||Guidelines For The Provision Of Hepatitis A And B Vaccine To Adults In Western Australia At Risk Of Acquiring These Infections By Sexual Transmission And Injecting Drug Use
||Operational Circular OP 1995/05
|Date of issue:
||Thursday, 22 September 2005
||NO LONGER APPLICABLE
||These guidelines have been designed to increase the accessibility of hepatitis A and B vaccines for adults at risk of acquiring these infections by sexual transmission and/or injecting drug use.
SUPERCEDED BY OD 0146/08
||General Practitioners, Community Health Care Centres and Population Health Care Units, Non Government Agencies, Health Care Workers.
|Period of effect:
||from 22 September 2005
||Dr Gary Dowse, A/Director, Communicable Disease Control Directorate, 10-Sep-2005
|| View print version
||Guidelines for the Provision of Hepatitis A and B Vaccine to adults in Western Australia at risk of acquiring these infections by sexual transmission and injecting drug use
Guidelines For The Provision Of Hepatitis A And B Vaccine To Adults In Western Australia At Risk Of Acquiring These Infections By Sexual Transmission And Injecting Drug Use
This Operational Circular is designed to advise Department of Health staff on Departmental policies and procedures.
These guidelines have been designed to increase the accessibility of hepatitis A and B vaccines for adults at risk of acquiring these infections by sexual transmission and/or injecting drug use.
Refer to OP 1529/02 “Hepatitis B vaccination program” and OP 1390/01 “Hepatitis A” for guidelines for vaccinating people at risk of acquiring hepatitis B or A via other transmission routes.
These guidelines have been developed in accordance with the National Health and Medical Research Council (NHMRC) recommendations for hepatitis B vaccination (Commonwealth of Australia, 2003). However, these guidelines do not apply to all groups that the NHMRC recommends be vaccinated against hepatitis B.
The NHMRC recommends that combined hepatitis A and B vaccine be considered for certain groups, including: expatriates and long-term visitors to developing countries; medical, dental and nursing undergraduate students; men who have sex with men; injecting drug users; patients with chronic liver disease; the intellectually disabled and their carers; and people with haemophilia who may receive pooled plasma concentrates. People who are not eligible to receive free hepatitis A or B vaccine under the program outlined in this operational circular are encouraged to be vaccinated for hepatitis B, although they may be liable for any associated costs. (Note: The Department of Justice provides free hepatitis B vaccination for Prison Officers and inmates, and free combined hepatitis A and B vaccine for prisoners who are hepatitis C and/or HIV positive.)
The Department of Health will provide combined hepatitis A and B vaccine and monovalent hepatitis A and hepatitis B vaccine to approved organisations that have a high proportion of at risk clients (See Sections 2.1 and 2.2) to be provided free to their at risk clients.
- PROVISION OF COMBINED HEPATITIS A AND B VACCINE OR MONOVALENT HEPATITIS A OR HEPATITIS B VACCINE FOR HIGH RISK ADULT GROUPS
2.1 Adult groups eligible to receive free hepatitis A and/or B vaccination
||Men who have sex with men|
||People with chronic liver disease and/or hepatitis C infection|
||People who inject drugs|
||People with HIV infection|
||People with multiple sex partners, e.g. sex workers|
Note: Inmates of correctional facilities are not eligible for Department of Health funded Hepatitis A and Hepatitis B vaccines as the Department of Justice provides vaccines in these settings.
2.2 Organisations authorised to provide free A and/or B vaccination
||Western Australian Substance Users’ Association|
||WA AIDS Council|
||Perth and Fremantle Streetdoctor|
||AMPRF – Perth Naltrexone Clinic|
||Magenta/Street Workers Outreach Project WA (SOPWA)|
||Next Step Clinical Services|
||General Practitioners who notify a newly diagnosed case of hepatitis C|
||Community Health Centres and/or Population Health Units that offer clinical services (Kimberley, Pilbara-Gascoyne, Goldfields and Midwest Murchison regions).|
It is commonly accepted that a patient population would need to have >30% prevalence of hepatitis B immunity/carriage before it becomes cost-effective to do pre-vaccination testing (Jacobs, 2003). However, if pre-vaccination testing is not performed, then people who are hepatitis B carriers (ie, hepatitis B surface antigen positive) will not learn of their HBsAg positive status, nor of the preventive measures that they and their household/sexual contacts should follow. Thus, although the prevalence of hepatitis B immunity/carriage in Australian populations is unlikely to be >30%, it is recommended that at the first visit, patients in the defined high-risk groups to which this circular applies receive the first dose of vaccine and have their hepatitis B immunity tested. Those who are already immune or are a hepatitis B carrier do not require further doses of hepatitis B vaccine, but should complete a course of hepatitis A vaccination.
Testing for hepatitis A immunity is not recommended because prevalence of immunity in Australian populations is low and because knowledge of immunity confers no advantage to either the patient or their household/sexual contacts (unlike knowledge of hepatitis B carriage status). Pre-vaccination screening for hepatitis A at the time of first vaccine dose may be considered on an individual case-by-case basis if the patient is from a high-prevalence group, e.g. born before 1945, born or lived in an area of high endemicity, Aboriginal and Torres Strait Islanders, MSM (men who have sex with men), past history of jaundice.
2.4 Vaccine Schedule
Patients known to be either immune to hepatitis B or a hepatitis B carrier before commencement of vaccination should have two doses of hepatitis A vaccine, 6-12 months apart.
Patients known to be immune to hepatitis A before commencement of vaccination should have three doses of hepatitis B vaccine administered at 0, 1 and 6 months. In high-risk groups, the use of an accelerated schedule may improve compliance and the speed at which immunity is achieved. An accelerated four dose schedule at 0, 7, 21 days, with a booster dose after 12 months, is approved for adult Engerix-B®.
The routine schedule for combined hepatitis A and B vaccination in adults is three doses administered at 0, 1 and 6 months. In high-risk groups, the use of an accelerated schedule may improve compliance and the speed at which immunity is achieved. An accelerated four dose schedule at 0, 7, 21 days, with a booster dose after 12 months, is approved for adult Twinrix® (720/20).
Patients who have an initial dose of Twinrix®, but are then found to be either immune to hepatitis B or a hepatitis B carrier, do not require further doses of Twinrix®. However, they should have a second dose of hepatitis A vaccine 6 to 12 months after the initial dose of Twinrix®.
2.5 Ordering and Record Keeping
Metropolitan, Wheatbelt, South West and Great Southern regions:
The STI/BBV program, Communicable Disease Control Directorate (CDCD), will post a vaccine order form to medical practitioners who have diagnosed a patient with hepatitis C infection as indicated by receipt of either a laboratory or a doctor’s notification of a newly diagnosed case of hepatitis C. Doctors should then fax the order form back to CDCD, which will coordinate vaccine supply by either CSL (metropolitan area) or the appropriate regional supply point.
Kimberley, Pilbara-Gascoyne, Goldfields and Midwest Murchison regions:
Population Health Units in these regions will post a vaccine order form to medical practitioners who notify a newly diagnosed case of hepatitis C to the regional Population Health Unit. Doctors should then fax the order form back to the population health unit, which may then order vaccines directly from CSL. Population health unit staff may also order vaccines directly from CSL for patients in the risk groups defined in section 2.1 who live in these regions.
Special clinical settings:
The Western Australian Substance Users’ Association, WA AIDS Council, Perth and Fremantle Streetdoctor, AMPRF – Perth Naltrexone Clinic, Magenta/SWOPWA and Next Step Clinical Services may order vaccines directly from CSL for patients in the risk groups defined in section 2.1 using a separate order form.
- FURTHER INFORMATION
For further information about this program contact Dr Donna Mak (telephone 93884828), Medical Adviser, STI/BBV program, Communicable Disease Control Directorate, Department of Health Western Australia.
||Commonwealth of Australia (2003), Australian Immunisation Handbook 8th Edition 2003, National Health and Medical Research Council. |
||Jacobs RJ, Saab S, Meyerhoff AS, Koff RS. An economic assessment of pre-vaccination screening for hepatitis A and B. Public Health Rep. 2003 Nov-Dec;118(6):550-8.|
||Letter to doctors: Metropolitan, Wheatbelt, South West and Great Southern regions. |
||Hepatitis A and/or B vaccination program for patients with newly diagnosed hepatitis C - Hepatitis A and/or B Vaccine Order Form for GPs.|
||Hepatitis A and B Vaccine Order Form for regional Population Health Units and Pharmacies.|
Dr Gary Dowse
COMMUNICABLE DISEASE CONTROL DIRECTORATE
BIBLIOGRAPHY / REFERENCES:
||Commonwealth of Australia (2003), Australian Immunisation Handbook 8th Edition 2003, National Health and Medical Research Council.
||Jacobs RJ, Saab S, Meyerhoff AS, Koff RS. An economic assessment of pre-vaccination screening for hepatitis A and B. Public Health Rep. 2003 Nov-Dec;118(6):550-8.
This circular last updated: Thursday, 18 September 2008 at 8:31am