• All private insurance plans should include coverage for all ACIP-recommended vaccinations. Hepatitis B vaccination should be free of any deductible so that first-dollar coverage exists for this preventive service.

There has not been a national shortage of the hepatitis B vaccine, however, temporary supply problems occurred with this vaccine in 2008 (adult and dialysis formulations of Recombivax HB) and 2009 (pediatric formulations of Recombivax HB and Pediatric Engerix-B). A shortage was avoided because other manufacturers were able to provide an adequate supply of the vaccine in adult and dialysis formulations, and CDC released doses of pediatric vaccine from its stockpile. To prevent future supply problems of the hepatitis B vaccine, the committee offers the following recommendation:

Recommendation 4-6. The federal government should work to ensure an adequate, accessible, and sustainable hepatitis B vaccine supply.

Efforts are going on to develop a vaccine for hepatitis C, which could substantially enhance hepatitis C prevention efforts. The committee recognizes the need for a safe, effective, and affordable hepatitis C vaccine and offers the following recommendation:

Recommendation 4-7. Studies to develop a vaccine to prevent chronic hepatitis C virus infection should continue.

Viral Hepatitis Services

Health services related to viral hepatitis prevention, risk-factor screening and serologic testing,2 and medical management are both sparse and fragmented among entities at the federal, state, and local levels. The committee believes that a coordinated approach is necessary to reduce the numbers of new HBV and HCV infections, illnesses, and deaths associated with these infections. Comprehensive viral hepatitis services should have five core components: outreach and awareness, prevention of new infections, identification of infected people, social and peer support, and medical management of infected people.

The committee identified major gaps in viral hepatitis services for the general population and specific groups that are heavily affected by HBV and HCV infections: foreign-born populations, illicit-drug users, and


Risk-factor screening is the process of determining whether a person is at risk for being chronically infected or becoming infected with HBV or HCV. Serologic testing is laboratory testing of blood specimens for biomarker confirmation of HBV or HCV infection.

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