Following complications with the manufacturing process, there is a global shortage of hepatitis B vaccine until early 2018.
Team members should ideally be vaccinated and have proof of immunity. However, where this is not possible due to shortages in vaccine availability, Public Health England (PHE), have recommended a risk assessment and risk management approach.
- Follow safe injecting, sharps disposal and universal precautions in healthcare settings
- Use appropriate protective precautions where contact is unavoidable
A recent statement from the General Dental Council advises:
“You may have heard that there is a global shortage of hepatitis B vaccine. Public Health England have issued this advice which suggests some dental professionals should restrict certain activities until vaccinated.”
Public Health England (PHE) has issued the following statement:
“Dentists coming from non-UK universities, if not already vaccinated, who are trying to get onto the Performers List, and other members of the wider dental team e.g. dental nurses hygienists may need to restrict certain activities until vaccine becomes available”
“Undergraduate courses who are due to start work as VTs in September may be due a routine booster (normally given around five years after the primary course). The benefit of this booster in known responders to vaccination is small, and therefore it can be safely deferred until early 2018. Not having received the booster should not be a barrier to ongoing work.’
PHE have developed the following temporary recommendations based on the table below:
A risk assessment should be made for each individual employee and categorised using the table of priorities ranging from 1- highest risk to 5- lowest risk.
|Prioritisation||Exposure type||Examples of individuals in this category (note this is not exhaustive but for illustration only)|
|1 Highest risk and urgency||Post exposure||Substantial exposure to infected blood from a known hepatitis B infected source||Infants born to hepatitis B infected mothers|
|2||Post exposure||Other exposure to a known hepatitis B infected source||Needlestick or other sharps injury from known positive person, sexual exposure to an acute case of hepatitis B|
|3||Post exposure||Exposure to an unknown source||Needlestick injury from discarded needle in community, sexual assault, mass casualties from a major incident|
|Pre-exposure||Priming for unavoidable, high and imminent risk||Clinical health care workers with regular blood exposure, particularly those performing exposure prone procedures (e.g. surgeons, dentists), and those working in certain settings (e.g. renal units, hospital laboratory workers). Other first responders required to attend major trauma with likely blood contamination.|
|Pre-exposure||Priming for unavoidable, high and imminent risk, with high risk of onward transmission and co- circulating viruses e.g. HIV, HDV||Sex workers, MSM with multiple partners, PWID, prisoners, people travelling to endemic countries for medical treatment, patients on renal dialysis units.|
|4||Pre-exposure||Priming for those at lower risk and those that can access advice in the event of a recognised exposure||Household contacts of people with hepatitis B, most other health care workers and ancillary staff in UK healthcare settings, other occupations at risk of percutaneous exposures.|
|Pre-exposure||Priming for those at lower risk or where risk may be avoided or delayed||Other travel to medium and high endemicity countries. Individuals with cirrhotic liver disease.|
|5 Lowest risk and urgency||Pre-exposure||Boosting and reinforcing doses||For healthy individuals who have completed a primary course of immunisation (three doses).|
PHE described “Clinical health care workers with regular blood exposure, particularly those performing exposure prone procedures (e.g. surgeons, dentists)” as priority 3. A risk assessment needs to be undertake, as not all staff will carry out exposure prone procedures and would not fall into category three.
What are Exposure prone procedures (EPPs)?
Exposure prone procedures refer to invasive procedures where injury to the worker can result in exposure of the patient’s open tissues to the blood of the worker. In particular procedures involving contact with sharp instruments, needle tips and sharp tissues (spicules of bone or teeth) inside a patient’s open body cavity, wound or confined anatomical space where the hands or fingertips may not be completely visible at all times.
How to manage a needle stick injury?
If an injury from a known hepatitis B positive person has occurred, this is categorised as high Priority 2, and the possibility of receiving the vaccine from occupational health, A&E or GP is more likely.
What to do with the Hep B shortage?
You must understand and follow the guidelines during the shortage to ensure the safety of you team members. Decisions must be made on each individual worker and should be based on the advise from PHE, GDC and an individual risk assessment.
- Review and adopt our guidance on immmunisations
- Request that team members are vaccinated by the GP or occupational health based on the PHE category 3: ‘Hepatitis B vaccination in adults and children: temporary recommendations from 21 August 2017’
- Perform a risk assessment and adapt or restrict activities accordingly.
Hepatitis B: vaccine recommendations during supply constraints
CAS alert – should be filed in your safety alert folder:
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