HEPATITIS B GUIDELINES
NEWCASTLE OCCUPATIONAL HEALTH
These guidelines should be read in conjunction with:
1. Newcastle Occupational Health current immunisation policy and Patient Group Directives
2. NHS Management Guidelines "Protecting Health Care Workers and Patients from Hepatitis B " HSC (93)40 (amended 1996)
3. "Immunisation against Infectious Diseases" Dept of Health 1996
4. Current Control of Infection Policy: "Immunisation Policy for Trust Staff and Protection Against Infectious Diseases"
5. Current Control of Infection Policy: "Policy for the Management of Health Care Workers Infected with HIV & Hepatitis C, and for the Prevention & Management of Hepatitis B Infection"
6. "Hepatitis B Infected Health Care Workers" NHS Executive HSC 2000/020 & associated "Guidance on Implementation of Health Service Circular 2000/020"
All employees should be offered Hepatitis B immunisation if they satisfy the following criteria:
a. Fit for employment, and have commenced employment.
b. Healthcare workers whose activities involve potential contact with blood and/or body fluids, or pathological specimens.
c. Have not already received a full course of Hepatitis B vaccinations.
d. There are no contraindications to Hepatitis B vaccination.
If the individual declines the immunisation offer, they should be advised regarding Universal Precautions and awareness of the Trusts current Control of Infection Policy "Code of Practice for Needlestick Injuries", and the action to be taken in the event of an accidental exposure incident involving blood and other high risk body fluids.
A full immunisation history should be obtained :
- has the client been immunised against hepatitis B in the past
- did they complete the course
- what was the result of post vaccine serology
Where possible documentary evidence should be sought to support reported hepatitis B immunisation history.
Offer hepatitis B vaccination. The details of the course, benefits of vaccination, contraindications, and potential adverse reactions should be discussed, to allow the client to make an informed decision.
Standard course:
Following a primary course of vaccination:
The client should be informed of their post vaccine serology result and advised when their next booster is due. (See the table "Hepatitis B Vaccination: suggested actions according to HBsAb results and occupational history", as a guide to advice to be given regarding subsequent booster vaccinations.) TOP
A full history of hepatitis B vaccinations received to date should be taken, obtaining, where possible, documentary evidence to confirm the history.
Depending on the amount of time elapsed since the 1st dose, either give the 2nd dose and continue the course as per Section 1,
OR
consider recommencing a full course of vaccination.
Note: A study by Marsano et al (1998) demonstrated that there was a significant response to a second dose of vaccine even when given 6 months after the first. Based on this study, information from Aventis Pasteur MSD Ltd, one of the manufacturers of hepatitis B vaccine, states that the timing of the 2nd and 3rd injection is not critical as long as there is at least 4 weeks between doses. Thus there may be no need to repeat a course if the client is late for their 2nd dose. (Marsano LS et al 1998, "A two dose hepatitis B vaccine regime: proof of priming and memory response in young adults." Vaccine 16(6) 624-629)
Depending on the amount of time elapsed since the 2nd dose, give the 3rd dose followed by post vaccination serology check 8 weeks later. See Suggested Actions Table for guidance regarding further vaccination in light of the blood test result.
Depending on the amount of time elapsed since completion of the primary course either take a blood sample to check post vaccination serology,
OR
offer a booster dose and check post vaccination serology 8 weeks later (if >5 years since completion of course and no history of further hepatitis B vaccinations). See Suggested Action Table for guidance regarding further vaccination in light of the blood test result.
When post vaccination serology results show HBsAb levels <10iu/l or non reactive, following completion of a primary course of vaccination (including 4th dose when appropriate), the client should be advised of the result.
Current evidence suggests that seroconversion may occur if further doses of vaccine are given, but it becomes less likely with each subsequent 'non-response'. Also, giving additional doses of vaccine potentially increases the risk of adverse reactions occurring.
Factors affecting seroconversion include male gender, advancing age, obesity, smoking, and genetic factors. Immunodeficiency will also adversely affect seroconversion. In addition the vaccine will be ineffective in an individual who is a carrier of Hepatitis B.
A second course of vaccination may be offered after discussion with the client of the pros and cons of further vaccination, and consideration of their work area. This need not involve use of an alternative hepatitis B vaccine unless there are specific reasons to do so. Clients should be advised regarding awareness of Universal Precautions and the actions to be taken in the event of an accidental exposure incident involving blood and other high-risk body fluids. Further advice can be sought from a senior Occupational Health Nurse and/or Occupational Health Physician.
At pre-employment, prior to commencing practice, all healthcare workers involved in exposure prone procedures and clinical duties in renal units, including setting up or maintenance of renal dialysis machines must provide documentary evidence of either immunity to hepatitis B or a negative test for markers of hepatitis B infection taken within the previous 12 months. If satisfactory documentary evidence cannot be provided, then further testing will be required prior to completion of health clearance. The Occupational Health Physician must review all results showing markers of infection.