410.001 Hepatitis B Vaccination for Adolescents

1.0 Purpose

This policy authorizes and encourages STD clinics under contract with the Texas Department of State Health Services (DSHS), TB/HIV/STD Section (Section), or operated by DSHS, to provide vaccination for the hepatitis B virus (HBV) to eligible persons 18 years of age or younger.
 

2.0 Authority

Health and Safety Code §81.005, §81.006; DSHS Texas Vaccines for Children Program (TVFC), Adolescent Hepatitis B Vaccine Initiative; Advisory Committee on Immunization Practices, VFC Resolution No. 02/03-1; Sexually Transmitted Diseases Treatment Guidelines – 2002, MMWR 2002:51(No. RR-6).
 

3.0 Background

In the United States, most persons infected with hepatitis B virus were infected as adolescents or young adults. From 1992 through 1999, DSHS received 3,710 reports of hepatitis B infection in adolescents and young adults ages 10 - 291. Sexual transmission accounted for many of the new HBV infections that occurred in the United States during the past 10 years. Many adolescents seek services at public health clinics in Texas due to exposure to STDs. As a result, health care workers have the opportunity to discuss issues related to the prevention and treatment of HBV and offer advice related to this health care concern. In line with the Section's mission to prevent and control STDs, the Section encourages STD clinics to vaccinate all adolescents who have not been previously vaccinated by utilizing vaccine available from the Texas Vaccines for Children Program (TVFC).
 

4.0 Informing Adolescents About Methods of Avoiding Infection

Health care workers in STD clinics should inform previously unvaccinated adolescents who are sexually active about the availability of hepatitis B vaccine. All adolescents attending an STD clinic should be informed about how they can protect themselves from infection. For example, advise the person about the following:

1. abstaining from sexual activity,
2. limiting sexual partners to just one person,
3. using condoms,
4. avoiding nonsterile drug injection equipment or sterilizing shared equipment,
5. being vaccinated for HBV, and
6. the risks associated with using nonsterile needles for tattooing or body piercing.
    

5.0 TVFC Vaccine Eligibility

The TVFC Program provides hepatitis B vaccine to STD clinics at no cost to be administered to all previously unvaccinated children and adolescents from birth through 18 years. STD clinics may not charge the patient for the cost of the vaccine.

Clinical staff should encourage youth to be vaccinated for HBV if they have not been previously vaccinated. Parental consent is not required before immunizing adolescents for hepatitis B (Family Code §32.001, Consent to Treatment by Child).
 

6.0 Determining Eligibility for State-Supplied Vaccines

Health care providers determine eligibility for children 18 years of age or younger who receive the state-supplied vaccine by completing the Patient Eligibility Screening Record, DSHS Form No. C10. A copy is retained in a file for each child receiving vaccines. Only one form is required to record HBV immunizations for each child as long as the child's eligibility status has not changed. Verification of the responses on the record is not required.
 

7.0 Management of Youths Exposed to HBV

A youth exposed to HBV should be offered post exposure prophylaxis. The success of the prophylaxis depends on how soon the vaccination is given after exposure and the number of subsequent vaccinations. STD clinics are expected to follow the treatment schedule for HBV found in the CDC’s guideline, Hepatitis B Virus: A Comprehensive Strategy for Eliminating Transmission in the United States Through Universal Childhood Vaccination: Recommendations of the Immunization Practices Advisory Committee (ACIP). These clinics are expected to develop protocols to insure completion of the vaccine series. A copy of the guideline is available on the Internet at cdc.gov/mmwr/preview/mmwrhtml/00033405.htm or by calling the TVFC Program at 800-252-9152 or 512-458-7284, Ext. 6530.
 

8.0 How to Become a TVFC Provider

Call the TVFC Program at 800-252-9152 to acquire vaccine and eligibility screening records from DSHS or call 737-255-4300 for questions on how to enroll in the program.
 

9.0 Vaccinations for Persons Over Age 18 Years of Age

STD clinics may continue to provide vaccinations to persons over 18 years of age. However, vaccine for persons over 18 years of age is not available through the TVFC program. Clinics must obtain the vaccine for adults from other sources and may then provide the vaccination in the manner currently followed by the individual clinic.
 

10.0 Revision History