KEYWORDS:
Hepatitis A; Hepatitis A Vaccination; American Indian/Alaska Native; Rural; Indian Health Service.

BACKGROUND:
Hepatitis A was historically endemic among American Indian/Alaska Natives (AI/AN). In 1995, hepatitis A vaccine was licensed and in 1996 vaccination recommendations for AI/AN children were published. Current status of AI/AN hepatitis A vaccination programs is unclear.

OBJECTIVE(S):
To determine knowledge, attitudes and practices about hepatitis A vaccination among Indian Health Service (IHS) providers, describe barriers to hepatitis A vaccination, and assess changes in knowledge, attitudes and practices since 1996.

METHOD(S):
A 10-page survey was sent to IHS facilities in September 1999 and responses were received until January, 2000. Data were entered and analyzed using Epi Info. Descriptive and inferential analyses were performed along with comparison to a similar survey, conducted in 1996.

RESULT(S):
Providers from 79 (87%) IHS facilities responded. Nearly all (94%) offered hepatitis A vaccine to children 2-18 years. Estimates of preschool-age coverage ranged from 5% to 99%. Provider attitudes were positive about hepatitis A vaccine. Concerns included duration of immunity from vaccination, negative public attitudes toward vaccination, and vaccine-related liability issues. Over 50% of respondents indicated that missed opportunities were a barrier to successful hepatitis A vaccination programs and 39% listed the two-year starting age. Hepatitis A vaccination was more widespread and provider knowledge and attitudes have improved since 1996.

CONCLUSIONS(S):
A majority of IHS facilities are offering hepatitis A vaccine to preschool and school-age children. Fewer than half of all IHS facilities reported > 70% coverage for preschool children. Suggestions for improving hepatitis A vaccination coverage are offered.

LEARNING OBJECTIVES:
Participants will be able to: relate the history of hepatitis A vaccination in AI/AN populations; describe the current status of hepatitis A vaccination in IHS facilities; describe barriers and provider concerns to hepatitis A vaccination in AI/AN communities.