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| Vol. 20, No. 18 |
| October 1, 1998 |
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Vaccine, Education Key to Hepatitis B Prevention by KRISTINA VAN ARSDEL Texas Medical Center News The American College Health Association has recently launched a new campaign to educate college students about the hepatitis B virus and prevention measures against the disease. Hepatitis B: Why Take the Risk? features professional extreme sports "risk-takers" such as skateboarder Tony Hawk, stunt biker Dave Mirra and U.S. Olympic snowboarder Barrett Christy, who agree hepatitis B is one risk not to take. A public service announcement is running on MTV through January. What is hepatitis B and who is at risk? Characterized by symptoms of jaundice, fatigue, abdominal pain, loss of appetite, nausea and vomiting, hepatitis B is a serious liver disease transmitted through infected blood or body fluids. According to the Centers for Disease Control and Prevention, an estimated 1 million to 1.25 million people in the United States have chronic hepatitis B. Between 140,000 and 320,000 new infections of hepatitis B arise each year in the United States. "When you see that 1 million to 1.25 million people in the U.S. are chronic carriers, those patients may have to undergo therapy. With medical costs, work loss costs, and cost of therapy, the total cost burden on the health dollar can be tremendous," says Dr. Rise Stribling, assistant director at the Liver Center recently opened by The Methodist Hospital and Baylor College of Medicine. Those at high risk for contracting hepatitis B in the United States include: infants whose mothers are infected with the disease, injection drug users, homosexual men, sexually active heterosexuals, health care workers, hemodialysis pati-ents, household contacts, and infants or children of immigrants from areas in which hepatitis B is prevalent. Getting a new belly button ring or a tattoo could also lead to hepatitis B if clean instruments and a safe procedure are not used. "If there is any break in those techniques used at a tattoo or body piercing parlor, than absolutely [hepatitis B could be transmitted]," says Dr. R. Palmer Beasley, dean of The University of Texas-Houston School of Public Health. "That's the real reason why girls who want to get their ears pierced should go to a place that has good procedures." Although a cure for hepatitis B does not exist, a vaccine is available to help safeguard against the disease. In 1991, the U.S. Department of Health & Human Services in conjunction with the Centers For Disease Control and Prevention embarked on a comprehensive strategy to eliminate hepatitis B transmission in the United States based on recommendations submitted by the Immunization Practices Advisory Committee. The recommendations called for, among other measures, the universal vaccination of children. The hepatitis B vaccine is now part of an infant's routine immunization schedule. Given as an injection in a series of three doses, the hepatitis B vaccine, after the three doses, has an efficacy of 95 percent in infants and children, says Dr. Celine Hanson, associate professor of pediatrics in the section of allergy and immunology at Baylor College of Medicine. "The data to date suggests there is long-term immunity to hepatitis B [after receiving the vaccine]," Dr. Hanson says. "But if we have just begun doing this in 1991, I think it will take us time to understand whether in fact this is longlasting. There is no reason to think it would not be." She notes that the response to the vaccine does tend to decline with age. In 1994, the Advisory Committee on Immunization Practices expanded its recommendations to include the vaccination of 11- and 12-year-olds who did not receive the vaccine as infants. The vaccine is also recommended for adults who fall into high risk groups; screening for hepatitis B is suggested for pregnant women as part of their prenatal care. "I'm estimating that this is the next eradicatable disease after polio," says Dr. Beasley, who has conducted research on the hepatitis B virus. "My guess is that hepatitis B will find its way on to that list as people begin to appreciate what it is and how long the duration of protection is." In terms of side effects, Dr. Hanson says the major responses are the same as one would find with other injectable vaccines. These include some pain at the injection site, mild complaints such as headaches, and in rare cases, a fever. Dr. Hanson is the director of an immunization project at Texas Children's Hospital charged with devising ways to improve immunization rates in Houston and Harris County. "We are working with the state health department and other government agencies to see what we can do to ensure that vaccines are delivered and that the vaccine delivered is the safest one with the best immunogenicity," she says. The crux of the project is the development of an electronic immunization tracking system that will transcend across medical institutions. The project is also looking at the use of reminder techniques to keep parents informed of when their child's next set of immunization shots are due. While the tracking system is not operational yet, the project does offer a community immunization helpline at 713-770-2061. Menu selections are in English, Spanish and Vietnamese.
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