Hepatitis prevention

Those who inject drugs are at very high risk of acquiring HBV and HCV infection, and 50–80 % of drug users become infected within five years of starting to inject, which can result in chronic infections that can damage and ultimately destroy the liver (EMCDDA, 2004b). While no vaccine is currently available against hepatitis C, hepatitis B can be effectively prevented by vaccination (142).

Several EU countries have introduced or reintroduced hepatitis B into national immunisation programmes in the past decade, and the vaccination is now part of the routine vaccination schedules for children in most EU countries. So far, only Denmark, the Netherlands, Sweden, the United Kingdom and Norway have not followed the WHO recommendation (143).

Although it will be some decades until no substantial at-risk populations are left, targeted vaccination programmes for drug users are currently implemented in most EU countries and Norway. To reach their target populations, vaccination is made available to drug users at easily accessible contact points and also increasingly in prisons (144).

Hepatitis B immunisation campaigns are often combined with hepatitis A vaccinations and hepatitis C virus counselling, testing and referral. Even though hepatitis C treatment is offered in all countries, access can in practice be difficult for drug users. As official medical guidelines are considered an important tool in steering the provision of hepatitis C treatment, in 2003–04 they were the subject of an analysis by the EMCDDA (145). Most guidelines recommend that drug users are treated after they have come off drugs or have been stable on an oral substitution treatment for a period of time that can vary from three months to two years. The more recent the guidance documents are, the more likely they are to take into account research showing the benefits for drug users of a multidisciplinary approach to treatment by teams of hepatologists and drug use specialists. The recent increase in national guidance is likely to improve treatment options and enhance outcomes for drug users.

(142) For more information on hepatitis, see the EMCDDA website.

(143) Report on the 14th Global Advisory Group: Expanded Programme on Immunization, 14–18 October 1991, Antalya, Turkey, endorsed by the World Health Assembly in 1992.

(144) See Hepatitis B vaccination table.

(145Consultant study on hepatitis C treatment guidelines for injecting drug users.