Dáil Éireann debate -
Thursday, 4 Jun 1998

Vol. 491 No. 7

Adjournment Debate. - Hepatitis A Incidence.

Mr. Flanagan

I am grateful for the opportunity to raise this matter and I thank the Minister of State for coming to reply.

There has been a considerable increase in the incidence of hepatitis A, particularly among school children. In 1996-97 reported cases increased by 400 per cent compared to the previous two years and in the past 12 months schools in Wicklow, Carlow, Kerry and Laois have reported outbreaks of the virus. Hepatitis A is a highly infectious viral disease which generally causes jaundice and, as its severity increases with age, when adults are exposed to it, more serious illness can result.

I am concerned at the lack of a co-ordinated Government policy or health board approach to this matter. The role of health boards should be co-ordinated to provide positive information directed at parents, teachers and others concerned. I understand efforts to stem an outbreak of hepatitis A in certain parts of the country were hampered because of fears among the general public of contracting a blood disease. People have been reluctant to take the human immunoglobulin because of the hepatitis C controversy.

Evidence has shown that in recent times the virus is most commonly associated with schools and centres of child care activity. We need to protect those most at risk, namely, teachers and child care professionals because of the link between the severity of the symptoms and age. Adequate control measures, with particular reference to the use of immunoglobulin as opposed to the hepatitis A vaccine, are not in place. In other countries administration of immunoglobulin is standard, but I do not believe that is the case here. Will the Minister of State clarify the position in that regard?

I acknowledge that hepatitis A is relatively common. Consequently, it is important that all health boards adopt the same plan of action to address the problem. At a minimum, we should issue leaflets to parents and those who live in towns surrounding affected schools, there should be proper consultation by way of meetings with parents and their representatives, public health and health board officials should visit schools and a programme promoting proper hygiene in schools should be devised.

How many teachers have been infected because of the increased incidence in recent years? What actions were taken when the virus reference laboratory reported the significant increase in hepatitis A? Will the Minister of State spearhead a national co-ordinated standard policy on the basis that we must stem the increase and ensure precautionary measures are taken by the State authority in all cases?

Minister of State at the Department of Health and Children (Mr. Fahey)

I am pleased to have an opportunity to set out the position on this matter. Hepatitis A is a notifiable disease under the Infectious Diseases Regulations and 365 cases were notified by health boards to my Department for the period from 1 May 1997 to 31 April 1998. Under the regulations general practitioners are required to notify their local director of community care or medical officer of health of all cases of hepatitis A.

Those officers in turn notify the Department on a weekly basis of the number of cases occurring in their areas. It is not possible to indicate the number of cases linked to schools as the information is not collected in that format. However, I am aware there has been an increase in the number of cases reported by the Eastern and Midland Health Boards since January 1998 and I am advised by the boards that the majority of cases occurred in children of school-going age. Control of infectious diseases is the statutory responsibility of the relevant health board and the boards advise that the full range of appropriate measures were employed in each case. In particular, advice on personal hygiene was provided and, where necessary, immunisation and immunoglobulin were provided.

Immunoglobulin may be offered to those who have had household family contact or to classroom contacts if there is evidence that transmission was through a school. The hepatitis A vaccine is available and may be used in the case of ongoing outbreaks and to immunise those who may be at particular risk of contracting the virus. My Department's policy on this issue is guided by the advice of the Immunisation Advisory Committee, an expert group established by the Royal College of Physicians of Ireland. These guidelines provide information on the use of hepatitis A vaccine and other preventative agents in outbreaks, including those linked to schools to prevent the transmission of the hepatitis A virus.

The health promotion unit of my Department also produces a guide entitled "Infection in School — A Manual for School Personnel" which was circulated to schools. The manual provides information on all infectious diseases, including hepatitis A, and on the course of action to be taken if pupils contract infectious diseases. Copies are available to schools through the health promotion unit.