Immunizing high-risk populations

The American Medical Association (AMA) is pleased to be collaborating with the Centers for Disease Control and Prevention (CDC) on their national campaign to increase the immunization rate for vaccine-preventable hepatitis in the men who have sex with men (MSM) and other high-risk populations.

This campaign was kicked off with a "Dear Colleague" letter (PDF, 300KB) from the Department of Health and Human Services (DHHS) urging all its partners at the federal, state, and local levels to promote and implement comprehensive interventions known to be effective in preventing sexually transmitted diseases among the MSM population, including immunization against vaccine-preventable hepatitis.

Additionally, the CDC has created a pocket information guide to vaccinating the MSM (PDF, 433KB) and other high-risk populations against vaccine-preventable hepatitis and a flyer with the same useful information (PDF, 849KB) for placing on clinic walls and other similar locations.

In order to complement this program and assist physicians in implementing this call to action, the AMA has created a trifold pocket guide to appropriate coding for immunizing high-risk populations (PDF, 357KB) against vaccine-preventable hepatitis.

The CDC’s 2002 STD treatment guidelines call for comprehensive STD prevention services care for MSM, including testing for HIV, syphilis, gonorrhea, and chlamydia at least annually, and vaccination against hepatitis A and B.  According to data from outbreak investigations and cross sectional surveys among MSM, 54-85 percent have a regular source of health care where these STD prevention services could be provided.  Increasingly, STD, HIV, and immunization programs are working together to facilitate the delivery of integrated appropriate services to populations at risk.  The call-to-action letter is intended to encourage and facilitate such efforts.

Clinicians are encouraged to routinely identify sexually-active MSM and to consistently provide all of the recommended STD prevention services.  HIV and STD prevention program managers offering behavioral and/or clinical interventions to MSM should look for ways to structure service delivery to address all STDs. Wherever they access clinical or preventive services, MSM should be able to obtain or be referred for all of the recommended STD prevention services.

Online resources

CDC resources for information and educational materials on STD prevention among MSM and on adult vaccination:

• Hepatitis
• STD treatment
• HIV/AIDS
• Vaccines and immunizations

Other resources for information about MSM health and information about hepatitis A and B immunization:

• Gay Health
• Gay and Lesbian Medical Association
• Immunization Action Coalition

Some useful references

• CDC. Unrecognized HIV infection, risk behaviors and perceptions of risk among young black men who have sex with men – six US cities, 1994-1998.  MMWR 2002;51:733-736.
• CDC. Hepatitis A vaccination of men who have sex with men – Atlanta, GA, 1996-1997. MMWR 1998;47:708-711.
• CDC. Sexually Transmitted Diseases Treatment Guidelines, 2002. MMWR 2002;51(RR-6):1-84.
• MacKellar D, Valleroy L, Secura G, et.al.  Two decades after vaccine license: hepatitis B immunization and infection among young men who have sex with men. Am J Public Health 2001;91:965-971.

AMA coding guidelines for vaccine preventable hepatitis 

Trifold version, (PDF, 357KB) suitable for folding into pocket-sized guide.

Page-by-page version, (PDF, 106KB) more suited to reading online.