A growing number of needle exchange and drug treatment programs are offering hepatitis A and hepatitis B vaccinations. Both vaccinations are recommended for injection drug users (IDUs).
However many IDUs have not been vaccinated for hepatitis A and B. A recent report from the Centers for Disease Control and Prevention (CDC) indicated that almost one in six, or 15%, of reported new hepatitis B infections occurred among IDUs.
Unfortunately, there’s still limited funding available for adult immunization programs. The main federal financing program for vaccination is the CDC’s Section 317 [PDF version]. But this program leaves several gaps, especially for adult immunization. Here's a perspective from a recent review on vaccine funding by Hinman et al.:
Unlike childhood immunization, for which there has been extensive public-private collaboration for 40 years, adult immunization has been left to the private sector until relatively recently. Vaccines currently recommended for universal use in adults are periodic tetanus-diphtheria boosters (all adults), influenza vaccine (persons aged ≥50 years), and pneumococcal vaccine (persons aged ≥65 years). A number of vaccines, including hepatitis B, influenza, pneumococcal, and rabies vaccines, are recommended for those at increased risk of infection and/or complication as a result of medical condition, occupation, lifestyle, etc.. Regular preventive care visits comparable to “well-child” visits are not as ingrained in adult medicine as in pediatrics.
There is no adult counterpart to the VFC program. The adult model is one of fee for service, in which the provider purchases vaccines up front and is reimbursed after administering them. Medicare, which insures virtually all Americans aged ≥65 years, specifically excluded coverage for preventive services until 1981, when reimbursement was permitted for pneumococcal vaccine and a limited number of other preventive services. In 1993, reimbursement for influenza vaccine was authorized. Hepatitis B vaccination has long been a covered service for beneficiaries at increased risk of acquiring hepatitis B disease, primarily through Medicare’s end-stage renal disease program.
Vaccination coverage levels for adults are substantially lower than the coverage rates among young children. The National Health Interview Survey (NHIS) is used to track vaccination coverage levels among adults. The 2002 NHIS shows that, among individuals aged ≥65 years, annual influenza vaccination coverage is 66% and pneumococcal coverage is 55%. Nonetheless, annual influenza vaccination coverage levels are more than double the 30% level in 1988, before Medicare’s coverage of influenza vaccination began. Medicare reimbursement for administration of influenza vaccine has been considered to be inadequate by many practitioners; it has recently been increased.
In contrast to childhood vaccination, there are marked racial/ethnic disparities in coverage among adults for each vaccine.
Insurance coverage for adults under the age of 65 years is not monitored systematically. The IOM estimates that only 24% of people 18–64 years of age have insurance coverage for vaccinations. This figure includes individuals for whom vaccination is not routinely recommended. The IOM also estimates that 25% of individuals in this age group are at risk from medical, occupational, or lifestyle exposure and do not have any health insurance with an immunization benefit.
CDC’s fact sheet on hepatitis A & B vaccinations for IDUs – PDF file
Immunization Action Coalition (IAC) a great resource on immunization programs and policy
IAC’s Hep Express newsletter on hepatitis vaccinations
IAC’s Model Harm Reduction Programs for Hepatitis A, B, and C Prevention