Transcript Document
Scottish Centre for Infection and Environmental Health A Division of the Common Services Agency Hepatitis B vaccine Impact of safety issues and international points of view – Scotland VHPB, Geneva, 13-14th March, 2003 Dr Claire Bramley Epidemiologist (Immunisation) Scottish Centre for Infection and Environmental Health Glasgow, Scotland, UK [email protected] Scottish Centre for Infection and Environmental Health A Division of the Common Services Agency 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 Scottish Centre for Infection and Environmental Health A Division of the Common Services Agency Current UK HepB policy Selective • 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 Scottish Centre for Infection and Environmental Health A Division of the Common Services Agency 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 Scottish Centre for Infection and Environmental Health A Division of the Common Services Agency 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™, 5mg, Aventis Pasteur MSD • 0, 1, 7 month schedule Scottish Centre for Infection and Environmental Health A Division of the Common Services Agency 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 Scottish Centre for Infection and Environmental Health A Division of the Common Services Agency UK vaccination ‘climate’ Extremely sensitive to vaccine safety allegations • MMR and autism / IBD Scottish Centre for Infection and Environmental Health A Division of the Common Services Agency Scottish Centre for Infection and Environmental Health A Division of the Common Services Agency UK vaccination ‘climate’ Extremely sensitive to vaccine safety allegations • MMR and autism / IBD • thiomersal and mercury poisoning / autism Scottish Centre for Infection and Environmental Health A Division of the Common Services Agency Scottish Centre for Infection and Environmental Health A Division of the Common Services Agency UK vaccination ‘climate’ Extremely sensitive to vaccine safety allegations • MMR and autism / IBD • thiomersal and mercury poisoning / autism • aP and wcP – relative safety and efficacy Scottish Centre for Infection and Environmental Health A Division of the Common Services Agency Scottish Centre for Infection and Environmental Health A Division of the Common Services Agency UK vaccination ‘climate’ Extremely sensitive to vaccine safety allegations • MMR and autism / IBD • thiomersal and mercury poisoning / autism • aP and wcP – relative safety and efficacy Media-driven Fuelled by pressure groups / isolated health professionals Selective Scottish Centre for Infection and Environmental Health A Division of the Common Services Agency D3 100 T3 95 P3 90 Pol3 Hib3 85 MMR 80 Men C 19 95 19 Q1 95 19 Q3 96 19 Q1 96 19 Q3 97 19 Q1 97 19 Q3 98 19 Q1 98 19 Q3 99 19 Q1 99 20 Q3 00 20 Q1 00 20 Q3 01 Q1 20 01 Q3 20 02 Q1 20 02 Q3 percentage vaccine uptake (%) Vaccine uptake, age 24 months, Scotland, 1995-2002Q3 years by quarter Scottish Centre for Infection and Environmental Health A Division of the Common Services Agency Knowledge and attitudes Previous 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 Scottish Centre for Infection and Environmental Health A Division of the Common Services Agency 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 Scottish Centre for Infection and Environmental Health A Division of the Common Services Agency 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 Scottish Centre for Infection and Environmental Health A Division of the Common Services Agency Media response Scottish Centre for Infection and Environmental Health A Division of the Common Services Agency Uptake • Total Roll • Consent 10,826 9,975 (92.1%) • Non-consent 942 (8.7%) • Written refusal • Non-return of form 91 (0.8%) 851 (7.9%) • Reasons for written refusal – 24 already vaccinated – 2 stated life threatening reaction – 37 inappropriate/needle phobia/safety – 26 no reason given Scottish Centre for Infection and Environmental Health A Division of the Common Services Agency Total Eligible n = 10826 Non Participants n = 942 (8.7%) Written Consent 91 (0.8%) Written refusal 89 (0.8%) Participants n = 9884 (91.3%) Passive Non-Consent 762 (7.0%) 3 Doses 8679 (80.2%) Only 2 Doses 988 (9.1%) Only 1 Dose 217 (2.0%) Scottish Centre for Infection and Environmental Health A Division of the Common Services Agency 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 Scottish Centre for Infection and Environmental Health A Division of the Common Services Agency Acknowledgements – Glasgow pilot project SCIEH Dr C Bramley, Dr L Wallace, Prof D Goldberg Greater Glasgow NHS Board Dr S Ahmed Schools Health Service, Yorkhill NHS Trust Mrs R Duff West of Scotland Specialist Virology Centre Dr W Carman, Dr S Cameron Aventis Pasteur MSD Dr N Kitchin, Dr M Watson Focus Groups Dr A Hinds and GlaxoSmithKline