1. 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, 13-14 th March, 2003 Dr Claire Bramley Epidemiologist (Immunisation) Scottish Centre for Infection and Environmental Health Glasgow, Scotland, UK claire.bramley@scieh.csa.scot.nhs.uk

2. 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

3. Scottish Centre for Infection and Environmental Health A Division of the Common Services Agency Current UK HepB policy 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 Selective

4. 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

5. 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™, 5  g, Aventis Pasteur MSD 0, 1, 7 month schedule

6. 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

7. 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

8. Scottish Centre for Infection and Environmental Health A Division of the Common Services Agency

9. 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

10. Scottish Centre for Infection and Environmental Health A Division of the Common Services Agency

11. 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

12. Scottish Centre for Infection and Environmental Health A Division of the Common Services Agency

13. 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

14. Scottish Centre for Infection and Environmental Health A Division of the Common Services Agency Vaccine uptake, age 24 months, Scotland, 1995-2002Q3

15. 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

16. 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

17. 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

18. Scottish Centre for Infection and Environmental Health A Division of the Common Services Agency Media response

19. Scottish Centre for Infection and Environmental Health A Division of the Common Services Agency Total Roll 10,826 Consent 9,975 (92.1%) Non-consent 942 (8.7%) Written refusal 91 (0.8%) Non-return of form 851 (7.9%) Reasons for written refusal – 24 already vaccinated – 2 stated life threatening reaction – 37 inappropriate/needle phobia/safety – 26 no reason given Uptake

20. Scottish Centre for Infection and Environmental Health A Division of the Common Services Agency Total Eligible n = 10826 Non Participants n = 942 (8.7%) Participants n = 9884 (91.3%) 3 Doses 8679 (80.2%) Only 2 Doses 988 (9.1%) Only 1 Dose 217 (2.0%) Written Consent 91 (0.8%) Written refusal 89 (0.8%) Passive Non-Consent 762 (7.0%)

21. 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

22. 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 GroupsDr A Hinds and GlaxoSmithKline