Learning Objectives for this Presentation:
By the end of the presentation participants will be able evaluate the practicality of offering free hepatitis A and B vaccines to high-risk adults in non-traditional immunization settings.

Background:
Public funds have not been traditionally available to provide hepatitis A (HAV) and hepatitis B (HBV) vaccines for high-risk adults. In 2004, Los Angeles County Immunization Program participated in a pilot project that offered a limited supply of free HAV and HBV to high-risk adults seen in clinics that do not traditionally offer immunizations, such as STD/HIV clinics, drug treatment centers, and primary care clinics offering family planning and/or homeless services.

Objectives:
To evaluate the practicality of offering free HAV and HBV to high-risk adults in non-traditional immunization settings.

Methods:
Beginning January 2004, 21 contracted clinics received single antigen HAV and HBV only, combination hepatitis A and B (Twinrix®) only, or all three vaccines. Clinics submitted monthly immunization reports to account for vaccines received or wasted, and to show vaccine use by recipient's age, vaccine type and dose. In 2005, vaccine was given to other health departments and four additional clinics to avoid wasted vaccine. Data collection was extended beyond December 2004 until vaccine supply was depleted or expired.

Results:
In 2004 only 35% (2,878 doses) of the total vaccine supply was used. By July 2005 73% (5,971 doses) was used - 80% (622) of HAV, 86% (1,600) of HBV, and 67% (3,749) of Twinrix®. STD/HIV clinics administered more vaccine doses (3,559) than primary care clinics and drug treatment centers combined (2,412).

Conclusions:
Despite being free, HAV and HBV administration in non-traditional immunization settings was lower than projected. Some clinics “saved” vaccine doses to complete patients' vaccination series while other clinics offered vaccine to a specific risk group (e.g. homeless) instead of a broader group. STD/HIV clinics were the most practical venue to vaccinate high-risk adults.