I raise this matter because it was recently brought to my attention that we have not implemented a World Health Organisation recommendation to introduce a universal hepatitis B vaccination programme for infants. Currently, we have a policy of selective vaccination but most countries recognise that this policy has little effect in containing the spread of infection.
Perhaps I should put hepatitis B in perspective by giving a few facts that I have uncovered in relation to the virus. First, the WHO estimates that hepatitis B is responsible for more than one million deaths per year worldwide. Second, the best informed estimates say that hepatitis B is one hundred times more contagious than HIV. Third, between 5 per cent and 10 per cent of adults infected with hepatitis B will become carriers of infection without knowing it. Carriers show no symptoms of the disease and can pass it on to many other more vulnerable individuals who could show symptoms and contract the disease. Fourth, a carrier could be someone who could carry the disease in their blood for many years, not feel any adverse effects and yet infect those in contact with him or her. They can also go on to develop serious liver disease in later life and many may die.
I accept Ireland is considered low risk because we have a relatively low incidence of hepatitis B, or at least as far as we know. This may have made us complacent about the disease. There were 663 new cases of hepatitis B between 1988 and 1993. The cause of transmission in 34 per cent of the cases was unknown. In 8 per cent of cases it was caused by drug addiction and activities such as needle sharing. In 15 per cent of cases it was sexually transmitted and in 5 per cent it was passed from mothers to new born babies.
There has also been a huge increase in the number of Irish people working and travelling abroad. People working abroad now have easier and cheaper access to commute home more regularly. Generally, these situations abroad are not covered by any vaccination programme, yet many people are entering high risk areas, such as the southern and eastern Mediterranean. As I understand it, a selection vaccination programme means that health care workers receive 85 per cent of the vaccine, and I understand the need to vaccinate health care workers. However, they only account for 5 per cent of hepatitis B infection.
In the United States health professionals believe the true incidence of hepatitis B infections is dramatically underestimated and I worry about possible underestimation in this country as well. They believe it is underestimated because the disease is under-reported, especially among ethnic groups, and many infants can have the disease in early stages but not yet show any serious symptoms. In Ireland health professionals believe that we, too, underestimate the true incidence of the virus and the carrier pool because we only screen high risk groups, which misses infections and carriers in low risk groups, and individuals in high risk groups can often be missed as they are less likely to be aware of the risks and may not present for testing. It is also worth noting that research in America has shown that infants infected with hepatitis B are at a disproportionate risk of developing major complications, including chronic hepatitis with sclerosis and liver failure.
To reduce the risk of contracting hepatitis B there appears to be two choices. First, we can try to avoid close contact with high risk groups or with people in close contact with these groups, but given the silent nature of this disease we cannot recommend this choice with any confidence. Secondly — this is the point of my case tonight — we could eliminate the risks as much as possible by introducing a hepatitis B vaccine into the existing vaccination system. This would seem to be the most cost-effective method. The alternative, to ignore the situation or let continue the present situation with the gross underestimation I believe exists, is frightening. An already strained health system would have to cope with a huge increase in the cost of treatments.
To get some idea of the cost we could face if we ignore this problem, we only have to look and extrapolate from the costs incurred to date in the relatively small number, but very serious, hepatitis C cases. We must not forget that hepatitis B is extremely debilitating and removes victims from the workplace for a considerable length of time. There is an inherent cost in that through lost work and lost days on the job as it were, apart from the medical cost of treatment.
We could face a situation far more serious than the hepatitis C crises because hepatitis B is far more contagious. In addition to the huge strain put on the health care system we could have a severe litigation problem because, first, the treatment costs are enormous; second, we are currently ignoring the World Health Organisation's recommendation on hepatitis C vaccination; third, the disease is potentially fatal; fourth, although this highly infectious disease is classified as low risk in Ireland, this still implies some risk and perhaps with underestimation of the incidence, it might be a higher risk than we realise; and, finally, the hepatitis B vaccination could be introducd at negligible cost into our existing vaccination programme. Anybody can be infected with the virus but nobody needs be.
I ask the Minister to do all he can in view of the facts on this issue. While not directly linked to hepatitis C, the hepatitis B issue has many parallels. Hepatitis B has the potential to be far more damaging to the medical, social and economic health of our country than even the tragedies linked to hepatitis C. I will be extremely interested to know the Minister's intentions on implementing the WHO recommendation on hepatitis B.
