Hepatitis B service description


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Hep B service description
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HEPATITIS B VACCINATION PROGRAMME

FOR

GROUPS OF PEOPLE AT INCREASED RISK OF COMMUNITY ACQUIRED HEPATITIS B INFECTION

INFORMATION PACK

FOR FURTHER INFORMATION ABOUT THIS PROGRAMME CONTACT:

JANE SMITH,

BLOOD BORNE VIRUS LIAISON NURSE

LANARKSHIRE HIV, AIDS AND HEPATITIS CENTRE

MONKLANDS HOSPITAL

MONKSCOURT AVENUE,

AIRDRIE, ML6 0JS.

TEL: 01236 712720

E-MAIL: Jane.Smith@laht.scot.nhs.uk

Hepatitis B Vaccination Programme

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Contents

Vaccination Programme Summary

Hepatitis B Vaccination Protocol

Documentation for photocopying

Lanarkshire Hepatitis B Vaccination Programme Registration Form

Hepatitis B Vaccination Consent Form

Lanarkshire Hepatitis B Vaccination Programme Vaccination Site Log

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Hepatitis B Vaccination Programme Summary

The programme has been developed as part of the NHS Lanarkshire's commitment to, 'develop effective, integrated methods of providing local vaccination programmes for injecting drug users and their partners'.

Aim

The aim of this programme is to reduce the incidence and transmission of Hepatitis B in Lanarkshire by providing a Hepatitis B vaccination service directed especially at Injecting Drug Users (IDU's) and their sexual partners, males who have sex with males and any female sexual partners they may have.

Objectives

Create a wide network of agencies who will raise awareness of the advantages and availability of Hepatitis B vaccination among at risk groups.
To offer a seamless service in NHS Lanarkshire in partnership with voluntary sector eg PHACE Scotland and local authorities, accommodation units for homeless people and Social Work Departments.
To establish a vaccination database at Lanarkshire Virus HIV AIDS and Hepatitis Centre (LHAHC).
To evaluate the programme, on an annual basis, and report results to the Blood Borne Virus Standing Committee.

Vaccination Information - Hepatitis B

Information will be offered on Hepatitis infection
Where the vaccination is available
The vaccination programme will commence February, 2002.

Contacts:

Vaccination Programme Co-ordinator -

Jane Smith,

BBV Liaison Nurse,

LHAHC,

Monklands Hospital,

Monkscourt Avenue,

Airdrie, ML6 0JS.

Tel: 01236 712720 Fax: 01236 712449

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Hepatitis B Vaccination Protocol

VACCINATION PROTOCOL FOR INDIVIDUALS CONSIDERED TO BE AT HIGH RISK OF HEPATITIS B INFECTION

1. Background Information

1.1 The aim of this vaccination programme is to vaccinate intravenous drug users (IDUs) and their sexual partners against Hepatitis B. Males who have sex with males and any female sexual partners they may have will also be offered vaccination against hepatitis B. This is also seen as an opportunity to educate clients about hepatitis B and C, HIV infection, needle exchange facilities, and methadone replacement.

1.2 Clients will not be tested for previous infection by hepatitis B as a pre-requisite for vaccination. Around 1 in 10 clients will have had previous hepatitis B infection - most of them will have developed natural immunity but 2-10% may be chronic carriers. Clients with previous hepatitis B infection will neither benefit nor be harmed by this vaccination course. It is more important that vaccination is given to the majority who will benefit rather than waiting for test results to identify the minority who will not benefit.

1.3 Clients should be offered three vaccinations over 3 weeks (see below). The accelerated schedule over 21 days maximises early immunity and the likely completion of the course with an option of a booster at 12 months. This schedule results in 65% and 76% of vaccinees having sero protective levels of antibody within one and five weeks respectively after three immunisations (Engerix B - Summary of Product Characteristic).

1.4 The success of this vaccination programme depends upon good and simple records being kept (see below).

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2 Keeping Records

2.1 Clients will be identified by their full name, or initial if the client does not wish to give his/her full name and date of birth.

2.2 A Registration Form will be completed for all clients who accept vaccination. When course of vaccination is completed these forms will be sent by post to Jane Smith, Vaccination Co-ordinator who will collate the data in a specially created database. If, the course is not completed over six weeks forms should be returned to Jane Smith, the BBV Liaison Nurse.

2.3 A Vaccination Site Log will be held by practitioner where vaccinations are given. It includes the data required to update the database for each injection given.

2.4 If the client is put off by the questions on the form then respect his/her wish for information not to be recorded. It is better to have the client begin vaccination and have incomplete records than 'scare' the client away from the service.

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3 Recruitment into the Vaccination Programme

3.1 All clients attending contact points should be offered hepatitis B vaccination, irrespective of reported previous hepatitis B infection or vaccination (unless documentation of the latter is complete). If a client thinks he/she has had a full course of hepatitis B vaccination but is not sure and if facilities are available give one dose, and test for hepatitis B antibody titre levels.

3.2 Clients should be advised on the nature of hepatitis B and the benefits of vaccination, using the patient information leaflet as a guide.

3.3 If a client agrees to vaccination, the protocol should be explained: this is, three injections - one today, then followed by injection 1 week and 3 weeks after the initial dose. The option of a booster at 12 months will also be offered.

3.4 If a client does not wish vaccination, the record form should still be completed to help monitor vaccine uptake.

3.5 A client who has initially refused vaccination is welcome to change his/her mind and enter the programme subsequently.

3.6 It is much better to get the complete vaccination course, but even giving one or two doses is better than giving no vaccination

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4 Consent

4.1 All clients must understand the consent form and then sign and date it. Remember many clients have difficulty in reading, so reading out each point to the client will often be necessary.

4.2 Client workers should explain all the notes on the consent form and then sign and date it also.

5 Administering the Vaccine

5.1 Training and Responsibility

Nurses administering hepatitis B vaccine (Engerix B) must:

Be willing to be professionally accountable for their work as defined in the Nursing and Midwifery Council guidance on the "Scope of Professional Practice."

Have received training and be competent in all aspects of vaccination, including the contraindications to hepatitis B vaccine.

Have adequate training in the recognition and treatment of anaphylaxis.

5.2 General Points

5.2.1 The leaflets supplied with the product and prepared by the manufacturer in consultation with the Licensing Authority should be read.

5.2.2 The identity of the vaccine must be checked to ensure the right product is used in the appropriate way on every occasion.

5.2.3 The expiry date must be noted. Vaccines should not be used after the expiry date on the label.

5.2.4 The date of immunisation, batch number and initials of the person giving the vaccine must be recorded in vaccination log.

5.2.5 The recommended storage conditions of 2-8° C must be carefully observed, (the cold chain must be preserved).

5.3 CONTRAINDICATIONS

HYPERSENSITIVITY TO ANY COMPONENT OF THE VACCINE GIVEN PREVIOUSLY

Detailed enquiry may reveal that the reported reaction does not match the specifications below and vaccination can proceed. The following reactions should be regarded as severe;

LOCAL - an extensive area of redness and swelling which becomes indurated and involves most of the antero-lateral surface of the thigh or a major part of the circumference of the upper arm.

GENERAL - fever equal to or more than 39.5° C within 48 hours of vaccine; anaphylaxis; bronchospasm; laryngeal oedema; generalised collapse.

SEVERE FEBRILE INFECTIONS/ACUTE ILLNESS. Minor infections without fever or systemic upset are not reasons to postpone immunisation.

5.4 ADMINISTRATION

5.4.1 Cleaning of Skin
If the skin is to be cleaned, alcohol and other disinfecting agents must be allowed to evaporate before injection of vaccine.

5.4.2 The vaccine is not recommended in pregnancy other than where risks clearly outweigh benefits. Seek medical advice if a pregnant woman seeks Hepatitis B vaccination.

IF IN DOUBT, PLEASE PHONE:
LHAHC - 01236 712247 (Office Hours)
24 Hours - 01236 747960 (Answering Machine)

5.4.3 Hepatitis B vaccine is for intramuscular use only and should not be given intravenously or intradermally.

5.4.4 The vaccine is supplied in a pre-filled syringe. Prior to vaccination, the vaccine should be well shaken and be visually inspected for any colour variations or particulate matter. Once shaken, the vaccine is slightly opaque.

5.4.5 The vaccine must not be mixed in the same syringe or injected at the same site as other vaccines.

5.4.6 The vaccination regimen consists of four doses of 20 micrograms (one ml) given at days 0, 7 and 21 and a booster dose at 12 months.

5.4.7 The vaccine should be administered in the deltoid region - usually to the non-dominant arm.

5.4.8 The vaccine should not be administered in the buttock since this may result in a lower immune response. Seek Medical Advice in patients with severe bleeding tendencies such as haemophiliacs, subcutaneous administration may be considered.

5.5 ADVERSE REACTIONS

Adverse reactions are usually mild. The most common reactions occurring in up to half of vaccinees, are mild transient local soreness, erythema and induration at the injection site.

Local swelling at the injection site and angioedema have been reported rarely

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6 DOCUMENTATION AND FOLLOW-UP

6.1 Documentation

6.1.1 All clients who come forward for vaccination should have a Registration Form completed and when completed returned to LHAHC.

6.1.2 Clients entered on the vaccination programme must have a:

Completed consent form sent to the BBV Vaccination Co-ordinator

Completed vaccination card

Patient information leaflet

Vaccination Site Log entry each time they receive an injection.

6.1.3 Records will be kept centrally at LHAHC on a confidential database.

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7 Follow-up

Each time a client receives an injection, he/she should also have the date that the next vaccination is due entered on his/her own vaccination card.

If the client is late for the next vaccination, he/she should be vaccinated and their next date of vaccination calculated from that point in time.

Success is partially dependent on the enthusiasm of the health care professional to encourage the client to finish the course.

All opportunities to further encourage clients to finish a started course should be taken.

8 Enquiries and Further Information

If you require further information on any aspect of hepatitis B vaccination, please contact Jane Smith, LHAHC - 01236 712247

Vaccination Of Individuals Considered To Be At Increased Risk Of Hepatitis B Infection

The following pages should be photocopied and used as required.

Lanarkshire Vaccination Of Individuals Considered To Be At Increased Risk Of Hepatitis B Infection

REGISTRATION FORM

This form to be completed for each new client registered on the programme. Please write or 4 in the boxes provided.

CLIENT DETAILS	NAME OF CLIENT	First name
	NAME OF CLIENT	Surname
		Post Code
	DATE OF BIRTH	___/___/___	SEX	Male	Female
	ARE YOU CURRENTLY INJECTING?			Yes	No
	IF NO, DID YOU PREVIOUSLY INJECT?			Yes	No
	ARE YOU A SEXUAL PARTNER OF AN INJECTING DRUG USER?			Yes	No
	ARE YOU A MALE WHO HAS SEX WITH A MALE OR FEMALE SEXUAL PARTNER THEY MAY HAVE			Yes	No

PREVIOUS VACCINATION DETAILS

HAVE YOU HAD ANY HEP B VACCINATIONS

IN THE PAST YEAR?

Yes

IF YES, HOW MANY & WHERE DID YOU RECEIVE THEM?

Clinical Criteria for Exclusion	Hypersensitivity to a component of the vaccine
	Acute severe febrile infection. The presence of a minor infection, however, is not a contraindication for vaccination.
	Pregnancy - advise the client to seek medical advice.
	Clients receiving anticoagulant therapy or who have a bleeding disorder - advise the client to seek medical advice.
	Clients who cannot consent to the treatment
	Clients with a history of Hepatitis B infection or vaccination.

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Cont'd.

VACCINATION ACCEPTED/REFUSED/REASON

VACCINATION DETAILS	SPECIFIC LOCATION
	VACCINATION LOCATION CODE	LHAHC	Social Work
		GP Practice	Fixed Needle Exchanges
		Homeless Units	Rough Sleepers Shelters
		Community Addiction clinics
		Lanarkshire Drug Service clinics	Other
		FIRST	THIRD	BOOSTER
	NAME OF PERSON GIVING VACCINE (PLEASE PRINT)
	DATE VACCINE GIVEN
	MANUFACTURER OF VACCINE
	BATCH NUMBER
	EXPIRY DATE

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Many thanks for your co-operation. Please return completed forms to Jane Smith, LHAHC. These can either be handed in directly at LHAHC or in a sealed envelope addressed to Jane Smith, BBV Liaison Nurse, LHAHC, Monklands Hospital, Monkscourt Avenue, AIRDRIE, ML6 OJS. Then either put in an internal mail envelope or post by Royal Mail.

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HEPATITIS B VACCINATION CONSENT FORM

I, _______________________________________________(NAME - please print)

__________________________ (DATE OF BIRTH) consent to a course of

four Hepatitis B vaccination injections

I understand that: (Tick box)

These injections are to prevent people getting Hepatitis B r

These injections are only for Hepatitis B r

I need to have four injections to get maximum protection r

I confirm that I am not aware of being pregnant (females only) r

I am not aware of any previous allergies to immunisation r

Signed ________________________________________________

Date _______________________

I have explained the notes on this consent form to the above-named individual .

Print Name___________________________________________________

Signed ______________________________________________________

Date ___________________________________________________

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LANARKSHIRE IDU HEPATITIS B VACCINATION PROGRAMME

VACCINATION SITE LOG

Only use this form for clients who have already been registered on a registration form.

[please click here to view form in a new browser window]

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BIBLIOGRAPHY

Department of Health (1996) Immunisation against infectious diseases. 95-108

Morbidity and Mortality Weekly Report. 1996, No. 45, 1-35

Best D, Noble A, Finch et al. (1999)

Accuracy of perceptions of hepatitis B and C status: cross sectional investigation of opiate addicts in treatment. British Medical Journal 1999, 319:290-291

Hughes N (October 1997) Hepatitis B vaccinations.. don't care, won't care. Mainliners Newsletter. 1-2.

Kemp K (1997)The Primary Care Unit. Report on activity and development within the Primary Care Unit from November 1994 to December 1997. London: Camden and Islington Community Health Service NHS Trust.

Borg L, Khuri E, Wells et al. (1999).

Methadone-maintained former heroin addicts including those who are anti-HIV-1 seropositive, comply with and respond to hepatitis B vaccination. Addiction 94 (4):489-93

Department of Health, (1999) Health Service Circular 1999/036. Drug Misuse Special Allocation: 1999/2000. Funding and Guidance on the Modernisation Fund Element.

Heptonstall J (1999) Strategies to ensure delivery of hepatitis B vaccine to injecting drug users. Communicable Disease and Public Health Vol 3 Number 3 154 - 160. This paper was one of the principle sources used to write the strategies for promoting hepatitis B immunisation on page 7.

Edmond W.J. Universal or selective immunisation against Hepatitis B virus in the United Kingdom.

Communicable Disease and Public Health Vol 1 No. 4 221 - 227

Lanarkshire Health Board Blood Borne Virus Strategy.

Lamagni L. Davison K.L. Hope V D et al (1999) Poor hepatitis B vaccine coverage in injecting drug users: England 1995 and 1996. Communicable Disease and Public Health Vol 2 No. 3, 134-137.

Winstock A.R. Sheridan J, Lovell S et al (2000). National Survey of Hepatitis Testing and vaccination Services provided by Drug Services in England and Wales. European Journal of Clinical and Microbiological Infectious Disease 19: 823-828

Smith Kline Beecham - Pharmaceutical - Engerex B - Summary of characteristics.

A C K N O W L E D G E M E N T

We would like to acknowledge N.H.S. Highland for their help in producing this document.

LANARKSHIRE HEPATITIS B VACCINATION GROUP.

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