HD37 - Hepatitis B Immunization Requirements for Selected Public Health, Public Safety and Emergency Services Personnel
Executive Summary: Hepatitis B is a viral infection. One of the prime modes for acquisition of the disease is exposure to blood contaminated with hepatitis B. Therefore, emergency response personnel (those involved in emergency medical services, fire service or law enforcement) who are constantly at risk for exposure to blood are at risk for the disease. A vaccine for the prevention of hepatitis B was licensed in 1982. It is an excellent vaccine and experience over the past eight years has clearly demonstrated its safety. Nevertheless, for various reasons there has been a lack of eagerness among emergency response personnel to take advantage of the vaccine. Among the reasons for this are the relatively high cost of the vaccine and unfamiliarity with the decease. While most persons who get hepatitis B recover completely, about 6% become chronic carriers, i.e., they "carry" hepatitis B virus particles in their blood indefinitely. The carrier state can lead to chronic active hepatitis and hepatic cancer. It is clear from the foregoing that emergency response personnel are unwittingly risking their health, and in a few instances even their lives. It is therefore essential that hepatitis B vaccine be offered to these dedicated individuals who unselfishly serve the public. Hepatitis B is just one of the blood-borne diseases that emergency response personnel are at risk of acquiring. Therefore, this issue must be approached from a broader standpoint of infection control in general. Education is the most powerful resource we have to inform emergency response personnel about infectious diseases and their personal protection. As a result of this study, the Division of Emergency Medical Services (EMS) has compiled and will distribute to all emergency response agencies a "Communicable Disease Primer" to educate and to be used as a resource guide. The Division of EMS has also scheduled a broadcast on infection control through the Virginia Emergency Medical Services Satellite (EMSAT) program. This broadcast will be viewed in May of 1991 by numerous emergency response agencies across the state as part of their continuing education. The next logical step after education is prevention. Survey results show that 47% of the emergency response agencies (of those responding) in Virginia have not been vaccinated against hepatitis B. The major reason cited for this is the high cost of the three-shot series of vaccinations required for full protection. Costs range from $120 to $200 per person. For most volunteer agencies in particular, this amount is not feasible without some kind of assistance. Recommendations The following are the Study Team's recommendations for educating, training and protecting public health and emergency response personnel: Recommendation 1 The Secretaries of Health and Human Resources and Public Safety will jointly appoint an Interagency Coordinating Committee on Infection Control for Emergency Response Agencies, hereafter referred to as the Interagency Coordinating Committee, with state and local representation. The purposes of the committee will be to assist with and monitor the progress on the following recommendations, to coordinate multi-disciplinary training on infection control, and to address other infection control issues within the public safety community. Recommendation 2 The Virginia Department of Health, in coordination with other appropriate state agencies, will notify all emergency response agencies in the Commonwealth that emergency response personnel should be offered immunization against vaccine-preventable diseases according to the Guidelines of the Immunization Practices Advisory Committee of the U.S. Public Health Services and that all such personnel should be educated in the use of universal precautions as specified by the Centers for Disease Control (CDC). Recommendation 3 Although Virginia Occupational Safety and Health (VOSH) Regulations do not specifically require volunteers to be covered under the immunization mandates, the Virginia Department of Health will advise local units of government and applicable emergency response agencies of the critical need to offer hepatitis B vaccine to all volunteer emergency response personnel because of their high risk for infection. Recommendation 4 The Virginia Department of Health, in cooperation with other appropriate state agencies, will make available to all emergency response agencies in the Commonwealth copies of the infection control guidelines and protocols. Recommendation 5 The Interagency Coordinating Committee will explore funding (public or private) for and assist in the implementation, support and dissemination of a model infection control program for emergency response agencies, including at a minimum the following elements: a. personnel protective equipment b. post-exposure management c. reporting and tracking of occupational exposures d. proper equipment and facility design e. other requirements of applicable Federal or State regulations Recommendation 6 The applicable regulations of the various state agencies will be amended, where necessary, to address the need for infection control information to be included in all applicable training courses for emergency response personnel (e.g., Emergency Medical Technician Training, Paramedic Training, Basic Law Enforcement Training) at the time of course development and/or revision. Recommendation 7 The Interagency Coordinating Committee will explore possible funding sources for the creation of a special matching grant program to assist localities and emergency response agencies in providing hepatitis B immunization for at-risk personnel, with special emphasis given to personnel in the volunteer sector, who may not otherwise have the resources to pay the full cost of the vaccine. The Committee will also explore funding from public or private sources to assure availability of on-going training to heighten the awareness of public health and emergency response personnel regarding infection control. The Committee will report related findings and recommendations to the Secretaries of Health and Human Resources and Public Safety. Recommendation 8 A. The Secretary of Administration and local governments, where applicable, should determine the cost of adding coverage of hepatitis B immunization to basic employee benefits under health insurance programs for employees at risk of infection due to the nature of their work and should consider including this benefit in contracts with health insurance providers. B. The Virginia Department of Health, in coordination with the Secretary of Administration and the Secretary of Health and Human Resources, will educate HMO's and other health insurance providers as to the degree of risk of hepatitis B infection for certain public health and emergency response personnel and the cost-effectiveness of preventive immunization. Recommendation 9 The Secretaries of Health and Human Resources and Public Safety will assure that information contained in this Report is shared with appropriate state agencies and organizations, primarily statewide organizations, through formal presentations by members of the Study Team or the Interagency Coordinating Committee. |
Menu
Published Documents
