- Vaccine against Hepatitis A protects kids and families
now; Hepatitis B vaccine protects kids as they become adults
- LOS ANGELES -- Beginning July 1, students headed into
the seventh grade in Los Angeles County will first have to stop by the
doctor's office to be vaccinated against hepatitis type B. The vaccination
is already required for entry into kindergarten and day-care centers but
the new law will ensure that all children are immunized before reaching
- Deborah Lehman, M.D., associate director of pediatric
infectious diseases at Cedars-Sinai Medical Center, says hepatitis B is
rarely seen in children but the vaccination program is the best way to
protect kids from the disease as they grow older. Hepatitis B is usually
transmitted by sexual contact with someone who is infected or by contact
with blood that might occur in IV drug abuse and the sharing of infected
needles. In the past, receiving a blood transfusion significantly increased
risk, but the blood supply has been screened for hepatitis B since 1975.
- "The young infants we're immunizing are not IV drug
abusers, they're not sexually active, and household contact is a very infrequent
cause of transmission," says Dr. Lehman. "But in about one-fourth
of cases of hepatitis B, the cause is unknown. And the disease is probably
the most common cause of chronic hepatitis, cirrhosis and liver cancer.
Furthermore, the earlier a person is infected in life, the more likely
they are to develop these life-threatening illnesses as an adult. Therefore,
immunizing children today against hepatitis B is a preventive measure.
In the long term, we?re preventing liver cancer."
- Although sexual activity and drug involvement may not
pose immediate threats to children, many adolescents are involved in two
seemingly innocent activities -- body piercing and tattooing -- that increase
their risk for acquiring hepatitis B and another potentially deadly virus
called hepatitis C.
- Few if any sterilization regulations exist within these
industries, and the viruses can be spread though a very small amount of
infected blood. Therefore, even getting ears pierced in a store that does
not properly clean or dispose of contaminated equipment can increase the
risk of transmission.
- The term "hepatitis" refers to any inflammation
of the liver, which can result from such diverse events as viral infections,
exposure to toxic chemicals or long-term alcohol abuse. Hepatitis B is
caused by a specific virus. Type A, caused by a different virus, does not
lead to the degenerative liver disease associated with hepatitis B, but
it can cause sudden, violent illness that quickly spreads through an entire
family or community. Strangely, while children often spread the disease,
they tend to remain symptom-free while the adults they contact become ill.
- "Hepatitis A causes serious flu-like symptoms, including
severe stomachache, diarrhea, vomiting and fever. The liver becomes inflamed
and infected and loses its ability to process bilirubin, which causes the
yellowing of eyes and skin called jaundice," says Dr. Lehman. "Infected
people often have to be hospitalized, for a couple of reasons. First, because
they are unable to tolerate anything by mouth, patients become dehydrated.
Also, because an infected liver may not be able to properly manufacture
clotting factors, there is a tendency to bleed, which can be dangerous."
- Hepatitis A infection can be sufficiently severe to cause
acute liver failure, requiring transplantation for survival. On the other
hand, patients who become infected but recover will be immune to future
infection. According to Dr. Lehman, all adults and children in Los Angeles
County may be required to receive hepatitis A vaccinations in the near
future because the area is considered to have a high rate of infection
-- more than 20 cases per 100,000 population. In the meantime, however,
vaccination is urged for people in high-risk categories, such as those
who travel internationally; American Indians, native Alaskans and others
in highly affected communities; homosexual and bisexual men; and patients
such as those with hemophilia who receive clotting factor.
- "Many people are understandably hesitant when they
hear about new vaccines. It seems like there's a new one every couple of
months," says Dr. Lehman. "But in the big picture, two shots
for hepatitis A over six months is a minor inconvenience compared to the
possibility of hospitalization, the possibility of an entire family being
infected, and the possibility of death. These vaccines are very safe and
very effective, and there will probably be a combination hepatitis A/hepatitis
B vaccine available in the future, reducing the number of injections that
will be required."
- The virus for hepatitis A is transmitted through fecal/oral
contamination. In even less glamorous terms, a microscopic amount of the
secretion from an infected person must somehow get into the another person's
mouth for the virus to be passed. This is why food preparers must wash
their hands after using the restroom, and why an outbreak of hepatitis
A can occur very quickly in a day-care center.
- "Truthfully, little kids aren't very careful about
washing their hands after they use the bathroom," says Dr. Lehman.
"And, of course, kids put things in their mouths all the time. This
can be a big problem in a day-care center where kids are running around
in leaky diapers and putting their hands in their mouths. With hepatitis
A being quite contagious, it can go through a community at a fairly rapid
- In fact, the kids may pass the disease around, remaining
asymptomatic, then take the virus home to their relatives who become violently
ill. For this reason, vaccinating the children may help protect not only
their health but that of their older, less robust family members, as well.
- To reduce the risk of infection of either hepatitis A
or hepatitis B, Dr. Lehman urges parents to have their children immunized
against both viruses. Also, because there is a chance that organisms, including
the virus that causes hepatitis B, can be transferred from one person to
another through small amounts of contaminated blood, children should be
cautioned against sharing toothbrushes and other personal items.
- "There are playground accidents and other circumstances
in which kids are exposed to other people's blood. I think it's a good
idea for parents to take the initiative to teach kids about taking precautions
and using good hygiene," says Dr. Lehman. "It isn't necessary
to make them excessively anxious but it is important for kids to learn
such things as washing their hands after using the bathroom."
- Contact: Sandra Van <email@example.com 1-800-396-1002
Cedars-Sinai Medical Center <http://www.csmc.edu