Scottish Centre for Infection and Environmental Health A Division of the Common Services Agency Hepatitis B vaccine Impact of safety issues and international

Scottish Centre for Infection and Environmental HealthA Division of the Common Services Agency

Hepatitis B vaccineImpact of safety issues and international points of view – Scotland

VHPB, Geneva, 13-14th March, 2003Dr Claire Bramley Epidemiologist (Immunisation)Scottish Centre for Infection and Environmental HealthGlasgow, Scotland, [email protected]


Hepatitis B vaccine – Scotland

• Current UK HepB policy

• Adolescent HepB vaccination – Glasgow pilot project• knowledge and attitudes• health education material • media response• vaccine uptake

• Summary and conclusions


Current UK HepB policy

• Babies born to mothers who are chronic carriers of hepB virus or to mothers who have had acute hepB during pregnancy

• Injecting drug users

• Individuals who change sexual partners frequently

• Close family contacts of a carrier

• Haemophiliacs

• Patients with chronic renal failure

• Healthcare workers

• Travellers to high prevalence areas

• Prison population

Selective


Why not universal HepB vaccination?

• Incidence of HepB is low

• Not cost-effective

• Selective immunisation protects almost all at-risk

• Too much pressure on infant schedule

• Low uptake


Adolescent HepB vaccination – Glasgow pilot project

Acceptability, practicalities and costs• 11,000 Secondary One pupils, age 11-12 years• Social, religious and ethnic diversity• High prevalence injecting drug use• Vaccine administered via School Health Service

• HBvaxPRO™, 5g, Aventis Pasteur MSD

• 0, 1, 7 month schedule


Knowledge and attitudes

• Focus group discussions in four Glasgow secondary schools

• Discussion with pupils (age 11-12 years) and parents

• Assess perceptions of acceptability and attitudes to

HepB vaccine

• Investigate what would influence uptake

• Explore reasons for participation and non-participation

• Inform health education material


UK vaccination ‘climate’

Extremely sensitive to vaccine safety allegations

• MMR and autism / IBD





• MMR and autism / IBD• thiomersal and mercury poisoning / autism





• MMR and autism / IBD• thiomersal and mercury poisoning / autism• aP and wcP – relative safety and efficacy





• MMR and autism / IBD• thiomersal and mercury poisoning / autism• aP and wcP – relative safety and efficacy

Media-driven Fuelled by pressure groups / isolated health professionalsSelective


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Vaccine uptake, age 24 months, Scotland, 1995-2002Q3


Knowledge and attitudesPrevious experience of vaccinations• Pupils dislike vaccinations, but understood their importance• Parents in favour of universal vaccination, but concerned about side-effects

Other countries already vaccinating against hepB• Pupils felt unfair not to be offered vaccine• Parents acknowledged UK behind, but caution could be beneficial

Vaccine administration• Pupils unhappy with 3 doses, but would still comply• Parents thought pupils would comply, but unwillingly• Two dose schedule would not influence decision and some parents suspicious of

safety


Knowledge and attitudes - recommendations

• Most pupils and nearly all parents favoured HepB vaccination

• Need increased awareness of hepB infection and vaccination

• Pupils require forum for discussion

• Pupils and parents need facility for answering questions

• Pupils should have separate information

• Improvements to HepB information sheet(s) suggested

- possible side effects of vaccination


Health education material

• Parent letter, information leaflet, consent form• Pupil information leaflet• Pupil health education session – school nurses

• School nurse education session• School nurse information folder • Teacher information

• Others - e.g. Members Scottish Parliament

• Press release

• Telephone help line, website


Media response


• Total Roll 10,826

• Consent 9,975 (92.1%)

• Non-consent 942 (8.7%)

• Written refusal 91 (0.8%)

• Non-return of form 851 (7.9%)

• Reasons for written refusal

– 24 already vaccinated

– 2 stated life threatening reaction

– 37 inappropriate/needle phobia/safety

– 26 no reason given

Uptake


Total Eligiblen = 10826

Non Participantsn = 942 (8.7%)

Participantsn = 9884 (91.3%)

3 Doses8679 (80.2%)

Only 2 Doses 988 (9.1%)

Only 1 Dose 217 (2.0%)

Written Consent

91 (0.8%)

Written refusal

89 (0.8%)

PassiveNon-Consent

762 (7.0%)


Summary and conclusions

• Possible to achieve high uptake in UK young adolescents• Uptake similar to other routine school vaccinations

• No significant safety concerns• Perceptions of safety could be undermined by media

• Current UK policy is for selective immunisation• HepB vaccination policy under review by UK JCVI


Acknowledgements – Glasgow pilot projectSCIEH Dr C Bramley, Dr L Wallace, Prof D Goldberg

Greater Glasgow NHS BoardDr S Ahmed

Schools Health Service, Yorkhill NHS TrustMrs R Duff

West of Scotland Specialist Virology CentreDr W Carman, Dr S Cameron

Aventis Pasteur MSDDr N Kitchin, Dr M Watson

Focus Groups Dr A Hinds and GlaxoSmithKline

Documents

Scottish Centre for Infection and Environmental Health A Division of the Common Services Agency Hepatitis B vaccine Impact of safety issues and international