Hello everyone, wondering if anyone can help me.

Im doing an audit in my practice on the number of IVDUs who have had the HBV vacc. In the "Guidance for hepatitis A & B vaccination of drug users in primary care and criteria for audit" (document published by SMMGP and RCGP), summary of recommendations suggest that ALL drug users should be vaccinated against HBV. The thinking behind this is that non-injectors may become injectors. Does anyone know if ALL drug users include legal substances - eg. alcohol, or is indicated at illicit drugs? I have tried to find some evidence/backing for this recommendation but failing miserably.

Thanks guys!!

I wouldn't bother with alcohol users. I have given jabs to young people who were starting using drugs and I was worried it may progress to other things.

Thanks for that Simon, you're opinion seems to be echoed by others. But do you have any idea where the suggestion that ALL drug users are vaccinated comes from? it is understandable that perhaps it is recommendation purely from experienced service providers.

It's in the 'green book', the department of health immunisation against infections disease guidelines. It can be downloaded here.

Sorry, hit send ratehr than post URL. The URL is http://www.dh.gov.uk/en/Publicationsandstatistics/Publi...ndGuidance/DH_079917

All pharmacies, PCTS, GP surgeries etc. should have a copy.

Page 168 - 169 states

"IDUS are a group at particular risk of acquiring Hepatitis infection. Vaccination is recommended for the following

all current IDUs, as a high priority
those who inject intermittently
those who are likely to ‘progress’ to injecting, for example those who are
currently smoking heroin and/or crack cocaine, and heavily dependent
amphetamine users
non-injecting users who are living with current injectors
sexual partners of injecting users
children of injectors.

Hi Madeleine,
those people snorting cocaine (or anything else) would also be at some risk of bbv transmission through sharing straws, rolled up notes etc

Thanks for the information - thats all been really helpful. Has anyone audited the uptake of the HBV vaccination? Interestingly the audit Im doing in Rotherham shows we need to be pushing it more!

Hi Madeleine
I tried to post you a link of a published audit but failed; if you search on Wright, Tompkins and Campbell you will find it; or Nat might help us if he's around on the forum soon.
This paper compares the conventional 6 month course with the so-called hyperaccelerated of 0,1 and 3 weeks and shows the huge increase in uptake in a homeless population. In the same population we continued to see year on year improvements in course completion using the hyperaccelerated regimen. Good luck!

Hi,
In birmingham, like you, we are trying to focus all our minds on this area, and as one step we have added a column to the claim forms we have to send in to be paid (for being part of our "LES"), asking the questions about BBV screening, Hep C discussion and HepB/A course completion. At present we are not stopping pay if the columns are not filled in, but the question being asked is triggering a lot of local activity, we hope.

I am just filling my forms in for the last quarter, (rather late as usual) and can see that I have quite a long way to go.I should be using our template each time, to trigger the question , probably. One of my colleagues recently presented a small audit, from his surgery, and out of 9 recent Hep C tests performed as part of this local drive, he found 4 people were positive for Hep C..