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GP enhanced services row looms again

Studies on the hepatitis B and pneumococcal vaccines put the focus on immunisation policy. Emma Wilkinson reports

Targeting high-risk groups for hepatitis B immunisation is not working, a new audit of drug misusers concludes.

Half of patients with a history of illicit drug use had admitted injecting drugs to their GP, but only 4 per cent had received the hepatitis B vaccine, the study found.

The researchers branded the current targeted programme 'patchy and often non-existent', while immunisation experts called for universal hepatitis B vaccination as the only solution.

The Joint Committee on Vaccination and Immunisation has been under increasing pressure to add hepatitis B vaccine to the childhood schedule. It is considering the issue and is expected to reach a decision shortly.

The new study identified 1,278 patients through general practices in Lothian, Scotland, and found 90 per cent had no protection against hepatitis B, 6 per cent had natural immunity and just 4 per cent were vaccinated.

Only 33 per cent of patients had been tested for hepatitis B, 28 per cent for hepatitis C and 36 per cent for HIV, according to the research, published this week in Communicable Disease and Public Health (December issue).

Research leader Rosina Weightman, research nurse in the primary care facilitation team at NHS Lothian, said: 'Despite Government guidelines advising hepatitis B vaccination for all injecting drug users, implementation continues to be patchy and often non-existent.'

She said she hoped the nationally enhanced service for drug misuse would help to improve vaccination rates.

Dr David Young, ex-GP and author of new RCGP guidance on hepatitis B vaccination, said: 'If everyone was vaccinated we wouldn't have to worry about the 20 per cent of drug users who become infected. The WHO actually recommended hepatitis B to be included in routine immunisations in children by 1997.'

Currently, only high-risk patients such as injecting drug users and gay and bisexual men are offered vaccination.

The RCGP is calling on GPs to use an accelerated hepatitis B vaccination schedule without waiting for test results.

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