back and forth
or repeat vaccine myths (as the person will
‘not remember a detailed explanation of why
the vaccine myth is incorrect but will
remember the simple narrative of the myth)
Use fear, as this can backfire
‘Overload the patient with information,
as this can backfire
1. is Ipharmaceuicaljoumal com'arile how to-address-vaccine-hesitancy.
PeerView.com/SHN827
PeerView.com
Copyright © 2000-2024, PeerView
Listen to the patient and acknowledge their
concems without judgment
Engage the patient in a dialogue; frame the
conversation beyond a binary yes/no
vaccination decision
Tailor your response to the patient's
concems
Keep messages clear and easy
to understand
Avoid jargon
Avoid using statements such as “no risk,” as
people mistrust strong statements and may
conversely believe the opposite
Help patients to weigh up the risks versus
benefits
Remind patients of the benefits
of vaccinations, the mildness of vaccine
adverse effects, and the very low risk
of serious adverse effects
Highlight the risks of not immunizing
Do
Correct misinformation, accept questions,
and explain
Provide personal examples
(e, pharmacist's own vaccination,
fact sheets, and other resources)
‘Communicate the high level
of endorsement of vaccines by various
‘communities
Refer patient to other providers or schedule
another appointment to discuss remaining,
vaccination concerns
Guide patient along the vaccine hesitancy
continuum toward acceptance, and
recognize the value of the conversation,
even if patient does not get vaccinated
at that appointment
D
Question an individual's sacred values:
or group identity
Griicize a particular group, such as
vaccine-hesitant parents
Get into an argumentidebate back and forth
or repeat vaccine myths (as the person will
‘not remember a detailed explanation of why
the vaccine myth is incorrect but will
remember the simple narrative of the myth)
Use fear, as this can backfire
‘Overload the patient with information,
as this can backfire
1. is Ipharmaceuicaljoumal com'arile how to-address-vaccine-hesitancy.
PeerView.com/SHN827
PeerView.com
Copyright © 2000-2024, PeerView
Improving Vaccine Rates:
Defining Roles of Genera
Administer HAV and HBV vaccines as part
of routine preventive care
Identify patients at high risk for HAV and
HBV and screen for high-risk factors
such as travel to endemic areas and
lifestyle risks
Provide patient education
Monitoring and follow-up
ts and Specialists
Specialists
Conduct detailed assessments for patients
with complex or high-risk conditions
(eg, liver disease, HIV, those undergoing
immunosuppressive therapy)
Specialized vaccination protocols for
high-risk patients (considering factors
such as immune status, potential
nonresponsiveness, severe allergies, or
other contraindications)
Management of any vaccine-related
complications
PeerView.com/SHN827
PeerView.com
Copyright © 2000-2024, PeerView
Defining Roles of Genera
Administer HAV and HBV vaccines as part
of routine preventive care
Identify patients at high risk for HAV and
HBV and screen for high-risk factors
such as travel to endemic areas and
lifestyle risks
Provide patient education
Monitoring and follow-up
ts and Specialists
Specialists
Conduct detailed assessments for patients
with complex or high-risk conditions
(eg, liver disease, HIV, those undergoing
immunosuppressive therapy)
Specialized vaccination protocols for
high-risk patients (considering factors
such as immune status, potential
nonresponsiveness, severe allergies, or
other contraindications)
Management of any vaccine-related
complications
PeerView.com/SHN827
PeerView.com
Copyright © 2000-2024, PeerView
Working Together to Improve Vaccine Rates:
Generalists and Specialists
Generalists and specialists can form integrated care teams to ensure comprehensive care
for high-risk patients
Regular communication and coordinated care plans can ensure that vaccination and
follow-up are seamlessly managed
Shared EHRs to track patients’ vaccination histories and status
Provide patient education and involve patients in shared decision-making
Specialists can provide education to generalists to enhance their ability to identify and
manage high-risk patients
Collaborate on targeted outreach programs for high-risk populations
PeerView.com
PeerView.com/SHN827 Copyright © 2000-2024, PeerView
Generalists and Specialists
Generalists and specialists can form integrated care teams to ensure comprehensive care
for high-risk patients
Regular communication and coordinated care plans can ensure that vaccination and
follow-up are seamlessly managed
Shared EHRs to track patients’ vaccination histories and status
Provide patient education and involve patients in shared decision-making
Specialists can provide education to generalists to enhance their ability to identify and
manage high-risk patients
Collaborate on targeted outreach programs for high-risk populations
PeerView.com
PeerView.com/SHN827 Copyright © 2000-2024, PeerView
1. Hom EX etal. J Nurse Pract. 2024:20:104953.
PeerView.com/SHN827
Nurse Practitioners’ Knowledge, Attitudes, and
Practices Surrounding Adult Hepatitis Vaccination!
NPs play a key role in recommending, prescribing,
Background ‘and administering adult vaccinations
745,000 hepatitis A cases. 880,000 individuals [62]
have been reported inthe WU inthe United States are <q in 4 neatheare Tin 10 NPs deliver
Uited States nce 2016 eg win ceric »
provers elvema] mary care
pats Bas of 2022 EX
Despite the CDC's Advisory Committee on Immunization Practices (ACIP)
a
recommendations for HepA and Hep8 vaccination, US adult vaccination een
‘coverage remains low at 12% and 30%, respectively rien eckson
= ‘The investigation of US NPs’knowiedge, attitudes, and practices related
jective to adult HepA and Hep8 vaccination and ACIP vaccination guidelines
Methods ‘A self-administered online ‚408 NPs were inch
‘survey was conducted from
‘September-October 2022 to
‘capture the views of NPS:
recommending, prescribing, and/or
administering HepA and HepB.
vaccines to adults aged 219 years
PeerView.com
Copyright © 2000-2024, PeerView
PeerView.com/SHN827
Nurse Practitioners’ Knowledge, Attitudes, and
Practices Surrounding Adult Hepatitis Vaccination!
NPs play a key role in recommending, prescribing,
Background ‘and administering adult vaccinations
745,000 hepatitis A cases. 880,000 individuals [62]
have been reported inthe WU inthe United States are <q in 4 neatheare Tin 10 NPs deliver
Uited States nce 2016 eg win ceric »
provers elvema] mary care
pats Bas of 2022 EX
Despite the CDC's Advisory Committee on Immunization Practices (ACIP)
a
recommendations for HepA and Hep8 vaccination, US adult vaccination een
‘coverage remains low at 12% and 30%, respectively rien eckson
= ‘The investigation of US NPs’knowiedge, attitudes, and practices related
jective to adult HepA and Hep8 vaccination and ACIP vaccination guidelines
Methods ‘A self-administered online ‚408 NPs were inch
‘survey was conducted from
‘September-October 2022 to
‘capture the views of NPS:
recommending, prescribing, and/or
administering HepA and HepB.
vaccines to adults aged 219 years
PeerView.com
Copyright © 2000-2024, PeerView
Nurse Practitioners’ Knowledge of and Adherence
to ACIP HAV and HBV Vaccination Guidelines!
[NPs were generally knowledgeable about the ACIP guidelines for HepA and HepB vaccination; however, adherence to these guidelines was suboptimal
2 ses nd
#0¢ cee...
we
+ Men who have sex with men
despite these groups being at higher risk of
HepA infection during the ongoing US outbreaks
NP's attitudes regarding HepA and HepB vaccination
Sl mare
SA Son
A pen
NPs who agreed that HepA and/or HepB vaccination
was a priority in their practice were significantly
more likely to recommendiprescribe those vaccines
vaccines to
= Alladutts aged 19-59 years
+ Adults aged 260 years who do not meet risk-based
recommendations but want to be vaccinated
despite the universal HepB vaccination recommendation for
adults aged 19-59 years since 2022
NPs’ past and future HepA and HepB vaccination training
A
40%
>80% of NPs were at least somewhat interested
in future hepatitis vaccination trainings
Hepa and B
Hops Hops combination
PS who had not vaccination vaccination Vaccination
recelved training
gen an fan
in future training
In NPs’ current perceptions and practices around HepA and Hep8 vaccination
ae Findings ilusvae ihe valuable contibuions of NPS in adul immunization and shed ight on areas for improvement
Key actions — (2) Ang every adit patent aged 219 year ey
) want 1 recetve Hepa or Hope vaccination
to Improve
hepatitis ¡> Preparing ahead of vists through
vaccination rates [El en vaccine recommendations, mentor pa
1. Hom EX etal. J Nurse Pract. 2024;20:104953.
A eat oi a ee voces
& IN Vekemerelvay. and prono ré patate
PeerView.com
PeerView.com/SHN827 Copyright © 2000-2024, Peerview
to ACIP HAV and HBV Vaccination Guidelines!
[NPs were generally knowledgeable about the ACIP guidelines for HepA and HepB vaccination; however, adherence to these guidelines was suboptimal
2 ses nd
#0¢ cee...
we
+ Men who have sex with men
despite these groups being at higher risk of
HepA infection during the ongoing US outbreaks
NP's attitudes regarding HepA and HepB vaccination
Sl mare
SA Son
A pen
NPs who agreed that HepA and/or HepB vaccination
was a priority in their practice were significantly
more likely to recommendiprescribe those vaccines
vaccines to
= Alladutts aged 19-59 years
+ Adults aged 260 years who do not meet risk-based
recommendations but want to be vaccinated
despite the universal HepB vaccination recommendation for
adults aged 19-59 years since 2022
NPs’ past and future HepA and HepB vaccination training
A
40%
>80% of NPs were at least somewhat interested
in future hepatitis vaccination trainings
Hepa and B
Hops Hops combination
PS who had not vaccination vaccination Vaccination
recelved training
gen an fan
in future training
In NPs’ current perceptions and practices around HepA and Hep8 vaccination
ae Findings ilusvae ihe valuable contibuions of NPS in adul immunization and shed ight on areas for improvement
Key actions — (2) Ang every adit patent aged 219 year ey
) want 1 recetve Hepa or Hope vaccination
to Improve
hepatitis ¡> Preparing ahead of vists through
vaccination rates [El en vaccine recommendations, mentor pa
1. Hom EX etal. J Nurse Pract. 2024;20:104953.
A eat oi a ee voces
& IN Vekemerelvay. and prono ré patate
PeerView.com
PeerView.com/SHN827 Copyright © 2000-2024, Peerview
The Role of the Pharmacist in Increasing Vaccine Uptake’
Pharmacists have the potential to substantially increase the nation’s capacity to provide the HBV vaccine
| to high-risk populations
Rise of acute HBV infections is associated with the opioid crisis and ~10% of these acute infections will
result in chronic HBV infections
— Pharmacists have already been called upon to play a greater role in addressing the needs of patients
with opioid use disorder
Pharmacists can identify methods for improving HBV vaccine services in the community pharmacy
setting (eg, providing reminders)
A study to determine the impact of community pharmacist-Ied motivational interviewing (MI) on HBV
vaccination initiation among previously unvaccinated adults with diabetes found
— A statistically significant 3.711% increase in HBV vaccination when comparing eligible individuals who
received MI to eligible individuals in the control group
— Among patients in the MI group who initiated HBV vaccination, 61.5% completed the vaccination series
1. tps vi de gorpodfissues/2020720_ 0062 him. PeerView.com
PeerView.com/SHN827 Copyright © 2000-2
Pharmacists have the potential to substantially increase the nation’s capacity to provide the HBV vaccine
| to high-risk populations
Rise of acute HBV infections is associated with the opioid crisis and ~10% of these acute infections will
result in chronic HBV infections
— Pharmacists have already been called upon to play a greater role in addressing the needs of patients
with opioid use disorder
Pharmacists can identify methods for improving HBV vaccine services in the community pharmacy
setting (eg, providing reminders)
A study to determine the impact of community pharmacist-Ied motivational interviewing (MI) on HBV
vaccination initiation among previously unvaccinated adults with diabetes found
— A statistically significant 3.711% increase in HBV vaccination when comparing eligible individuals who
received MI to eligible individuals in the control group
— Among patients in the MI group who initiated HBV vaccination, 61.5% completed the vaccination series
1. tps vi de gorpodfissues/2020720_ 0062 him. PeerView.com
PeerView.com/SHN827 Copyright © 2000-2
Faculty
Discussion
Discussion
Summary
+ There have been ongoing outbreaks of HAV in the United States since 2016
— There has been difficulty reaching and vaccinating groups that are more
likely to be infected with HAV (eg, those who use drugs, homeless)
+ Rates of acute HBV have risen in states affected by the opioid crisis, and up to
2.4 million people are chronically infected
+ CDC’s Viral Hepatitis 2025 Strategic Plan aims to reduce new HAV infections
by 240% and new HBV infections by 220%
A universal HBV vaccination recommendation could help reduce disparities
in vaccination rates
An interprofessional approach can also help address disparities and improve
vaccination rates
PeerView.com
PeerView.com/SHN827 Copyright © 2000-2024, PeerView
+ There have been ongoing outbreaks of HAV in the United States since 2016
— There has been difficulty reaching and vaccinating groups that are more
likely to be infected with HAV (eg, those who use drugs, homeless)
+ Rates of acute HBV have risen in states affected by the opioid crisis, and up to
2.4 million people are chronically infected
+ CDC’s Viral Hepatitis 2025 Strategic Plan aims to reduce new HAV infections
by 240% and new HBV infections by 220%
A universal HBV vaccination recommendation could help reduce disparities
in vaccination rates
An interprofessional approach can also help address disparities and improve
vaccination rates
PeerView.com
PeerView.com/SHN827 Copyright © 2000-2024, PeerView
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