Head Start Hepatitis A Immunization Initiative

ACYF Administration on Children, Youth and Families	U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families
	1. Log No. ACYF-IM-HS-97-11	2. Issuance Date: 07/15/97
	3. Originating Office: Head Start Bureau
	4. Key Word: Hepatitis A

INFORMATION MEMORANDUM [See Attachments at the bottom]

TO: Migrant Head Start Grantee and Delegate Agencies

SUBJECT: Head Start Hepatitis A Immunization Initiative

BACKGROUND: In December, 1996 the Advisory Committee on Immunization Practices (ACIP) published its recommendations for the prevention of Hepatitis A in this country. Hepatitis A is a highly contagious viral disease that is spread from person to person. Communities that have high rates of infection of Hepatitis A are well defined and include American Indians, Alaskan Natives, Pacific Islanders, and selected Hispanic and religious communities. Children in day care settings are also at risk of infection with Hepatitis A. Recently, there have been highly publicized outbreaks of Hepatitis A due to food being contaminated with the virus.

Early this year, the manufacturer of the Hepatitis A vaccine, SmithKline Beecham, contacted the Head Start Bureau to discuss their intention to donate a number of the two-dose pediatric Hepatitis A vaccine, HAVRIX.

Based on findings from the Fall 1996 Hepatitis Report and the Centers for Disease Control and Prevention's Morbidity and Mortality Report, "Prevention of Hepatitis A Through Active or Passive Immunization," Recommendations of the Advisory Committee on Immunization Practices, and the unique needs of the migrant population, it was decided that the Head Start population to receive this vaccine would be Migrant Head Start children and their siblings.

INFORMATION: Participation in this initiative is voluntary. To assist programs in planning for the ordering, storage and administration of the vaccine, we have attached an order form (Attachment A ). It is recommended that Head Start staff, the Health Services Advisory Committee, and local health agencies meet to discuss how to implement this initiative in their community before completing this order form. An important issue to discuss is storage of the vaccine. HAVRIX must be stored between 36-47 degrees Fahrenheit. It should not be frozen or left standing out, and must be administered by a licensed practitioner in accordance with State law. Since two doses of HAVRIX are needed to fully immunize a child, programs should order both doses for each child when placing their initial order.

Programs should send by facsimile their request for vaccine and educational materials to 1-423-652-3450. Shortly thereafter, a representative from SmithKline Beecham will be calling the contact person to verify information on the order from before it is filled.

An important aspect of any vaccine administration program is patient education. Attached you will find a fact sheet on Hepatitis A, in English and in Spanish (Attachments B and C). The English version can be found in the Head Start publication, "Training Guides for the Head Start Training Community: Preventing and Managing Communicable Diseases." SmithKline Beecham will also make available to programs Hepatitis A educational materials written both in English and in Spanish. These materials will be sent prior to shipping the vaccine, so that programs can conduct educational activities with parents and children before the vaccine is administered.

Orders for the vaccine will be taken until August 29, 1997. Grantee and delegate agencies participating in this initiative are urged to keep a copy of their completed order form for their own records.

/S/
Helen H. Taylor
Associate Commissioner
Head Start Bureau

Attachments:
ATTACHMENT A: Sample Order From
ATTACHMENT B: Hepatitis A Fact Sheet (English)
ATTACHMENT C: Hepatitis A Fact Sheet (Spanish)

ATTACHMENT A

MIGRANT HEAD START AND SMITH KLINE-BEECHAM

HEPATITIS A INITIATIVE

ORDER FORM

General Information

Date of request: _______________________________

Check one:

______ Migrant Head Start Grantee Agency

______Migrant Head Start Delegate Agency

Name and Address of Migrant Head Start Program:

_______________________________________

Contact Person: ___________________________

Telephone number: _________________________

Best time to call (am or pm):__________________

Vaccine Order Form

Number of children to be vaccinated: ____________________________________

Number of doses needed (include both doses in this number): __________________

Address to ship vaccine to:

Agency Name_______________________________________

Contact Person_______________________________________

Address____________________________________________

__________________________________________________

Telephone Number___________________________________

Does this address have a refrigerator (separate from the one used for food) to store the vaccine?

______yes ________no

If no, then where will vaccine be stored?

Address where the vaccine would be administered:

Name________________________________________

Address_______________________________________

Phone_________________________________________

Educational Materials Order Form

Number of Spanish Educational brochures to be sent:______

Number of English Educational brochures to be sent: ______

Send educational materials to:

Agency Name_______________________________________

Contact Person_______________________________________

Address____________________________________________

__________________________________________________

Telephone Number___________________________________

Please keep a copy of this form for your records

Appendix: Communicable Disease Fact Sheets

Hepatitis A

What is hepatitis A? It is an infection of the liver caused by a virus. It can last from one week to several months with:

No symptoms at all, especially in young children - OR-
Jaundice or yellowing of the skin and whites of the eyes
Abdominal pain, nausea, loss of appetite
Dark urine and pale-colored stools
Low-grade fever, fatigue

How does hepatitis A spread? It spreads by:

Touching stool when diapering and toileting
Not washing hands before handling food
Not cleaning and disinfecting toys and diapering, toileting and hand-washing areas
Playing in wading pools and water-play tables
Drinking contaminated water and eating shellfish in areas with inadequate sewage treatment

When is hepatitis A contagious?

From two weeks before until one week after the start of jaundice.
After exposure to hepatitis A, it can take two to eight weeks (typically four weeks) to get sick.

How do I know if my child has hepatitis A? If anyone in the family has symptoms, see your doctor immediately. Hepatitis A is diagnosed by special blood tests.

What should I do if my child has hepatitis A?

Treatment: Follow your doctor's recommendations:

Help your child recover by encouraging rest, food, and plenty of liquids to drink.

If children or adults at home or school were exposed to hepatitis A within the previous two weeks and haven't gotten sick yet, they can get a special injection to prevent them from getting sick or make their illness milder.

Keep your child home: until one week after the start of jaundice and until the child feels well enough to participate in activities. Notify your Head Start program immediately.

To limit the spread:

Report the illness to the local health department.
Ask your doctor about getting hepatitis A vaccine.
Wash hands after diapering and toileting and before handling food.
Clean and disinfect diapering areas, mouthed toys, and dining tables after each use; clean and disinfect toileting, areas and hand-washing sinks daily.
Use sprinklers instead of wading pools. Use individual water-play basins instead of water-play tables.

ATTACHMENT C

Hepatitis A

¿Qué es la hepatitis A? Es una infección del hígado causada por un virus. Puede durar desde una
semana hasta varios meses, presentándose:

Sin ningún síntoma, especialmente en niños pequenos, o
Ictericia, color amarillento de la piel y de la esclerótica (blanco del ojo)
Dolor abdominal, nausea, pérdida del apetito
Orina de color oscuro y deposición descolorida
Fiebre baja, fatiga

¿Cómo se transmite la hepatitis A? Ésta se transmite de la siguiente forma:

Tocando deposición al cambiar pañales o ir al baño
No lavándose las manos antes de manipular alimentos
No limpiando y desinfectando los juguetes y las áreas para cambiar pañales, áreas del baño y áreas para lavarse las manos
Jugando en piscinas de poca profundidad y mesas para el juego con agua
Bebiendo agua contaminada y comiendo mariscos en áreas con tratamiento deficiente de aguas residuales

¿Cuándo es contagiosa la hepatitis A?

Desde dos semanas antes hasta una semana después del comienzo de la ictericia.
Después de haber estado expuesto a la hepatitis A, pueden pasar de dos a ocho semanas (normalmente cuatro semanas) para que la persona se enferme.

¿Cómo sé si mi hijo(a) tiene hepatitis A? Si a1guien en la familia tiene síntomas, consulte a su doctor de inmediato. La hepatitis A sólo puede ser diagnosticada con exámenes especiales de sangre.

¿Qué debo hacer si mi hijo(a) tiene hepatitis A?

Tratamiento: Siga las indicaciones de su doctor:
Ayude a su hijo(a) a recuperarse, animándole a que descanse, se alimente, y tome bastantes líquidos.

Si los niños o los adultos en el hogar o en la escuela han estado expuestos a la hepatitis A dentro de las últimas 2 semanas y aún no se han enfennado, se les puede administrar una inyección especial para prevenir que se enfermen o hacer que su enfermedad sea más leve.

Deje a su niño en casa: hasta una semana después del comienzo de la ictericia y hasta que el niño se sienta suficientemente bien como para participar en actividades. Notifique a su programa Head Start de inmediato.

Para limitar la transmisión realice lo siguiente:

Notifique sobre la enfermedad al departamento de salud local.
Pregunte a su doctor si puede recibir una vacuna contra la hepatitis A.
Lávese las manos después de cambiar pañales y de ir al baño y antes de manipular alimentos.
Limpie y desinfecte las áreas para cambiar pañales, los juguetes que los niños se han echado a la boca, y las mesas para comer, después de cada uso; limpie y desinfecte diariamente las áreas del baño y los lavamanos.
Utilice regaderas en lugar de piscinas de baja profundidad. Utilice recipientes individuales para jugar con agua en lugar de mesas para el juego con agua.

Fuente: Guías de Capacitación para la Comunidad de Head Start