Guidelines for prevention and control of hepatitis A in American Indian and Alaska Native communities.

The Aberdeen Area Indian Health Service (IHS), South Dakota Department of Health, and the Centers for Disease Control and Prevention have collaborated since 1985 to investigate hepatitis A in Indian communities in the Northern Plains and to implement clinical trials of hepatitis A vaccine. This study examines the results of community wide immunization programs in several communities experiencing Hepatitis A outbreaks. In February 1995, the state and tribal health departments, IHS facilities, Head Start programs, and schools provided hepatitis A immunizations to children age 2-12 years in targeted communities after obtaining parental consent. Culturally specific educational materials were developed and extensive health education efforts were provided by IHS and tribal programs. Hepatitis A contacts age 2-12 were offered the hepatitis A vaccine at the same time they were offered passive immunization with immune globulin. To date over 70% of parents contacted by letter or in person have returned consent forms to have their children immunized. Higher response rates were obtained in communities where home visits were made to explain this program in more detail. The outbreak appears to have stopped after 70% or more of the children age 2-12 years were immunized. Immunization programs are being implemented in all Northern Plains Indian communities utilizing hepatitis A vaccine from the Vaccine for Children Program. These efforts will likely eliminate hepatitis A as a problem for Indian communities.