Reduction of Hepatitis a and B in Texas - An Emerging Success

Background:
Hepatitis B is a highly contagious disease that can have life-changing consequences, including liver failure and cancer: Hepatitis A is also a problem in the United States and control of both is a national health priority.

Setting:
Hepatitis B disease incidence in Texas has plummeted from almost 2,000 reported acute cases ten years ago to only 741 such cases last year, as has hepatitis A, which fell from over 4,500 cases to only 264 last year.

Population:
Texas Statewide.

Project Description:
Texas has implemented a multifaceted approach through a collaboration of partners that has childhood immunization its foundation followed by a phased expansion of outreach to adults, one that is likely to result in even lower disease rates over the next few years. Specifically, this approach has included: school rules that now require hepatitis B immunity for all children K-12, such that cohorts moving into adulthood are now protected; rules that required hepatitis A vaccination earlier than the national recommendations; a stronger Perinatal Hepatitis B Program; early introduction of hepatitis B immunization at to STD sites, expansion to health department adult safety net programs, family planning clinics, federally qualified health centers and the prison system; addition of an HIV and substance abuse site referral component; provisions for patients discharged from mental health institutions to complete the series at health department sites; and the addition of Twinrix and hence protection against hepatitis A, for many site types.

Results/Lessons Learned:
As we watch disease incidence fall, the most important lesson, especially for the larger public, is that vaccines really do work. We are witnessing an important and even historic shift in Texas, as hepatitis B, a widespread threat only ten years ago, is now in final stages of coming under control.