Academic journal article Journal of School Health

A School-Based Hepatitis B Immunization Program for British Columbia, Canada

Academic journal article Journal of School Health

A School-Based Hepatitis B Immunization Program for British Columbia, Canada

Article excerpt

In autumn 1992, the British Columbia Ministry of Health launched the first school-based hepatitis B immunization program in North America. The program is delivered by public health nurses throughout the province and all sixth grade students are eligible for the program. Important factors contributing to establishment of the program included the continued rise in the annual incidence of hepatitis B in British Columbia relative to other areas of the country, together with a greater level of public awareness and concern following the death of a teen-ager with the disease in late 1989. Program funding covered both vaccine and staffing costs, thereby permitting the most liberal hepatitis B virus control program available in Canada at that time. The Yukon, and the provinces of Quebec and Ontario, initiated school-based programs in fall 1994, followed by Saskatchewan, Alberta, Prince Edward Island, Newfoundland, Nova Scotia, New Brunswick, and the North West Territories in fall 1995.

During the past decade, reported cases of acute hepatitis B in British Columbia have risen, while the national rate rose initially, then declined slightly [ILLUSTRATION FOR FIGURE 1 OMITTED]. In British Columbia, the rate now is more than four times the national average with more than 40 reported cases per 100,000 population, compared with an average of less than 10 per 100,000 in Canada. The age distribution is similar to other countries [ILLUSTRATION FOR FIGURE 2 OMITTED] with only 5% or fewer reported cases occurring in those ages [less than]15. Most cases of acute disease in British Columbia are in the 20-44 age group at disease onset. In this age group, transmission occurs predominantly through sexual activity and other risk activities such as intravenous drug use. Another factor contributing to the increase in reported cases in British Columbia may be immigration from countries with a high prevalence of hepatitis B.


Two possible approaches for a universal hepatitis B immunization program were considered in British Columbia: immunization of all infants as part of their routine series, or immunization of school-age children at one grade level. Universal immunization of school-age children was chosen because of the potential to produce a measurable effect on incidence of disease 10 years before such an effect would be seen from an infant program. Children age 11 were chosen because they still are compliant with their parents' wishes and can comprehend the seriousness of the disease. Another advantage was that children are easier to reach in elementary school because they generally stay in one classroom. They also are less likely to be truant or to have undertaken activities which place them at risk of hepatitis B.

In British Columbia, it was agreed that the universal sixth grade hepatitis B immunization program would be offered in schools and be undertaken solely by public health nursing. These nurses already were providing health services in all schools and therefore could readily reach the entire sixth grade population. This access is unlike other publicly funded immunization programs in British Columbia where routine immunizations are administered by both private physicians and public health nursing personnel.


The most important feature of planning this new program was development of a 15-person working group comprised mostly of senior public health nurses. The group was formed to meet the three-month deadline for production of all materials to implement the program.

Materials developed during the planning period (July-August 1992) included letters introducing the program to elementary schools, teaching materials to encourage students and their parents to participate, consent forms, and information pamphlets. Program evaluation materials also were designed. A prerecorded 1-800 telephone information line was established, funds were allocated for innovative design and production of materials, and a resource file was compiled to respond to possible concerns about hepatitis B immunization. …

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