Vaccinations in the city have more than doubled

The Health Protection Agency urged the city's primary care trusts to deal with an increase in cases of the liver disease in 2002.

But it has been claimed that health managers in the city did not come up with the cash to tackle the outbreak for almost a year.

Over the past two and a half years there have been 200 reported cases of Hepatitis B in Bristol - seven times the national average.

Tackling outbreak

Concerned by Bristol's situation, the doctor in charge of public health, Charles Irish, urged the local health service in the autumn of 2002 to fund various measures to tackle the outbreak.

"The recommendations were that GPs should be paid an additional fee for immunising drug users on their books, " he told the BBC.

"Working prostitutes should be paid to come in and be immunised and that additional support should be given for immunisation in hostels and for the homeless."

Despite the urgency of the situation, it was not until ten months later, in September 2003, when the primary care trusts agreed to fund all Dr Irish's recommendations.

"I would like to have seen my recommendations carried out at the time," he said.

"It is possible because of the infectious nature of this disease, that some people could have become infected because of the delay in the implementations of the recommendations."

He has just written an outbreak prevention report which is highly critical of the delays in funding his measures.

At risk

The consultant in charge of Bristol's clinic for sexually transmitted disease, Dr Peter Greenhouse, said his team could only vaccinate people who came forward and that figure was a fraction of those most at risk.

"Obviously if you want to control an epidemic you need to get in there quickly and we haven't been able to do that," he told the BBC.

Chris Borne from the Primary Care Trust, said the Trust had realised there was a "serious problem" and had more than doubled the number of vaccinations in the past two years.

"There were differences of view on how to reach what are a difficult group of people," he said.

"We trusted advice that we needed to do more, but we needed to know exactly what more that was."

He added that the Trust had learned a lesson.

"We need to get professionals together and get a quicker decision on how to speed the vaccination process up ," he said.

A second vaccination nurse has now been appointed for the city.