HEP C UK
www.hepcuk.info
This site is intended to be the main online hepatitis C resource for the UK, providing accurate and up-to-date information. It is managed by The Hepatitis C Trust, the national UK hepatitis C charity run by people with hepatitis C for people with hepatitis C.

Sections include: Treatments, Support, “Just been diagnosed?” and a Discussion Forum

HEP LINKS
www.hep-links.com
Links to established Hepatitis C patient associations and liver organisations across the world; and facts about Hepatitis C.
This is the result of a co-operative initiative amongst hepatitis C and liver disease patient associations from across Europe and the Middle East. It provides website access and information to over 60 patient groups in 60 countries and plans to include many other countries in 2005.

BRITISH LIVER TRUST
The national charity for adult liver disease Information available in English, Urdu, Chinese, Hindi and Bengali
www.britishlivertrust.org.uk

DEPARTMENT OF HEALTH
www.dh.gov.uk

HEALTH PROTECTION AGENCY
www.hpa.org.uk

HEPATITIS A-Z
www.hepatitis.org.uk

OMNI
http://omni.ac.uk/
Offers free access to a searchable catalogue of hand-selected and evaluated, quality Internet resources in Health and Medicine. New resources are added to the database on a weekly basis.

EXTENSIVE HIV/AIDS INFORMATION AND LINKS, BOTH NATIONAL AND INTERNATIONAL, AT:
http://www.brad.ac.uk/staff/ijhodgson/hivlinks.htm

AVERT
www.avert.org
An international HIV and AIDS charity based in the UK, with the aim of AVERTing HIV and AIDS worldwide

AIDSMAP
www.aidsmap.com
Comprehensive HIV information site with information also available in Español, Português and Français

TERRENCE HIGGINS TRUST
www.tht.org.uk

NATIONAL AIDS TRUST
www.nat.org.uk
The National AIDS Trust (NAT) is a UK's HIV and AIDS policy development and campaigning organisation

HEPATITIS A (HAV) ::

Overview from The British Liver Trust www.britishlivertrust.org.uk

The British Liver Trust site also provides sections on Symptoms, Diagnosis, Prevention, Treatment and More Information

Hepatitis means your liver becomes inflamed (swollen and tender). The most common cause is being infected with a virus. An inflamed liver can also be caused by:

drinking too much alcohol
the side effects of some medicines and chemicals
a liver disease called autoimmune hepatitis where the body's immune system doesn't work properly and attacks the liver.

There are several different hepatitis viruses which affect the liver - the main ones are hepatitis A, B, C, D and E.

The viruses are different from each other in:
how they are passed from person to person
the way they cause liver damage
the effects they can have on health.

Hepatitis A, sometimes called hep A or HAV, is a liver disease caused by the hepatitis A virus. You can prevent illness by having a vaccination that will protect you from being infected for up to 10 years.
Hepatitis A is common in places where water supplies and sewage disposal are of a poor standard, and where personal and food hygiene standards are poor. Southern and Eastern Europe, Africa and parts of the Middle and Far East are high-risk areas.

Hepatitis A is passed from person to person by eating food or drinking water contaminated (infected) with the virus. The illness can spread easily within families and where people live closely together.
The virus is passed out in the bowel motions of an infected person, which is why it is important to wash your hands after going to the toilet. Drinking water can be contaminated with the virus.
Fruit, vegetables and uncooked food washed in contaminated water can cause infection, especially in hot countries. Shellfish can be infected if it comes from sea contaminated with sewage. Cooked food is safe, but can be contaminated if it has been handled by someone with the virus.
Infection is not very common in the UK. But the true number of people affected is unknown as people who only have mild symptoms may not go to a doctor.

DEPARTMENT OF HEALTH
www.dh.gov.uk

Hepatitis A
The hepatitis A virus is mainly transmitted from person to person, although it can also be transmitted through food or drink. The incubation period is about 15-40 days, and the symptoms are generally mild. A vaccine against the virus is recommended for people travelling to countries with moderate or high levels of hepatitis A.
Hepatitis A useful links
Websites containing information about Hepatitis A
British Liver Trust: Hepatitis A
Symptom, diagnosis, prevention and treatment information about Hepatitis A from the British Liver Trust.
British Liver Trust: Hepatitis A

Health Protection Agency: Hepatitis A
Epidemiological data and guidelines on Hepatitis A from the Health Protection Agency (HPA).
Health Protection Agency: Hepatitis A

Hepatitis A key documents
Hepatitis A publications for travellers and health professionals
Health Advice for Travellers
Every year, residents of the United Kingdom go on more than 56 million overseas journeys. Travel across the world is now so common that it is easy to forget the health risks which can be involved and the fact that very few countries offer such easy access to medical facilities as Britain. This area of the website contains advice for travellers about planning ahead, staying healthy and getting treatment elsewhere in the world. Also in this area is information about the E111, UK citizens' passport to free or reduced-cost emergency care in most other European countries.
Health Advice for Travellers

Health information for overseas travel
Published: 18/10/2001
Department of Health publication
Health information for overseas travel

HEPATITS B (HBV) ::

Overview from The British Liver Trust www.britishlivertrust.org.uk

The British Liver Trust site also provides sections on Symptoms, Diagnosis, Prevention, Treatment and More Information
Hepatitis means your liver becomes inflamed (swollen and tender). The most common cause is being infected with a virus.

An inflamed liver can also be caused by:
drinking too much alcohol
the side effects of some medicines and chemicals
a liver disease called autoimmune hepatitis where the body's immune system doesn't work properly and attacks the liver.

There are several different hepatitis viruses which affect the liver - the main ones are hepatitis A, B, C, D and E.

The viruses are different from each other in:
how they are passed from person to person
the way they cause liver damage
the effects they can have on health.

Hepatitis B, sometimes called hep B or HBV, is a liver disease caused by the hepatitis B virus. You can prevent illness by having a vaccination that will give you protection from the virus.
Hepatitis B is common in south-east Asia, the Middle and Far East, southern Europe and Africa. The World Health Organisation estimates that one third of the world's population has been infected at some time and that there are approximately 350 million people who are infected long term. In Europe, there are estimated to be one million people infected every year. In the UK, approximately 1 in 1000 people are thought to have the virus. In some inner-city areas, where there is a high percentage of people from parts of the world where the virus is common, as many as 1 in 50 pregnant women may be infected.

The virus is present in body fluids such as blood, saliva, semen and vaginal fluid. In the UK, Europe and North America, hepatitis B is mainly passed from person to person by having unprotected sex. In the rest of the world the most common way of getting infected is from infected mothers to their children, or from child to child.

Blood
A tiny amount of blood from someone who has the virus will pass on the infection if it gets into your bloodstream, e.g. through an open wound, cut or scratch, or from a contaminated needle.
People who use drugs and share any injecting equipment have a high risk of infection.
The virus can also be passed on from medical and dental treatment in countries where equipment is not sterilised properly.
All blood donations in the UK are tested for hepatitis B, but before testing was introduced it was possible to become infected by receiving blood or blood products from an infected person.
In countries where blood is not tested, blood transfusions may still be a cause of infection.

Sex
You can become infected by having unprotected sex (without a condom) with an infected person. Sexually active young adults have a high risk of getting hepatitis B.

Mother to baby
Infected mothers can pass the virus to their babies possibly during pregnancy, when giving birth or during breastfeeding. Since April 2000, all pregnant women in the UK are tested for hepatitis B. If they are infected, the baby is given a course of injections of antibodies called immunoglobulin and vaccinated immediately after birth.

Acupuncture, tattoos, body piercing
A few people have become infected by unsterile needles being used for ear and body piercing, acupuncture and tattooing. The best way to protect yourself is to ensure disposable needles are used and that they come straight out of a sterile packet.

Other body fluids
The virus may be present in other body fluids, such as saliva and vaginal fluid, particularly if it is contaminated with blood, which can pass on the infection.

People who are most at risk of being infected are:
injecting drug users
babies born to infected mothers
family members and partners of an infected person
healthcare workers who have direct contact with blood, e.g. doctors, dentists, nurses and midwives
people who live and work in accommodation for people with severe learning difficulties
prisoners
people travelling and working in countries where the virus is common
people who have unprotected sex (without a condom) with people who may be infected.
Hepatitis B can be very infectious. Some people pass on the virus more easily than others because they have more of the virus in their bloodstream.

DEPARTMENT OF HEALTH
www.dh.gov.uk

Health clearance for serious communicable diseases new health care workers draft guidance for consultation
Published: 02/01/2003
This consultation seeks views on draft guidance to implement a new health clearance policy for health care workers new to the NHS (England). The proposals follow recommendations made by an expert group set up to assess the potential health risks posed to patients from health care workers new to the NHS infected with serious communicable diseases, in particular HIV, hepatitis B, hepatitis C and tuberculosis.
Health clearance for serious communicable diseases new health care workers draft guidance for consultation

Getting ahead of the curve: a strategy for combating infectious diseases (including other aspects of health protection)
Published: 10/01/2002
This sets out an infectious diseases strategy for England. It aims to describe the scope of the threat posed by infectious diseases, as well as establishing the priorities for action to combat the threat.
Getting ahead of the curve: a strategy for combating infectious diseases (including other aspects of health protection)

Hepatitis B infected health care workers: guidance on implementation of Health Service Circular 2000/020
Published: 23/06/2000
This guidance is intended to assist in implementation of Health Service Circular (HSC) 2000/020 Hepatitis B Infected Health Care Workers.
Hepatitis B infected health care workers: guidance on implementation of Health Service Circular 2000/020

Protecting health care workers and patients from hepatitis B
Published: 18 August 1993
The new guidance recommends that carriers of the hepatitis B virus who are known to be e-antigen positive must not carry out procedures where there is a risk that injury to themselves will result in their blood contaminating a patient's open tissues. Such procedures are termed 'exposure prone procedures' and are described in paragraph 3.4 of the guidance.
Download Addendum To HSG(93)40: Protecting Health Care Workers And Patients From Hepatitis B- April 2004 (PDF, 39K)
Download Addendum To HSG(93)40: Protecting Health Care Workers And Patients From Hepatitis B- 26 September 1996 (PDF, 203K)
Download Health Service Guidelines - HSG(93)40 (PDF, 32K)
Download Protecting health care workers and patients from hepatitis B - Olive Book (PDF, 87K)

Information for midwives: hepatitis B testing in pregnancy
Published: 01/01/2000
Department of Health publication
Information for midwives: hepatitis B testing in pregnancy

Hepatitis B how to protect your baby (2002)
Published: 2002
This document outlines what hepatitis B is and how it can affect babies.
Hepatitis B how to protect your baby (2002)

Screening for infectious diseases in pregnancy: Standards to support the UK antenatal screening programme
Published: 11/08/2003
These generic and disease-specific standards cover screening for rubella antibody, syphilis, HIV and hepatitis B, the four infections currently included in the UK antenatal-screening programme.
Screening for infectious diseases in pregnancy: Standards to support the UK antenatal screening programme

Hepatitis B immunisation of homosexual and bisexual men attending GUM clinics: provision of extra vaccine
Published: 20/06/2002
The Department of Health is providing centrally purchased hepatitis B vaccine to Genito Urinary Medicine (GUM) clinics in 2002/2003-2004/2005 as part of implementation of the sexual health and HIV strategy. The strategy proposes improving the uptake of hepatitis B immunisation by homosexual and bisexual men attending GUM clinics. The letter announces vaccine distribution details.
Hepatitis B immunisation of homosexual and bisexual men attending GUM clinics: provision of extra vaccine
Health clearance for serious communicable diseases new health care workers draft guidance for consultation

Published: 02/01/2003
This consultation seeks views on draft guidance to implement a new health clearance policy for health care workers new to the NHS (England). The proposals follow recommendations made by an expert group set up to assess the potential health risks posed to patients from health care workers new to the NHS infected with serious communicable diseases, in particular HIV, hepatitis B, hepatitis C and tuberculosis.
Health clearance for serious communicable diseases new health care workers draft guidance for consultation

Guidance for clinical health care workers: protection against infection with blood-borne viruses
Published: 15/4/1998
This booklet contains guidance on measures to protect clinical health care workers (HCWs) against occupational infection with blood-borne viruses (BBVs). It is based on the recommendations of the Expert Advisory Group on AIDS and the Advisory Group on Hepatitis. It draws also on work done by the Advisory Committee on Dangerous Pathogens and the Microbiology Advisory Committee.
Guidance for clinical health care workers: protection against infection with blood-borne viruses

Prevalence of HIV and hepatitis infections in the United Kingdom 2000 annual report of the unlinked anonymous prevalence monitoring programme
Prevalence of HIV and hepatitis infections in the United Kingdom 2000 annual report of the unlinked anonymous prevalence monitoring programme
Download Prevalence of HIV and hepatitis infections in the United Kingdom 2000 annual report of the unlinked anonymous prevalence monitoring programme (PDF, 282K)

Good practice guidelines for renal dialysis/transplantation units: prevention and control of blood-borne virus infection
Published: 03/09/2002
This guidance contains recommendations of the working group convened by the Public Health Laboratory Service on behalf of the Department of Health. It applies primarily to renal haemodialysis units but aspects will also apply to other units.
Good practice guidelines for renal dialysis/transplantation units: prevention and control of blood-borne virus infection

Green book
The Green Book is a publicly available document on immunisation against infectious disease, which charts the history of immunisation and immunisation advice over the years since this kind of preventative treatment was first used in 1786. This edition was published in 1996, the bicentennial year of Edward Jenner's world-changing discovery.
Green book
Download Chapter 18 - Hepatitis B (PDF, 69K

HEPATITIS C (HCV) ::

Overview from The British Liver Trust www.britishlivertrust.org.uk

The British Liver Trust site also provides sections on Symptoms, Diagnosis, Prevention, Treatment and More Information

Hepatitis means inflammation of the liver. The commonest cause is infection with a virus, but inflammation can be caused by drinking too much alcohol, the side effects of some drugs and chemicals, and a liver disease called autoimmune hepatitis, in which the body's immune system malfunctions and attacks the liver. There are several different viruses that affect the liver, primarily hepatitis A, B, C, D and E. The main difference between the viruses is how they are spread, the way they cause liver damage and the effects they can have on your health.
Hepatitis C, sometimes referred to as hep C or HCV, is a liver disease caused by the hepatitis C virus.
Hepatitis C is passed on by:

Contact with blood
A tiny amount of blood - too small to be visible to the naked eye - from someone who has the virus, will transmit the infection if it gets into someone else's bloodstream, for example, through an open wound, cut or scratch.
Blood donations in the United Kingdom have been screened for hepatitis C since September 1991. Some people who received blood or blood products before then may be infected, e.g. haemophiliacs (and pregnant women who received anti D as a treatment for rhesus incompatibility in the Republic of Ireland).
Blood and blood products may not be screened for the virus in some overseas countries.
Sex
Sexual transmission of hepatitis C is thought to be unusual, but probably does occasionally occur. Doctors are unsure whether the infection that occurs between partners is because of sexual exposure or because of other reasons, for example, sharing a personal item such as a toothbrush or razor.
People with more than one sexual partner are advised to use condoms, as there is some evidence that those with many sexual partners have an increased risk of being infected. Condoms may reduce the risk of infection, and all other sexually transmitted infections.
Naturally, couples are often worried about infecting each other, but when one partner is positive and the other negative after many years, it seems reasonable to advise that it is unnecessary to change to using condoms for protection.
Penetrative sex during a period is best avoided when a woman is hepatitis C positive.
Normal social contact
Infection is not acquired through normal social contact, for example, from a cup or by touching an infected person. However, it is a sensible precaution if you are HCV positive to use your own personal items such as a nailbrush, scissors or razor and to be meticulous about cleaning up any blood, for example from cuts or scratches. Undiluted household bleach should be used to clean up blood from floors and work surfaces. Scratches, cuts and wounds should be carefully cleaned and covered with a waterproof dressing or plaster.
Injecting drug use
Current evidence suggests that 50% - 80% of past and present users may be infected with hepatitis C. They become infected by sharing any equipment used in the process of injecting because it is likely to have invisible contamination with blood. Only one occasion of sharing injecting equipment is needed to be exposed to the virus - and that may have been years previously. An increasing number of people who injected a few times many years ago, are now being diagnosed as having hepatitis C.
Recently there has been some concern about sharing straws for snorting cocaine because the practice may be a route of infection through nosebleeds.
For more information on injecting drug use, please ask for a copy of our booklet Injecting Drug Use and Hepatitis C.
Acupuncture, tattoos, body piercing
A few people have become infected by unsterile needles being used for ear and body piercing, acupuncture and tattooing. The best way to protect yourself is to ensure disposable needles are used and that they come straight out of a sterile packet.
Saliva
The virus has been detected in saliva, but it is unlikely that it can be transmitted by kissing. It is advisable to reduce the possibility of infection by not using someone else's toothbrush and by maintaining good oral hygiene.
Mother to baby
The risk of a mother with hepatitis C infecting her baby during pregnancy or during the birth is about 6%. When it does occur, it is not known whether this is in the womb, during delivery or immediately after the birth, but it is not during conception.
Babies are sometimes found to have antibodies to the virus, but these usually disappear by the time the baby is 12 to 18 months old, which shows that the antibodies are acquired from the mother and that the baby has never been infected with the virus. Since the usual test is for antibodies, it may not be possible to determine if a baby is infected until it is over a year old, but there is a test for the virus itself (“PCR test”) that may detect it in the first few months. Doctors do not yet know if the disease that occurs when a baby is infected will go on to become serious in all cases.
Infected mothers are often concerned about passing the virus on to their other children. As long as all the precautions listed below are taken, household transmission is a low risk. Kissing and cuddling a child is safe.
Breastfeeding
Most doctors consider breastfeeding to be safe if the mother has no symptoms. In theory infection could be possible if a mother has cracked nipples that bleed and the baby has a cut in the mouth.
Unknown
In some cases doctors don't know how people became infected.

DEPARTMENT OF HEALTH
www.dh.gov.uk

The Hepatitis C Strategy proposes developing professional and public awareness of hepatitis C and strengthening services for its prevention, diagnosis and treatment.

Hepatitis C: Action Plan for England
Hepatitis C essential information for professionals briefing paper
Hepatitis C infected health care workers
Hepatitis C strategy for England
Hepatitis C: guidance for those working with drug users
Guidance for clinical health care workers: protection against infection with blood-borne viruses
Download Hepatitis C: Sexual Health Fact Sheet (PDF, 55K)

HEALTH PROTECTION AGENCY
www.hpa.org.uk

Hepatitis C: Information and Guidance in the Occupational Setting

What is it?

Hepatitis C is a bloodborne virus which causes inflammation of the liver. Many people who are infected have no symptoms and are unaware that they are carrying the virus. Chronic infection is defined as infection lasting longer than six months and up to 80% of infected people do go on to chronic infection. People with chronic hepatitis C infection are at long term risk of developing cirrhosis and liver cancer. There is no vaccine available to prevent hepatitis C infection.

For further information on hepatitis C please click here.

Specific to injury and follow up
Guidance on the investigation and management of occupational exposure to hepatitis C (inflammation of the liver caused by a viral infection). Commun Dis Public Health 1999; 2 :258-62

Specific occupational health guidelines

Hepatitis C infected care workers Health Service Circular, HSC 2002/010, Department of Health
Hepatitis C infected healthcare workers, Department of Health

Health clearance for serious communicable disease:
New healthcare workers. London:
Department of Health, January 2003 (Draft guidance for consultation)

DEPARTMENT OF SOCIAL SCIENCE AND MEDICINE, DIVISION OF PRIMARY CARE AND POPULATION HEALTH SCIENCES, IMPERIAL COLLEGE

The Executive Summaries series provided professionals in the substance use field with up-to-date, relevant, and timely scientific reviews for over 9½ years. The series ran since December 1990 until June 2000. Whilst the series is no longer published, a full and free archive of all back issues is available by following the links below.

Executive Summary
69. Management of Chronic Hepatitis C
Graham Foster, and Janice Main (2000), Department of Medicine, Imperial College School of Medicine

Executive Summary
50. Hepatitis C among injecting drug users
Adrian Renton and Janice Main (1996), St Mary's Hospital Medical School

HEPATITS D (HDV) ::

Overview from The British Liver Trust www.britishlivertrust.org.uk

The British Liver Trust site also provides sections on Symptoms, Diagnosis, Prevention, Treatment and More Information

Hepatitis D virus (HDV) requires the presence of Hepatitis B virus (HBV) to reproduce it. You can acquire Hepatitis D infection at the same time as you are infected with Hepatitis B, this is called co-infection.
Infection may also occur if you already have chronic Hepatitis B and it has not cleared from your body, this is called super-infection.
The combination of Hepatitis D and Hepatitis B can be more serious than Hepatitis B alone and is more likely to cause chronic hepatitis and cirrhosis .
Hepatitis D is seen mainly in Central Africa, the Middle East and central South America. Low rates of infection are present in most of Europe, the United States and Australia.
Hepatitis D is spread through anyone coming into contact with infected blood, contaminated needles or by having unprotected sex with a Hepatitis D infected person. The risk factors are similar to those for Hepatitis B infection.
The symptoms of Hepatitis D infection are similar to Hepatitis B infection, many people who are infected have no symptoms and others have flu-like symptoms or even jaundice (yellowing of the skin and whites of the eyes). The virus has an incubation period of between 3 and 12 weeks, it is diagnosed by an antibody blood test.
There is no vaccine for Hepatitis D, however vaccination against Hepatitis B will prevent Hepatitis D infection. Those people with Hepatitis B cannot prevent infection with Hepatitis D.
Currently Interferon alpha is used to treat patients with chronic Hepatitis B who also have Hepatitis D infection.

HIV (Human Immuno-deficiency Virus)::

HIV (Human Immuno-deficiency Virus) ::

Summary from the Health Protection Agency
www.hpa.org

HIV (Human Immuno-deficiency Virus) is the infection which through progressive destruction of specific immune cells (CD4 cells) leads to AIDS. Opportunistic infections, specific malignancies, HIV wasting or HIV encephalopthy are part of a complex case definition which comprise the Acquired Immuno Deficiency Syndrome. HIV is a sexually transmitted and bloodborne virus (BBV). This means it can be transmitted by unprotected sexual intercourse or by routes similar to other BBVs i.e. shared needle use by injecting drug users, needlestick injuries in healthcare workers, or mother to child transmission before, during or after (via breast milk form an infected mother to her child) the birth of the child. In countries which can afford anti-retroviral therapies the progression to AIDS is not inevitable and the patterns of survival have been fundamentally changed by these drugs. However, there is currently no cure and patients need to continue on therapy. There is currently no effective vaccine although much research is going on to seek to develop one.

HEALTH PROTECTION AGENCY

www.hpa.org.uk

Renewing the focus -
HIV and other sexually transmitted infections in the United Kingdom in 2002,
Annual Report, November 2003

Other recent publications of interest

DEPARTMENT OF SOCIAL SCIENCE AND MEDICINE, DIVISION OF PRIMARY CARE AND POPULATION HEALTH SCIENCES, IMPERIAL COLLEGE

The Executive Summaries series provided professionals in the substance use field with up-to-date, relevant, and timely scientific reviews for over 9½ years. The series ran since December 1990 until June 2000. Whilst the series is no longer published, a full and free archive of all back issues is available by following the links below.

Executive Summaries:

52. Has the UK averted an epidemic of HIV-1 among drug injectors?
Gerry Stimson (1996), The Centre for Research on Drugs and Health Behaviour

49. HIV-related cognitive impairment
Jose Catalan and Adrian Burgess (1996), Chelsea and Westminster Hospital

6. Prisons, HIV and AIDS
5. Trends in HIV infection among drug injectors in London
3. The Community Pharmacist and HIV/AIDS reduction strategies
2. Outreach work as a community-based initiative aimed at reducing the spread of HIV infection
1. Research on behavioural change by drug users with regard to HIV infection
28. Drug users, HIV/AIDS and the criminal justice system 1: an introduction
33. Estimates of HIV prevalence and rates of HIV testing among drug injectors in London
32. Health-related quality of life evaluation in HIV infection
30. HIV outreach: a glossary of keywords
29. AIDS and Drug Misuse - update, by the Advisory Council on the Misuse of Drugs
28. Drug users, HIV/AIDS and the criminal justice system 1: an introduction

GENERAL ::

HEALTH PROTECTION AGENCY

www.hpa.org.uk

The Chief Medical Officer for Health, Sir Liam Donaldson, announced the need for the Health Protection Agency in his report Getting Ahead of the Curve published in January 2002. This recognised the need to bring together the skills and expertise in a number of organisations to work in a more co-ordinated way, to reduce the burden and consequences of health protection threats or disease. This would provide a more comprehensive and effective response to threats to the public's health. The Health Protection Agency's role involves:

• Advising government on public health protection policies and programmes

• Delivering services and supporting the NHS and other agencies to protect people from infectious diseases, poisons, chemical and radiological hazards

• Providing an impartial and authoritative source of information and advice to professionals and the public

• Responding to new threats to public health

• Providing a rapid response to health protection emergencies, including the deliberate release of biological, chemical, poison or radioactive substances

• Improving knowledge of health protection, through research, development, and education and training

Bloodborne Viruses (BBVs) and Occupational Exposure

Many organisms are potentially transmissible in the occupational setting via percutaneous (sharp) or mucocutaneous (mucous membrane/broken skin) routes. Definition - Healthcare worker and EPPs

Information and guidance for the occupational setting on the three most recognised bloodborne viruses in the United Kingdom are available below:

The main bloodborne viruses in the UK

Hepatitis B
Hepatitis C
HIV

Related topics

Healthcare associated infections
Injecting drug users
Tuberculosis

Main Menu

General information and advice
Epidemiological Data
Guidelines

Updates

Examples of good and bad practice to avoid sharps injuries
Surveillance report
Downloadable poster for sharp injuries first aid
Reporting of occupational exposure to bloodborne viruses - history and how to report
Transmission

Laboratory Services:

Go to Bloodborne Viruses Unit for the Hepatitis Reference Laboratory
Go to the Sexually Transmitted Viruses Unit for the HIV Reference Laboratory
Publications
Contacts

Preventing infection in the occupational setting

General prevention

Good practice guidelines for renal dialysis/transplantation, Department of Health

Guidance for clinical healthcare workers:
protection against infection with bloodborne viruses. London:
Department of Health, March 1998

Standard principles for preventing hospital-acquired infections.
J of Hospl Infect . 2001 47 (Supple ment): S21-37

Specific to procedure

• Wear protective gloves and face mask
• Cover cuts and wounds with a waterproof dressing
• Never re-sheath needles
• Use disposable sterile needles
• Ensure all equipment is appropriately sterilised
• Wash your hands after any incident involving blood

For further details - Guidance for clinical healthcare workers: protection against infection with bloodborne viruses. Department of Health. March 1998

The Control of Substances Hazardous to Health Regulations 1994 (COSHH) requires both employers and employees to take responsibility to avoid any risk where possible e.g. safe handling and disposal of sharps and the use of personal protective equipment (gloves, face visors) to minimise exposure to blood or body fluids. Employees are governed under COSHH to perform their own assessment of risk and to implement necessary measures to protect both themselves and others.

IV USERS ::

HEALTH PROTECTION AGENCY

www.hpa.org.uk

Injecting drug users

Injecting Drug Users are vulnerable to a diverse range of infectious and communicable diseases, including HIV, wound botulism, and hepatitis C, which can result in considerable morbidity and mortality. The surveillance of communicable diseases, and the associated risk and protective behaviours, among this group are important public health functions.

In addition to laboratory and clinician reports there are also data on the prevalences of hepatitis C, hepatitis B, and HIV from Unlinked Anonymous Prevalence Monitoring Programme Survey of HIV and Hepatitis in Injecting Drug Users. This large ongoing multi-site survey is a collaboration with over 50 specialist agencies that work with injecting drug users throughout England and Wales. In addition to monitoring prevalence this survey collects information on risk/protective behaviours and healthcare utilisation.

Bloodborne viruses

Hepatitis C
Hepatitis B
Hepatitis A
HIV

Unlinked Anonymous Prevalence Monitoring Programme

Other infections

Botulism
Tetanus
Severe systemic sepsis
Staphylococcus aureus
Group A Streptococcal infections

Risk and protective behaviour

Unlinked Anonymous Prevalence Monitoring Programme
Behavioural Surveillance

Prisons

Prison surveillance

Links

Relevant organisations

Publications

Shooting Up - infections among injecting drug users in the United Kingdom

Shooting Up - Infections among injecting drug users in the United Kingdom 2003, An update: October 2004

Key Points from the report

• Overall more than two in five injecting drug users (IDUs) have been infected with hepatitis C, and the incidence among recent initiates in both Glasgow and London has been estimated to be high. In England and Wales hepatitis C transmission among IDUs may have increased recently, with one in six of those who had started to inject since the beginning of 2001 having become infected.

• There had been around 60,000 reported laboratory diagnoses of hepatitis C in the United Kingdom (UK) by the end of 2003. The majority of these reports are associated with injecting drug use. Although uptake of testing for hepatitis C among IDUs has increased in recent years it is estimated that around half of IDUs with hepatitis C still remain unaware of their infection.

• In recent years there has been a growing problem with injecting site infections associated with methicillin resistant Staphylococcus aureus and severe group A streptococcal infection among IDUs.

• The recent outbreak of tetanus and the continuing occurrence of other clostridia infections among IDUs, such as wound botulism, indicate that environmental contamination of heroin, with the spores from these bacteria, remains a problem.

• Transmission of both hepatitis A and B continues among IDUs even though there are effective vaccines. Although the proportion of IDUs vaccinated against hepatitis B has increased in recent years many still remain unvaccinated. In Scotland the rise vaccine uptake has followed the implementation of universal vaccination to all prisoners in Scotland.

• Overall HIV infection remains rare among IDUs in the UK, however there is evidence of ongoing and possibly increased transmission. The prevalence of HIV among IDUs has remained substantially higher in London than the rest of the country.

• Needle and syringe sharing increased in the late 1990s, and since then has been stable with around one in three IDUs reporting this activity in the last month. The sharing of other injecting equipment is more common, whilst few IDUs wash their hands or swab injecting sites prior to injecting.

Shooting Up - Infections among injecting drug users in the United Kingdom 2003,
An update: October 2004 ( 456 KB)

Shooting Up - Infections among injecting drug users in the United Kingdom 2002,
An update: December 2003 ( 230 KB

Daily Dose and Weekly Dose (Wired) offers daily collections and a large resource of Archive material

www.drugscope.org.uk