The Netherlands Drug Situation 2010 - Trimbos-instituut

Table 6.1.5: Antibody test results collected from medical files of 645 detainees with dataavailable on injecting drug use (IDU)Antibodies for hepatitis CNo antibodies for hepatitis CN % N %Ever IDU 47 40.5 69 59.5Not registered as IDU 14 2.6 515 97.4Source: NIVEL/ WODC (Leemrijse et al., 2010).In November 2002, the national hepatitis B vaccination campaign targeted at behaviouralrisk groups started, after a pilot period in Amsterdam since 1998 (see also §7.2). In2010, the 100.000th person has been included in the program. The campaign consists of three vaccinations per participant, at month 0, 1 and 6. Inmonth 0 also the anti-HBc and HBsAg titres are determined. If a person is immune,than the vaccinations of months 1 and 6 are not given; if the person is carrier, he isreferred to a medical specialist. Since the campaign aims to reach a group immunityand is not primarily concerned with individual care, the post vaccination titre is notmeasured. For the drug users targeted in the campaign, several definitions have been made. TheHealth Council advised to include all intravenous drug users. In the campaign itself,however, the following practical definition was employed: “drug users who currentlyuse hard drugs or did so in the past (especially those with intravenous drug use), andwho are using low threshold facilities of addiction care”. This definition takes into accountthat some drug users only inject occasionally, that some are not very eager onadmitting injecting drugs and that apart from injecting, also other lifestyle factorsmay increase the risk on hepatitis B transmission, such as sexual risk behaviour orthe sharing of drug paraphernalia other than needles. On the other hand, this definitionlimits the target group to those that are in active contact with an addiction careinstitution. The campaign for drug users is carried out by addiction care institutions and municipalhealth services (often outreaching) and the division of work between these twodiffers locally, e.g., depending on the ability of addiction care workers to draw blood.In some institutions hepatitis vaccination is by now fully integrated in daily practice,while in others integration plans are being developed or may be developed in the future. Until the end of 2009, a total of 17,119 drug users received a first vaccination (includingthe 1,125 participants in the pilot phase) (Haverkate 2010). Until the end ofAugust 2010, another 627 received a first vaccination.o Of the 17,119 drug users included up until December 2009, 11.6% were found tobe immune: 28.7 % of the participants in the pilot project and 10.4% in the nationalcampaign (Haverkate 2010). Although this is high compared to the generalpopulation (in the population-based Pienter-2 study the prevalence of anti-HBc is3.4% (Hahné 2010)), the percentage of participants that are immune is decreasingsince 2006, from around 12% to less than 3% in 2009. An explanation for this decreasemay be that in previous years already the highest risk individuals were includedin the campaign. On the other hand, drug users who state that they werepreviously infected with hepatitis B are not tested or vaccinated and therefore notincluded in these figures.89