Exposure to hepatitis B and C of tattooists in Victoria in 1984.

Although tattooing is recognized as a risk factor for transmission of hepatitis C, the efficiency with which transmission occurs is unknown. Sera stored from a serosurvey of tattooists undertaken in 1984 to test for human immunodeficiency virus (HIV) provided the opportunity to determine the prevalence of serological markers of hepatitis B virus (HBV) and hepatitis C virus (HCV) in tattooists at that time. The stored sera had been obtained from five unregistered and 36 of 37 (97%) of the registered tattooists operating in 1984. Serological status for hepatitis B (hepatitis B surface antigen (HBsAg), antibody to hepatitis B surface antigen (HBsAb) and antibody to hepatitis B core antigen (HBcAb) in standard assays) or hepatitis C (HCV antibody reactivity in second and third generation tests, confirmed by recombinant immunoblot assay) was determined. No sera was HIV positive or HBsAg positive. Of 35 specimens tested for HCV specific antibody, only two (5.6%) were positive despite markers of HBV in 48.6% of the same sera. As acute HBV infection was common amongst tattooists prior to 1984, it is clear that hepatitis B vaccination would be of benefit to this group. Despite frequent needlestick injuries reported by tattooists at the time, the low seroprevalence of HCV in this group suggests that HCV may not be transmitted efficiently by intradermal inoculation using solid-bore tattooing needles.

Knowledge of and attitudes to infection control of tattooists at registered premises in Victoria, 1994.

Historically, the relationship between health authorities and tattooists has been marked by suspicion and mutual distrust, with tattooists being stereotyped as having little concern for hygiene, and considered largely ineducable about infection control. In this study, a random sample of tattooists working at one-third of the 65 registered tattooing premises in Victoria completed a questionnaire that recorded demographic information and knowledge and attitudes to Standards of practice for tattooing 1990, which specifies guidelines for infection control in Victorian tattooing premises. Of these premises, 89 per cent participated and 36 of 37 tattooists working therein (22 metropolitan, 14 country) completed the questionnaire; 81 per cent were male. Reports by the tattooists indicated that: 50 per cent had not commenced immunisation for hepatitis B; that 78, 42 and 34 per cent either had not been tested or were unsure whether they had been tested for hepatitis C, hepatitis B and human immunodeficiency virus (HIV); and that no tattooist was a hepatitis B carrier or was positive for hepatitis C or HIV. Respondents acknowledged the potential for transmission of infectious diseases through tattooing, endorsed formal training in tattooing and infection control for new tattooists, and supported continuing education in infection control for existing tattooists. Most were critical of environmental health officers, particularly for inaction in not closing and prosecuting unregistered tattooists. Despite deficiencies in the knowledge and training of tattooists in infection control, they recognise its importance and are willing to attend appropriate training.

Evaluation of infection control in registered tattooing premises in Victoria, 1994.

Tattooists at a random sample of registered tattooing premises were surveyed for self-reported compliance with infection-control practices specified in the Victorian Standards of practice for tattooing, and some were observed while tattooing. Of 35 respondents, 94 per cent reported that they believed their practice fully met the standards, yet 19 per cent of tattooists did not have a copy of the standards at their premises. Most believed the standards could be improved. There was considerable discrepancy between reported practice and that observed. Few tattooists understood or implemented universal precautions, and while most wore gloves, there was low level of use of eye and clothing protection. Tattooists touched many surfaces that had not been cleaned or disinfected between clients. Ultrasonic cleaners were generally operated without lids. Because of this, they were a danger both to operators and their clients. At no premises was equipment used that had been both cleaned according to the standards and sterilised in an autoclave that had passed a sterilisation test. The situation in Victoria is similar to that identified in other states. There is an urgent need for training of tattooists and the environmental health officers who supervise them.

An evaluation of school entry immunisation certificates in Victoria.

We evaluated legislation introduced into Victoria in 1991 requiring that all children enrolling in primary school certify their immunisation status. Information was requested from all local councils. All primary schools in two local government areas were followed up, providing an indication of the validity of the analysis obtained from data collected during the mid-year census. From 166 of 210 local councils in Victoria, 48,422 documents relating to school entry immunisation certificates were issued for children entering their preparatory year. At least 522 children were enrolled in school on an undertaking to complete immunisation, and were likely to have had their immunisation completed as a result of the legislation. Only 170 statutory declarations of conscientious objection to immunisation were made, indicating that few parents are willing to express firm anti-vaccine sentiments. Compliance with the immunisation certificate legislation is overestimated by the mid-year census because many schools have accepted nonstatutory evidence of immunisation. Mobile and immigrant families find it particularly difficult to achieve certification. Local councils are inconsistent in the way in which they issue certificates. Further follow-up and feedback is essential to better inform schools and parents about the legislation. Such follow-up can improve the certification rates of children then and in subsequent years. The legislation has imposed a considerable workload on councils, but without efforts to improve compliance with the legislation and to develop practical guidelines for documentation of immunisation and appropriate guidelines regarding transfer, many inadequately immunised children may remain at risk from vaccine-preventable diseases.

Legislation for school entry immunisation certificates in Victoria.

In 1982 the National Health and Medical Research Council recommended that every state introduce legislation requiring immunisation certificates at school entry. Victoria was the first state to enact such legislation. This paper explores the process and difficulties encountered in achieving this legal requirement, describes the requirements under the legislation as it was finally introduced, and examines the early data available to the state health department regarding its implementation. Compliance with the legislation and immunisation status of children enrolling in government primary schools were ascertained from mid-year census data. In 1992 almost 90 per cent of children complied with the legislation, but because 10.2 per cent of children did not present a certificate it was possible to estimate only the lower limit of statewide coverage at 85 per cent against the prescribed diseases. School entry immunisation legislation may provide an important safety net to identify children with incomplete immunisation. However, the effectiveness of the legislation in Victoria remains unproven, and the requirements of the legislation are demanding for parents, local councils, and schools. The failure to document immunisation status in over 10 per cent of children indicates that further efforts to increase compliance are needed. This will require information on the vaccination status of those without certificates and the reasons they have not complied. The impact of the legislation needs further evaluation, although it may be years before its effectiveness can be gauged. Its effectiveness may depend upon enforcement of the requirement to exclude unimmunised children in disease outbreaks.