'Meet people where they are:' Local health departments key to hepatitis B vaccination
In 2018, West Virginia had the highest rate of acute hepatitis in the nation. That same year, the state had the highest rate of opioid prescriptions per 100,000 people. That's not a coincidence: drug use—including opioid misuse—raises a person's risk of contracting the hepatitis B virus.
A study led by Stacy Tressler—who earned her doctorate in epidemiology from the West Virginia University School of Public Health—suggests that local health departments are vital to getting the hepatitis B vaccine to the people who need it most.
Her findings appear in the American Journal of Preventive Medicine.
"I don't think people realize the amount of health care that local health departments provide across West Virginia," Tressler said. "They really reach some of our most vulnerable populations, they do a lot of really great work and they've already built a lot of relationships in the community."
Now an epidemiologist with the Pennsylvania Department of Health, Tressler previously worked for the West Virginia Department of Health and Human Resources. During her 10 years of public health work in West Virginia, she "worked, for the most part, with local health departments. And the work that the local health departments do is really overlooked," she said.
Tressler and her colleagues at WVU analyzed data from local health department clinics that participated in the West Virginia Hepatitis B Vaccination Pilot Project. The pilot project distributed more than 10,000 doses of the hepatitis B vaccine to at-risk adults in West Virginia from 2013 to 2015.
The data encompassed 1,201 at-risk adults vaccinated at local health department clinics or through local health departments' outreach efforts to correctional facilities and substance use treatment centers.
Participants who received the vaccine at substance use treatment centers or local health departments' family planning clinics were significantly more likely to complete the series of injections—which consists of three shots—than people vaccinated at local health departments' sexually-transmitted-infection clinics.
"People who receive services through substance use treatment centers have a relationship with that facility," Tressler said. "Even if—for some reason—they're not in treatment anymore, I think those facilities can continue to work with people to try to get them the resources they need."
She credits these relationships—between facility staff members and the clients they serve—with increased odds of vaccine completion.
The researchers also found that participants vaccinated at substance use treatment centers, correctional facilities and local health departments' family planning clinics were much more likely to receive at least two doses of the hepatitis B vaccine.
That's important because it can be hard to get people to complete any vaccination that involves multiple shots, spread out over weeks or months. That's the case whether it's people with substance use disorders being vaccinated against the hepatitis B virus or middle-schoolers receiving the three-shot HPV vaccine.
"It's always a challenge getting people back in to finish the series—especially if you're trying to reach people who may have life circumstances that prevent them from engaging with the healthcare system," Tressler said. "There are going to be issues with trying to keep those people on your radar and being able to get them back in and to finish the series."
But even two doses of the three-dose hepatitis B vaccine impart some protection in most healthy adults. And in 2017, the Food and Drug Administration approved a new hepatitis B vaccine that requires just two shots.
"The high uptake of hepatitis B vaccine when health departments partnered with local drug treatment programs is very encouraging, as West Virginia has the highest rate of new hepatitis B infections in the U.S.," said Judith Feinberg, vice chair of research for the School of Medicine and a member of Tressler's research team. "People who are engaged in a treatment program have the opportunity to reliably receive the multiple vaccine doses required: three doses over six months for the older vaccine, and two doses over two months for a newer version."
The team also included School of Public Health researchers Christa Lilly, Diane Gross and Thomas Hulsey.
"This study shows that you can create partnerships with local health departments to provide healthcare for at-risk people," Tressler said. "People who may be at risk of contracting the hepatitis B virus might not access a primary care provider. You have to meet people where they are."