Vol. 481 No. 3
1 Mr. Shatter asked the Minister for Health and Children the steps, if any, he will take to implement the World Health Organisation directive that all children be vaccinated against hepatitis B by means of universal mass vaccination and that such a vaccination programme be initiated by the end of 1997; and his views on whether hepatitis B is globally second only to tobacco smoking as a cause of cancer deaths. [15970/97]
There is no obligation in Ireland to introduce hepatitis B vaccine into the primary childhood immunisation programme. While the WHO has issued recommendations on hepatitis B immunisation, a number of northern European countries, including Ireland, where the incidence of hepatitis B is low, do not have plans to introduce this vaccine into their schedule at present. Hepatitis B vaccine is available to all high risk categories, as recommended by the WHO.
Earlier this year, my Department identified a number of issues in relation to vaccination which required examination in the light of developments. These included the question of whether there should be routine hepatitis B vaccination for either infants or adolescents. In July 1997 the chief medical officer requested the Royal College of Physicians to re-establish the National Immunisation Committee to review and, where necessary, update the recommendations in its document "Immunisation Guidelines for Ireland" produced in 1996. The committee is expected to reconvene shortly.
Hepatitis B is globally a very important cause of morbidity and mortality, especially in the Asian and African regions. This is not the case in Europe, where the disease is much less prevalent. Tobacco smoking is considered to be the major risk factor for preventable mortality in Europe. In Ireland, more than 6,000 deaths each year, both from cancer and other diseases, are directly attributable to smoking.
Is the Minister aware that Dr. Gary Courtney, a consultant gastroenterologist in St. Luke's in Kilkenny, has said that complacency about the spread of hepatitis B is resulting in its increased incidence in Ireland? Is he aware there are more than 3,000,000 carriers of hepatitis B worldwide? Will he acknowledge that, with greater international mobility, it is inevitable there will be an annual increasing incidence of hepatitis B and, therefore, it is in the interests of the health of our population that we seriously examine the introduction of a mass vaccination programme?
I acknowledge what Deputy Shatter said about increased mobility in the modern world, but we are advised on these matters by the National Immunisation Committee, chaired by the former president of the Royal College of Physicians, Professor Stephen Doyle. It is a multidisciplinary committee, the recommendations of which have been well received generally and have informed the national policy in this area.
The production of guidelines last October was the culmination of approximately two and a half years' work. The area of vaccination and immunisation is a fast moving one, both in terms of scientific developments relating to vaccines and the changing epidemiological picture in respect of a number of vaccine preventable diseases. Therefore, a number of recent developments have, in the view of the chief medical officer of the Department, implications for our vaccination policy and require further review.
Far from being complacent, the chief medical officer of the Department has asked the National Immunisation Committee to meet and to further review a number of developments, for example, in relation to the question of polio immunisation which needs to be reviewed in the context of the possible elimination of the wild virus from Europe over the next few years, and the continuation of the diphtheria epidemic in Eastern Europe.
The question raised by Deputy Shatter of routine hepatitis B vaccination for infants or adolescents needs to be looked at again in the light of developments in this area. The direct response to the Deputy is that, in view of these recent developments, the National Immunisation Committee will consider the matters in relation to hepatitis B, in addition to the other matters I outlined.
The committee needs to urgently look at this matter, particularly in the context of young people and adolescents. Is the Minister aware that Dr. Deirdre Kelly, who is a director of the liver unit at the Birmingham Children's
Hospital, said at a recent conference in Dublin that selective vaccinations of high risk groups had effectively failed as a strategy? Is he aware she stated that high risk people may not be recognised in time as they are often reluctant to be identified, and there is no effective means of delivering vaccines to these groups? There are inherent dangers in our delaying re-examining this issue in the context of the experiences of some other European countries in which, as I understand it, the possibility of mass vaccination is being reopened for consideration.
As I said earlier, it is not a question of delay. The guidelines were finally drawn up in 1996 after two and a half year's work. In July 1997 the chief medical officer took up the issue the Deputy raised today, among other matters relating to vaccination policy, and asked the National Immunisation Committee to advise us on this matter. The chief medical officer has suggested the committee remains in existence as a standing committee to advise on vaccination policy issues in the future, so that there will be continuing monitoring of these issues. I hope it will advise us as quickly as possible.
Is the Minister saying the World Health Organisation's view on the need for mass vaccination is wrong?
No. The WHO position on vaccination against hepatitis B is outlined in the 1992 document, "Expanded Programme of Immunisation", which states:
Hepatitis B vaccines should be integrated into national immunisation programmes in all countries with a hepatitis B carrier prevalence of 8 per cent or greater by 1995, and in all countries by 1997. Target groups and strategies may vary with the local epidemiology. When carrier prevalence is 2 per cent greater, the most effective strategy is incorporation into the routine infant immunisation schedules. Countries with lower prevalence may consider immunisation of all adolescents as an addition or alternative to infant immunisation.
According to the WHO, the high risk groups consist of some groups of health personnel, patients on haemo-dialysis, haemophiliacs or recipients of blood products, clients in the psychiatric and mental handicap services, prison inmates and injectable drug users. The WHO has recommended that in areas where there is a low prevalence of hepatitis B, the vaccine should be made available to sections of the population which run a high risk of infection.
Given the fact that, while the presence of hepatitis B in Ireland is small, it is generally accepted that health care workers are at particular risk, the Department, as far back as 1988, wrote to all health agencies in which it was considered staff were at risk of infection and offered free vaccination to staff deemed by management to be at risk. Following the 1996 guidelines, the Department wrote again in June 1997 to health boards and voluntary agencies, drawing their attention to the most up to date advice and stressing the importance of vaccination for "at risk" health care staff and clients.
It is clearly the case that we are vigilant in this matter. It is untrue to say that the WHO is against simply providing immunisation for only high risk groups — it is very much dependent on the prevalence of the virus in the home community. We are taking what are regarded as prudent and adequate steps, given the current level of prevalence. In view of developments, some of which were mentioned by the Deputy, we are ensuring the National Immunisation Committee looks at this matter and provides us with its expert advice.
