Hepatitis B and Launch of Guidance for hepatitis A and B vaccination of drug users in primary care a

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Hepatitis B andLaunch of Guidance for
hepatitis A and B vaccination of drug users in
primary care and criteria for audit

• Dr David Young

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Setting the scene

• Hepatitis B is a viral infection of the liver
• Incubation period of 40 - 160 days
• Acute hepatitis B infection anorexia, vague abdo
  discomfort, nausea and vomiting, jaundice and
  occasionally fever
• Deranged LFTs
• Presence of serological markers of acute
  hepatitis B infection (hepatitis B surface
  antigen HBsAg, anti HBcIgM)

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Extent of the Problem

• Areas with high endemicity (HBsAg prevalence gt
  8, e.g. S E Asia and Africa) more than half the
  population becomes infected at some point in
  their lives
• Areas with low endemicity (HBsAg lt 2, e.g. N
  America, Western Europe, Australia) most of the
  population do not become infected
• Nearly ? of the world population has been
  infected at some point
• gt 350 million people (5-6 of world population)
  are chronic carriers of hepatitis B infection

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Extent of the Problem(2)

• Despite the fact that injecting drugs users
  (IDUs) have been targeted since 1988 for
  vaccination against hepatitis B. It is estimated
  that 21 of IDUs in England and Wales have
  evidence of past or current hepatitis B infection

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HEPATITIS B DISEASE CAN BE PREVENTED BY
VACCINATION
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• W.H.O. recommended hepatitis B vaccinations be
  included in routine infant and childhood
  immunisation programmes -
• in countries with high endemicity by 1995
• in all countries by 1997

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HEPATITIS B NOTIFICATIONS England and Wales, By
Sex, 1990 - 2003
Male Female Unknown Total 1990 260 175
- 435 1991 280 208
- 488 1992 280 209
- 489 1993 362 219
- 581 1994 322 206
- 528 1995 387 236
- 623 1996 401 212
- 613 1997 444 286
- 730 1998 578 306
2 886 1999 510 339
15 864 2000 636 393
6 1035 2001 592 417
19 1028 2002 620 446
7 1073 2003 667 469 15 1151

Source Notifications of Infectious
Diseases Reviewed on 05 Aug 2004
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Acute hepatitis B infection laboratory reports
England and Wales, by risk group, 1990 - 2003
Intravenous drug user Note Case Definition -
HBsAg positive and Anti-HBc IgM positive with or
without recent history of discrete onset jaundice
or other symptoms compatible with acute
infection. Last updated 26 August 2004
provisional Source Laboratory reports to CDSC
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HEPATITIS B NOTIFICATIONS England and Wales, By
Age Group, 1990 - 2003
Source Notifications of Infectious
Diseases Reviewed on 05 Aug 2004
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HEPATITIS B NOTIFICATIONS England and Wales, By
Region, 1990 - 2003
Source Notifications of Infectious Diseases
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HENCE THE GUIDANCE