IDUs offered on-site vaccination and a $5–10 incentive at a New York City needle-exchange program.

The committee believes that the hepatitis B vaccination rate in the high-risk IDU population is unacceptably low. Studies of vaccine protocols show that completion rates are substantially higher when vaccination is offered at such a location as a needle-exchange program. Using a modeling approach, Hu et al. (2008) found that hepatitis B vaccination of IDUs who participate in needle-exchange programs in the United States is likely to be cost-saving to society.

Incarcerated Populations Hennessey et al. (2009) reported that only 12% of inmates at three jails in Chicago, Detroit, and San Francisco had serologic evidence of hepatitis B vaccination compared with a 25% self-reported vaccination rate in the US population. The study also found an unexpectedly high rate of chronic hepatitis B infections (3.6%) and the lowest rate of hepatitis B vaccination (10%) among Hispanic inmates.

Twenty states require that inmates receive at least some immunizations, including the hepatitis B vaccine (CDC, 2008a). Four of those states require vaccination of all inmates, and 16 require only that juvenile inmates be vaccinated. Several studies reported that if offered the hepatitis B vaccine, most inmates (60–93%) would agree to be vaccinated (Rotily et al., 1997; Vallabhaneni et al., 2004). Alternative vaccination schedules may be effective for inmates. In a study of inmates in Denmark, 63% completed the hepatitis B vaccination series on an accelerated 3-week schedule compared with 20% of those on a 6-month schedule (Christensen et al., 2004).

According to CDC, 28.8% of patients who had acute hepatitis B reported a history of incarceration before HBV infection (Goldstein et al., 2002). Thus, immunization of incarcerated people could potentially prevent nearly one-third of all acute hepatitis B cases in the United States. Although most prison systems in the United States do not provide universal hepatitis B vaccination for inmates, Charuvastra et al. (2001) noted that 25 of 26 states that responded to a survey reported that they would routinely vaccinate their inmates against HBV infection if funding for vaccination were available.

Although the length of stay is shorter in jails than in prisons, offering hepatitis B vaccination to jail inmates is feasible and provides a benefit to the community after the inmates are released. Using an accelerated schedule increases the completion rate (Christensen et al., 2004). Substantial protection is provided after even one or two of the three doses of the series. It is important to have a health-record system that tracks immunizations so that the vaccine series can be continued if later incarcerations occur. Ideally, immunizations administered in jails will be captured in an adult immunization registry (see discussion on immunization-information systems below) so

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