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Evolution of the Viral Hepatitis Prevention Board
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Vol. 13. Supplement 1, pp. S7-B9,1995 Copyright 0 1995 Elsevier Science Ltd Printed in Great Britain. All rights reserved 0264-41 ox/95 $10.00 + 0.00
Evolution of the Viral Hepatitis Prevention Board Elizabeth McCloy* The Viral Hepatitis Prevention Board (VHPB), an independent, international group of experts, wasformed in I992 to raise awareness about the risks of viral hepatitis and the need to prevent the disease. The VHPB’s first initiative was an Action on Hepatitis B as an Occupational Hazard, under the auspices of the Society of Occupational Medicine. The objectives of this action were to increase the protection of workers at riskfrom infection with hepatitis B. In 1993, the VHPB widened its scope and established an Action on Hepatitis B as a Community Health Risk, under the auspices of the European Public Health Association. This action aims to inform and educate the public and policy makers about the dangers of hepatitis B, its modes of transmission and how it can be prevented in the community. Keywords:
Hepatitis
B; community
health; Viral Hepatitis Prevention
Board
Hepatitis B virus (HBV) infection on a global scale is a major cause of morbidity and mortality. Safe and effective vaccines have been available since the early 1980s but many people at risk are still unprotected, particularly in countries of low endemicity where the disease does not have a high profile. In 1992, a group of experts in various aspects of HBV, such as the disease itself and its epidemiological profile, came together as the Viral Hepatitis Prevention Board (VHPB) to discuss how this situation could be improved. The VHPB was established to consider and encourage action towards prevention of viral hepatitis. As the VHPB will address many different issues as it evolves over time, there are four core advisers. In addition, for each meeting of the VHPB, the core advisers invite special advisers and guest advisers. These invited advisers have expertise in particular aspects of HBV infection and make important contributions to the work of the VHPB. Many of these advisers will make presentations at this congress. In its first year, 1992, under its Action on Hepatitis B as an Occupational Hazard, the VHPB focused on the occupational health risk - for example to healthcare workers, paramedics, public safety workers. The VHPB worked with the Society of Occupational Medicine to consider and encourage action on hepatitis B as an occupational hazard in Europe, Australia and North America. In 1993, under its Action towards Control of Hepatitis B as a Community Health Risk, the VHPB is concerned with community health risk. It is working under the auspices of EUPHA, as is appropriate for the change of focus to community health risk. The aims of the VHPB for 1992, under its Action on Hepatitis B as an Occupational Hazard, were to increase awareness and to advise employers, employees and inter*Chief Executive and Director, Civil Service Occupational Health Service, Edinburgh, UK and past President of the Society of Occupational Medicine
ested organisations of the risk of HBV infection in the workplace, and to develop a set of recommendations which would improve the commitment to vaccination of workers at risk. Additional aims were to support and assist the European Parliament and Commission, and appropriate national and regional authorities, to adopt clearer guidelines on HBV as an occupational hazard and to ensure that workers at risk are offered HBV vaccine free of charge. The VHPB produced a number of publications on hepatitis B as an occupational hazard’-9 which included its seven-point consensus (Table 1). It was felt that these seven points were of critical importance in increasing protection against HBV infection as an occupational hazard and that prevention programmes should apply equally to Viral Hepatitis Prevention Board seven-point consensus on hepatitis B as an occupational hazard235
Table 1
Occupational hepatitis B vaccination programmes should apply equally to employees in both the private and public sectors, self-employed staff, students, contract workers and voluntary workers. The employer must ensure that the risk of occupational transmission is assessed. This assessment should be based on work practice and should be independent of job title or status. If the assessment shows the worker is at risk of contamination, the employer has an obligation to inform that worker at risk. Information, training and education must be provided by the employer for the above workers on the measures to be taken to protect them from risk. The employer must offer the above workers vaccination free of charge. The employer has an obligation to ensure that exposed workers are correctly vaccinated. Employees who decline vaccination must be counselled and sign a refusal form. Current practices should be improved by providing information to increase awareness and change attitudes, thereby improving acceptance of vaccination. Information and education should be targeted at occupational health professionals, employers and managers, workers, health and safety representatives and unions.
Vaccine 1995 Volume 13 Supplement
1
9.7
Viral Hepatitis Prevention
Board: E. McCloy
everybody in the workplace - whether employed in the private or the public sector, or working for themselves, and including students at the start of their working career. The VHPB felt strongly that decisions on who is at risk should be made for each individual workplace by assessing and identifying the risk to each individual employee. This is firmly based on European legislation; in this legislation, all workplace hazards have to be assessed by discussing risk and, if such assessment shows that a worker may be likely to contract hepatitis, he must be informed of the risk and he must also receive training and education so that he understands how the disease may be acquired. The VHPB felt that there was a duty on employers that, if their workforce was at risk, workers should be protected at no charge to themselves, vaccination should be correctly given and workers must be aware that they would remain at risk if they were not vaccinated. It was also felt that the VHPB should work hard to increase the amount of information which is given to those with responsibility for health in the workplace. These were wide-reaching objectives. At the European Parliament in November 1993, the Council, who were considering the Biological Agents Directive, passed an amendment to the Directive which stated that vaccination in the workplace for people at risk must be offered by the employer and must be offered free of charge. The Directive will become law throughout Europe by April 1994 (December 1995 for Portugal) and the VHPB regards this as a significant achievement.
S8
Vaccine 1995 Volume 13 Supplement
1
The occupational risk of hepatitis B has not disappeared and many of the initiatives from the work of the VHPB in this area are now being carried forward at national level. This was a very important outcome from the workshops at the first VHPB congress, in 1993, on occupational risks. As part of the 1993 VHPB Action towards Control of Hepatitis B as a Community Health Risk, it is hoped that the awareness which is generated at this congress, and the initiatives which are developed within the workshops, will provide each country with the knowledge and impetus to establish effective community programmes. REFERENCES VHPB. Making hepatitis B prevention a priority in the workplace. Viral Hepatitis Vol. 1, No. 1. Medical Imorint. London, 1992 VHPB. ‘Employers’have’key role in staff protection. Viral Hepatitis Vol. 1, No. 2, Medical Imprint, London, 1992 VHPB. VHPB acts to eliminate hepatitis B risk to workers by 1997. viral Hepatitis Vol. 1, No. 3, Medical Imprint, London, 1992 VHPB. Five-step plan to prevent hepatitis B infection. Viral Hepatitis Vol. 1, No. 4, Medical Imprint, London, 1992 McCloy, E., Kane, M. and Hallauer, J. (Eds ) Eliminating Hepatitis B as an Occupational Hazard Medical Imprint, London, 1993 VHPB. Developing a Successful Hepatitis 6 Prevention Policy. Medical Imprint, London, 1994 VHPB. VHPB Video - Hepatitis B as an Occupational Hazard: Who is at Risk? Medical Imprint, London, 1994 VHPB. Hepatitis B Prevention Programmes in the Workplace. Medical Imprint, London, 1994 VHPB. Hepatitis B as an Occupational Hazard. Document No. 8, European Occupational Health Series, WHO Regional Office for Europe, 1994
Vol. 13. Supplement 1, pp. S7-B9,1995 Copyright 0 1995 Elsevier Science Ltd Printed in Great Britain. All rights reserved 0264-41 ox/95 $10.00 + 0.00
Evolution of the Viral Hepatitis Prevention Board Elizabeth McCloy* The Viral Hepatitis Prevention Board (VHPB), an independent, international group of experts, wasformed in I992 to raise awareness about the risks of viral hepatitis and the need to prevent the disease. The VHPB’s first initiative was an Action on Hepatitis B as an Occupational Hazard, under the auspices of the Society of Occupational Medicine. The objectives of this action were to increase the protection of workers at riskfrom infection with hepatitis B. In 1993, the VHPB widened its scope and established an Action on Hepatitis B as a Community Health Risk, under the auspices of the European Public Health Association. This action aims to inform and educate the public and policy makers about the dangers of hepatitis B, its modes of transmission and how it can be prevented in the community. Keywords:
Hepatitis
B; community
health; Viral Hepatitis Prevention
Board
Hepatitis B virus (HBV) infection on a global scale is a major cause of morbidity and mortality. Safe and effective vaccines have been available since the early 1980s but many people at risk are still unprotected, particularly in countries of low endemicity where the disease does not have a high profile. In 1992, a group of experts in various aspects of HBV, such as the disease itself and its epidemiological profile, came together as the Viral Hepatitis Prevention Board (VHPB) to discuss how this situation could be improved. The VHPB was established to consider and encourage action towards prevention of viral hepatitis. As the VHPB will address many different issues as it evolves over time, there are four core advisers. In addition, for each meeting of the VHPB, the core advisers invite special advisers and guest advisers. These invited advisers have expertise in particular aspects of HBV infection and make important contributions to the work of the VHPB. Many of these advisers will make presentations at this congress. In its first year, 1992, under its Action on Hepatitis B as an Occupational Hazard, the VHPB focused on the occupational health risk - for example to healthcare workers, paramedics, public safety workers. The VHPB worked with the Society of Occupational Medicine to consider and encourage action on hepatitis B as an occupational hazard in Europe, Australia and North America. In 1993, under its Action towards Control of Hepatitis B as a Community Health Risk, the VHPB is concerned with community health risk. It is working under the auspices of EUPHA, as is appropriate for the change of focus to community health risk. The aims of the VHPB for 1992, under its Action on Hepatitis B as an Occupational Hazard, were to increase awareness and to advise employers, employees and inter*Chief Executive and Director, Civil Service Occupational Health Service, Edinburgh, UK and past President of the Society of Occupational Medicine
ested organisations of the risk of HBV infection in the workplace, and to develop a set of recommendations which would improve the commitment to vaccination of workers at risk. Additional aims were to support and assist the European Parliament and Commission, and appropriate national and regional authorities, to adopt clearer guidelines on HBV as an occupational hazard and to ensure that workers at risk are offered HBV vaccine free of charge. The VHPB produced a number of publications on hepatitis B as an occupational hazard’-9 which included its seven-point consensus (Table 1). It was felt that these seven points were of critical importance in increasing protection against HBV infection as an occupational hazard and that prevention programmes should apply equally to Viral Hepatitis Prevention Board seven-point consensus on hepatitis B as an occupational hazard235
Table 1
Occupational hepatitis B vaccination programmes should apply equally to employees in both the private and public sectors, self-employed staff, students, contract workers and voluntary workers. The employer must ensure that the risk of occupational transmission is assessed. This assessment should be based on work practice and should be independent of job title or status. If the assessment shows the worker is at risk of contamination, the employer has an obligation to inform that worker at risk. Information, training and education must be provided by the employer for the above workers on the measures to be taken to protect them from risk. The employer must offer the above workers vaccination free of charge. The employer has an obligation to ensure that exposed workers are correctly vaccinated. Employees who decline vaccination must be counselled and sign a refusal form. Current practices should be improved by providing information to increase awareness and change attitudes, thereby improving acceptance of vaccination. Information and education should be targeted at occupational health professionals, employers and managers, workers, health and safety representatives and unions.
Vaccine 1995 Volume 13 Supplement
1
9.7
Viral Hepatitis Prevention
Board: E. McCloy
everybody in the workplace - whether employed in the private or the public sector, or working for themselves, and including students at the start of their working career. The VHPB felt strongly that decisions on who is at risk should be made for each individual workplace by assessing and identifying the risk to each individual employee. This is firmly based on European legislation; in this legislation, all workplace hazards have to be assessed by discussing risk and, if such assessment shows that a worker may be likely to contract hepatitis, he must be informed of the risk and he must also receive training and education so that he understands how the disease may be acquired. The VHPB felt that there was a duty on employers that, if their workforce was at risk, workers should be protected at no charge to themselves, vaccination should be correctly given and workers must be aware that they would remain at risk if they were not vaccinated. It was also felt that the VHPB should work hard to increase the amount of information which is given to those with responsibility for health in the workplace. These were wide-reaching objectives. At the European Parliament in November 1993, the Council, who were considering the Biological Agents Directive, passed an amendment to the Directive which stated that vaccination in the workplace for people at risk must be offered by the employer and must be offered free of charge. The Directive will become law throughout Europe by April 1994 (December 1995 for Portugal) and the VHPB regards this as a significant achievement.
S8
Vaccine 1995 Volume 13 Supplement
1
The occupational risk of hepatitis B has not disappeared and many of the initiatives from the work of the VHPB in this area are now being carried forward at national level. This was a very important outcome from the workshops at the first VHPB congress, in 1993, on occupational risks. As part of the 1993 VHPB Action towards Control of Hepatitis B as a Community Health Risk, it is hoped that the awareness which is generated at this congress, and the initiatives which are developed within the workshops, will provide each country with the knowledge and impetus to establish effective community programmes. REFERENCES VHPB. Making hepatitis B prevention a priority in the workplace. Viral Hepatitis Vol. 1, No. 1. Medical Imorint. London, 1992 VHPB. ‘Employers’have’key role in staff protection. Viral Hepatitis Vol. 1, No. 2, Medical Imprint, London, 1992 VHPB. VHPB acts to eliminate hepatitis B risk to workers by 1997. viral Hepatitis Vol. 1, No. 3, Medical Imprint, London, 1992 VHPB. Five-step plan to prevent hepatitis B infection. Viral Hepatitis Vol. 1, No. 4, Medical Imprint, London, 1992 McCloy, E., Kane, M. and Hallauer, J. (Eds ) Eliminating Hepatitis B as an Occupational Hazard Medical Imprint, London, 1993 VHPB. Developing a Successful Hepatitis 6 Prevention Policy. Medical Imprint, London, 1994 VHPB. VHPB Video - Hepatitis B as an Occupational Hazard: Who is at Risk? Medical Imprint, London, 1994 VHPB. Hepatitis B Prevention Programmes in the Workplace. Medical Imprint, London, 1994 VHPB. Hepatitis B as an Occupational Hazard. Document No. 8, European Occupational Health Series, WHO Regional Office for Europe, 1994