vaccination against hepatitis B should be considered as a preventive measure against horizontal transmission.

## (2) Issues to be considered

a) The national government shall promote research aimed at development of materials for dissemination of recommendations for infection control in daily life, and guidelines for infection control in group living facilities in order to prevent new infection with hepatitis virus. The national government shall cooperate with local governments using results of relevant research, and shall provide and disseminate information regarding hepatitis.

b) The national government shall develop information to be provided to youth likely to participate in activities that put them at risk of infection (such as activities that involve exposure to blood or bodily fluids, including piercings and sexual activity). Having accurate knowledge regarding hepatitis is necessary for youth to understand the risk, and will require cooperation with local governments for the provision and dissemination of such information.

c) The national and local governments shall provide information regarding the efficacy and safety of the hepatitis B vaccine, mainly to populations at high risk for infection such as health care workers.

d) The national government shall consider the development of a system for vaccination with the relevant vaccine based on information about efficacy and safety of hepatitis B vaccination as a preventive measure against horizontal transmission.

## Chapter 3 Implementation system for hepatitis testing and improvement in test performance (1) Policies to be developed

There are various parties involved in performing hepatitis testing, including health care insurers and business operators, which conducts hepatitis testing in individuals to inform them of conditions of infection to hepatitis virus, and the test is sometimes conducted anonymously due to privacy considerations. Therefore, it is difficult to determine the full extent of such testing. However, such measures are required to effectively develop systems for hepatitis testing and to provide and disseminate information regarding hepatitis. While there has been previous surveys conducted to determine the number of individuals undergoing hepatitis testing, new surveys and further research are required to determine the true extent of hepatitis testing at the current time.

Many patients with hepatitis do not know that they are infected because they have not undergone testing. Moreover, even those that have undergone such testing may fail to understand their test results. Therefore, preparation and dissemination of appropriate information about hepatitis, including various routes of infection and the possibility of individuals being unaware of their infection status, will be implemented to inform all members of the population of the necessity of undergoing hepatitis testing at least once. It is necessary to develop a system in which all members of the population who want to undergo hepatitis testing are able to do so, and to promote research to validate the effect of such testing.

Furthermore, it is necessary to provide information about hepatitis to examinees to ensure that all those tested understand their hepatitis test results, and all health care workers