Types of viral hepatitis
Hepatitis A virus, or infective hepatitis, is considered to be a common infection that mainly affects children and young adults. The cause of the illness is a virus in the faeces. The infection may be passed from person to person by contamination of the hands with infected faeces, which may lead to the introduction of the germ into the mouth.
Although the virus can give severe symptoms and is potentially fatal, in many cases the symptoms are so mild as not to be apparent. The severity of the disease increases with age. In infants and young children, the infection can be mild or even asymptomatic. However, almost one in five infected 15- to 39-year-olds require hospitalisation due to the severity of their symptoms, and for those over 40, the fatality rate is 1.9 per cent. Unlike hepatitis B or C, there is no evidence of a permanent carrier state resulting from the disease and, although the infection is difficult to control, its spread can usually be reduced by the introduction of simple hygiene measures. Hepatitis A can be prevented by vaccination.
Hepatitis B virus is altogether more serious, with there being a risk of permanent carrier state and of irreversible liver damage, sometimes leading to liver cancer. Hepatitis B may be transmitted through spittle or blood contact and as a result, groups most at risk include: long-stay hospital patients since it is recognised that the disease is particularly prevalent in institutionalised people; patients with natural or acquired immune deficiency; healthcare personnel; and staff of institutions for those with learning difficulties.
Hepatitis B can be prevented by vaccination.
Hepatitis C is another serious hepatitis virus, which can lead to chronic liver diseases such as liver cirrhosis and liver cancer. It is contracted by close contact with blood contaminated with the virus, for example, through blood transfusions (before screening was introduced in the early 1990s) or through needle sharing among drug users. Unlike hepatitis B, no vaccine is currently available to prevent hepatitis C. The hygiene procedures described below apply equally to the prevention of the spread of hepatitis C.
Hepatitis B and C are diseases recognised under the Prescribed Diseases Regulations. Such recognition permits sufferers to claim additional benefits, provided that they are workers who have come into contact with the source of infection in the course of their work. Teachers will, therefore, need to prove that they contracted the disease as a result of their work. In most cases this will require the identification of the pupil who was the source of the infection.
Control of viral hepatitis
The control of hepatitis A can be achieved by strict personal hygiene measures and it should be ensured that there are adequate hand washing facilities for all concerned in the school, from the teaching, administrative and kitchen staff to the children. Adequate facilities should include the availability of hot and cold running water, soap and towels, with individual disposable towels being preferable to roller towels or ordinary hand towels.
Hepatitis A is a notifiable disease. This means that the GP making the diagnosis of hepatitis A infection will need to notify the local health protection team.
Children with hepatitis A infection should stay away from school until seven days after onset of jaundice or until they are well. Contacts of cases should also stay away from school, and should see the GP if they have symptoms suggestive of the illness.
Over the years, there have been cases of this type of viral hepatitis being contracted by staff in special schools. The Department of Health (DoH) is of the view that children living at home and attending non-residential institutions are not a high-risk group in terms of carrier status. It is possible that a higher proportion of children attending residential special schools, or who have previously done so, may be carriers of the disease. It is also known that Down’s syndrome children have a higher carrier rate because of a deficiency in their immune system.
The hepatitis B vaccine
The vaccine is made from blood taken from hepatitis B carriers, but there is no risk of catching the disease from the vaccine as only non-infectious components of the blood are used. Blood used to make the vaccine is rigorously screened to ensure its purity. More than three million doses of the vaccine have now been given worldwide and there has been no reported case of infection from the vaccine.
The vaccine is effective against hepatitis B in about 90 per cent of cases. After the first course of vaccine, ‘booster’ jabs may be necessary as the vaccine loses its effectiveness after a number of years. Advice can be sought from GPs/occupational health providers on this point.
The DoH advises that vaccination is safe for pregnant women. If any member of staff at risk is pregnant, or plans to become pregnant, she should be warned that hepatitis B is very dangerous for both mother and baby. It is important that they should be protected against the disease.
Two-thirds of people vaccinated suffer no after-effects at all. Many of the rest have a sore arm and perhaps a small rash where the jab was given. Very rarely, flu-like symptoms develop after vaccination, but these clear up completely after a few days.
Under the Health and Safety at Work etc Act 1974 and the Control of Substances Hazardous to Health (COSHH) Regulations 2002, employers have a legal duty to assess the risk of infection for employees and others affected by their work. When a risk is identified in a school, employers should take suitable precautions to protect the health of their employees and others affected by their work. Employees should also be given adequate information, instruction and training on any risks to their health that they may face in the course of their work.
The DoH has identified staff of residential and other accommodation for those with learning difficulties to be at an increased risk of exposure to blood-borne viruses, and recommends that they be immunised against hepatitis B. Furthermore, the Health and Safety Executive (HSE) recognises that designated first aiders might also be at an increased risk in any occupational setting.
The NEU is of the view that any member of staff who feels they may be at particular risk of contracting hepatitis B should be offered the vaccine, and the health authorities should respond positively to combat this disease and to protect the health and welfare of staff working within ‘high risk’ establishments.
Hepatitis C can cause a form of hepatitis that leads to chronic liver disease. There is no vaccine and no known way to prevent this infection following exposure. However, hepatitis C has only rarely spread within a school setting.
For more information, please download the full ‘Hepatitis in schools’ guidance