Hepatitis A virus infection control: an audit of practice in England and Wales prior to guidelines being published.

This survey was conducted in September 2001 to audit the practice of Consultants in Communicable Disease Control (CsCDC) and to gain a systematic picture of pre-guideline approaches to the control of hepatitis A virus infection in England and Wales. An audit form was distributed to all CsCDC by email and responses were entered in a database and analysed. Response rate is estimated at 44%. CsCDC predominantly recommend vaccination for prevention. For 31% of the CsCDC, index cases were not reported within a week of the onset of illness. As a result, vaccine was often used sub-optimally. By contrast 95% of the CsCDC were informed of an index case within two weeks of onset of illness, in time for effective use of human normal immunoglobulin (HNIG). CsCDC were cautious in the use of HNIG for a number of reasons including concerns about variant Creutzfeldt-Jacob Disease (vCJD). A substantial proportion (between 5% and 28% for different age groups) of CsCDC did not recommend any active prevention among close family contacts of a case. Important ways to improve practice include facilitating use of HNIG and speeding up reporting by doctors and laboratories.