• Correctional institutions should offer hepatitis B vaccination to all incarcerated persons. Accelerated schedules for vaccine administration should be considered for jail inmates.

• Organizations that serve high-risk populations should offer the hepatitis B vaccination series.

• Efforts should be made to improve identification of at-risk adults. Health-care providers should routinely seek risk behavior histories from adult patients through direct questioning and self-assessment.

• Efforts should be made to increase rates of completion of the vaccine series in adults.

• Federal and state agencies should annually determine gaps in hepatitis B vaccine coverage among at-risk adults and estimate the resources needed to fill those gaps.

Immunization-information systems are used for collection and consolidation of vaccination data from multiple health-care providers, vaccine management, adverse-event reporting, and tracking lifespan vaccination histories. States have made progress on developing and implementing immunization-information systems, particularly with regard to collecting vaccination data on children. The committee believes that it is also important to include vaccination data on adolescents and adults in immunization information systems and offers the following recommendation:

Coverage for hepatitis B vaccination is greater for children and youths than for adults. Except for Medicaid’s Early Periodic Screening, Diagnosis, and Treatment entitlement, public-health insurance often contains cost-sharing, which may create a barrier to vaccination for some people. Private health insurance has gaps for vaccination coverage because it does not universally cover all ACIP-recommended vaccinations for children and adults. Furthermore, most privately insured persons are required to pay to receive vaccinations. To reduce barriers to children and adults for hepatitis B vaccination, the committee offers the following recommendation:

• Public Health Section 317 should be expanded with sufficient funding to become the public safety net for underinsured and uninsured adults to receive the hepatitis B vaccination.