GPs' college issues guidance on hepatitis A and B vaccination
http://www.100md.com
《英国医生杂志》
Injecting drug users should be vaccinated against hepatitis A, and all users of illegal drugs should be vaccinated against hepatitis B, the Royal College of General Practitioners recommended this week. The vaccinations should be carried out without waiting for prevaccination tests for hepatitis A or B.
One of the authors of the five page guidelines document, Dr David Young, clinical director of the drug and alcohol clinical management unit at Cheshire and Wirral Partnership Trust, emphasised that the guidance was for the whole of primary care and not just for people who specialised in treating drug users. He said the paper was the first defining guidance in England and Wales.
It is estimated that 21% of injecting drug users in England and Wales have evidence of past or current hepatitis B infection. Infection can be prevented by vaccination. Poor uptake of vaccination in drug users has led experts now to advise that vaccination is done before waiting for test results for hepatitis B.
Dr Clare Gerada, head of the Royal College of General Practitioners?substance misuse unit, said: "Prescreening can do more harm than good because a drug user may become infected before the next visit or, worse still, not return to see his or her GP."
All drug users should be vaccinated with hepatitis B vaccine because non-injectors often became injectors. The accelerated schedule for hepatitis B vaccination should be used, under which the vaccination is given at 0, 7, and 21 days.
All injecting drug users should be vaccinated against hepatitis A. The single A vaccine should be given in two doses, with the second dose preferably given after 6-12 months, although it can be delayed for up to three years. (The combined A and B vaccination is not recommended as it has only half the amount of hepatitis A antigen of the single component vaccine.)
Dr Young emphasised that the partners and children of drug users are also at risk of hepatitis B infection (through non-sexual or sexual intimate contact) and should be offered vaccination. This, he admitted, may be difficult: "Families may not be registered with the same practice as the drug user. Some drug users may be reluctant to disclose the risk to their partners." The guidance states that healthcare staff need to work with drug users to advise them of the risks and promote the routine offering of vaccination to partners and children.
Guidance for heptatitis A and B vaccination of drug users in primary care and Criteria for Audit is available at www.rcgp.org.uk/drug/(London Robert Short)
One of the authors of the five page guidelines document, Dr David Young, clinical director of the drug and alcohol clinical management unit at Cheshire and Wirral Partnership Trust, emphasised that the guidance was for the whole of primary care and not just for people who specialised in treating drug users. He said the paper was the first defining guidance in England and Wales.
It is estimated that 21% of injecting drug users in England and Wales have evidence of past or current hepatitis B infection. Infection can be prevented by vaccination. Poor uptake of vaccination in drug users has led experts now to advise that vaccination is done before waiting for test results for hepatitis B.
Dr Clare Gerada, head of the Royal College of General Practitioners?substance misuse unit, said: "Prescreening can do more harm than good because a drug user may become infected before the next visit or, worse still, not return to see his or her GP."
All drug users should be vaccinated with hepatitis B vaccine because non-injectors often became injectors. The accelerated schedule for hepatitis B vaccination should be used, under which the vaccination is given at 0, 7, and 21 days.
All injecting drug users should be vaccinated against hepatitis A. The single A vaccine should be given in two doses, with the second dose preferably given after 6-12 months, although it can be delayed for up to three years. (The combined A and B vaccination is not recommended as it has only half the amount of hepatitis A antigen of the single component vaccine.)
Dr Young emphasised that the partners and children of drug users are also at risk of hepatitis B infection (through non-sexual or sexual intimate contact) and should be offered vaccination. This, he admitted, may be difficult: "Families may not be registered with the same practice as the drug user. Some drug users may be reluctant to disclose the risk to their partners." The guidance states that healthcare staff need to work with drug users to advise them of the risks and promote the routine offering of vaccination to partners and children.
Guidance for heptatitis A and B vaccination of drug users in primary care and Criteria for Audit is available at www.rcgp.org.uk/drug/(London Robert Short)