KEYWORDS:
Hepatitis A, Hepatitis B, Hepatitis C, IVDU, case management, adult vaccination, standing orders

BACKGROUND:
Patients with HepC suffer increased sequelae from HepA and HepB infection. They are indicated for HepA and B vaccinations but have had historic low vaccination rates; improvement strategies are unclear.

OBJECTIVE(S):
To investigate opportunities for vaccine compliance improvement in a high risk under-vaccinated adult population.

METHOD(S):
Since 1991 patients at the Wenatchee Valley Medical Center have been enrolled in a NCM program using standing orders for diagnostic assessment, HepC treatment, and vaccination. Enrolled patients, their demographics, response to therapy, and vaccination were entered into a case management registry from which descriptive statistics were generated.

RESULT(S):
162 patients have been enrolled since 1991; 59% are male, 41% female; 77% were IVDU. On entry 45% and 23% had serologic evidence of past HepB and HepA infection, respectively; 11% and 0% had prior vaccination for HepB and HepA. Of patients indicated for vaccination 100% have received or are in the midst of a HepA and/or HepB vaccine series. No episodes of acute hepatitis have occurred in enrolled patients.

CONCLUSIONS(S):
HepC patients are at high risk for HepB and to a lesser extent HepA infection; rates of natural immunity are high for both agents. Serologic screening and vaccination where indicated is appropriate. NCM significantly improves the very low vaccination rates seen with standard care.

LEARNING OBJECTIVES:
To understand: 1) The serious nature of HepA and HepB infection in HepC patients; 2) The sero-susceptibility rates of HepC patients to these agents; 3) The present vaccine treatment gap; 4) The contribution of delivery system redesign, specifically NCM in improvement strategies.