Hepatitis B

General information

Hepatitis B is a serious disease of the liver caused by a virus. Hepatitis means inflammation of the liver, sometimes it can be brought on by alcohol or drugs, but usually it is caused by a virus. There are several different types of virus known to cause hepatitis, but the one that causes most concern amongst healthcare workers is Hepatitis B. Symptoms of Hepatitis B vary considerably from flu like symptoms to an acute illness with abdominal pain and jaundice. The consequences of hepatitis infection vary from one individual to another; these can include chronic liver disease, cancer of the liver and, in severe cases, death. Ninety percent of patients recover completely. Those who do not become chronic carriers, the individual recovers completely from the initial infection but remains infectious to others, this carrier state can persist for many years.

Hepatitis B is transmitted via blood and other body fluids. The most common cause of transmission in healthcare workers is via needle stick injury, cuts and skin lesions can provide a portal of entry. It is also spread through sexual contact and drug abuse.

The risk of contracting Hepatitis B is five to ten times higher amongst healthcare workers than in the general population.

The spread of Hepatitis B can be prevented amongst healthcare workers by good practice and adoption of ‘Universal Precautions’, a system of good practice regardless of whether the situation is considered high risk or not.

Department of Health guidelines (August 1993) have recommended that ‘Healthcare workers who may be at risk of acquiring Hepatitis B from a patient are protected by immunisation’. The immunisation programme consists of a course of three doses of vaccine, the first dose is followed four weeks later by the second; the third dose is given five months later. A blood test should be taken approximately three months after the third injection to estimate the antibody titre (the response to the vaccine). If the titre is not high enough a booster dose will be needed, followed by a second blood test after a three month interval. A percentage of the population will not produce immunity, they are classed as ‘vaccine non-responders’. Should you fall into this category, appropriate advice will be given. It will not prevent you continuing with your training.

You are strongly advised to undergo this immunisation programme. Not only are you at risk from an infected patient but if you become infected and develop carrier status you will be a risk to your patients and the consequences of that will be exclusion from certain areas of practice. Healthcare workers are expected to produce evidence of immunity prior to employment in the NHS.

HYMS occupational health units will provide a course of immunisations if you have not been immunised elsewhere because it is a requirement that all HYMS students complete the course as soon as possible after starting their programme. With your consent a specimen of blood will be obtained at health interview or on completion of your course of Hepatitis B immunisation. The blood will be tested for response to the vaccine and also for evidence of previous infection (Hepatitis B surface antigen). (DOH January 2003)

Anyone found to be Hepatitis B Surface Antigen positive will be recalled to the occupational health unit for advice and further testing. A positive test would indicate a history of Hepatitis B infection and would therefore prevent commencement of areas of training involving exposure prone procedures. Refusal to undergo testing would be treated as a positive result.

Further information is available at http://www.doh.gov.uk/pub/docs/doh/chcguid1.pdf