Background:
Despite guidelines recommending Hepatitis B vaccination of all STD clinic patients, vaccination is not widespread. Barriers to vaccination in this setting include cost of the vaccine as well as feasibility in busy staff-limited clinics with poorly compliant patients. A pilot of Hepatitis A/B combination vaccination was performed at three STD clinics.

Objective:
1) Determine the feasibility of vaccinating STD clinic patients, 2) identify risk-factors for failure to complete the vaccine series, and 3) evaluate the utility of pre-screening for hepatitis A and B antibodies

Method:
Vaccine administration began in March, May, and November 2004 at three STD clinics. Information was collected on hepatitis risks and history of prior vaccination or infection. All new patients were offered vaccination regardless of reported vaccination history. A computerized immunization registry was used to record vaccines administered, create mandatory documentation and print recall postcards for defaulters. Hepatitis serology was offered to a subset of patients in two clinics.

Result:
A total of 1299 patients began the vaccine series. Compliance with second dose was 52% (646/1248) and third dose was 25% (274/1078) as of December 2005. While there were no differences in terms of gender, race/ethnicity, and recent STD History, older age and clinic location were associated with series completion. A total of 391 patients received hepatitis antibody screening resulting in a hepatitis antibody positivity of 13% to Hepatitis B core and 47% to Hepatitis A.

Conclusion:
Vaccination of STD patients is feasible and worthwhile. Minimal staff effort was needed to ensure that one-half to one-quarter of patients returned for second and third dose, respectively

Implications:
STD programs should offer hepatitis B vaccination to all STD clinic patients. An evaluation of clinic population hepatitis A and B antibody status may be useful to determine utility of a combination vaccine versus hepatitis B vaccine alone as well as the cost-effectiveness of pre-screening.