A Dose of Prevention : Medicine: Health workers are promoting Hepatitis B vaccines for children in an effort to stop the spread of this highly contagious disease.
Vaccines aren’t just for babies and kindergartners.
Hepatitis B--which is highly contagious and potentially fatal--is now the second-most commonly reported sexually transmitted disease in the United States, according to the American Academy of Pediatrics.
The growing impact of hepatitis B prompted the academy in February to recommend that infants and young children--and adolescents where resources allow--be routinely immunized against it.
There are between 200,000 and 300,000 new hepatitis B infections every year, and while many cases are mild and are not even diagnosed as hepatitis, up to 10% of them will progress after 10 to 30 years to cause cirrhosis or cancer of the liver.
The virus is transmitted through exposure to blood and blood products, through sexual contact and from mothers to their infants, primarily during birth. It also can be acquired through close contact within families.
But the risk to children is long-term. “Hepatitis B is not an immediate threat to children,” said Dr. Lorraine Stern, a Newhall-based pediatrician and associate clinical professor at the UCLA School of Medicine. “The purpose of the vaccine is to protect them in adulthood,” she said, when sexual activity, and the potential for intravenous drug use and for blood transfusions, puts them at greater risk.
The statistics are staggering. “The epidemic is worse than polio ever was,” said Stern, “because with polio, 20,000 people a year--at the disease’s peak--got polio, and 200 died a year. With hepatitis B, 200,000 people get the disease every year, and 500 to 550 die of it annually.” Hepatitis B, she said, is the major reason people need to get liver transplants.
It may be tough to get the average adolescent immunized, though, said Dr. Monica Richter, an Agoura pediatrician. “Adolescents don’t like coming to the doctor much,” she said, adding that because the hepatitis B vaccination requires a series of three injections, in many cases, the chances teens will be fully vaccinated are small. That’s one reason the pediatricians’ academy is trying to target infants; they routinely see a pediatrician regularly anyway. The academy recommends that newborns be vaccinated before they are discharged from the hospital and then get subsequent doses at one to two months and at six to 18 months of age.
According to the pediatricians’ group, infant immunization is the most feasible way to protect all people and eventually eliminate the disease, but the complete effect of this strategy will not be known for at least 25 years. At least 20 other countries now recommend the hepatitis B vaccine for all infants.
For some parents, the cost of the vaccine may be off-putting. The average private practice charge for the vaccination is between $30 and $50 a dose--multiplied by three doses, Stern said. The cost is higher for children over 10 because they need larger doses. HMO and third-party insurance coverage varies widely, and public health clinics don’t offer the immunization routinely but give it to those at greatest risk, according to Stern.
At Kaiser Permanente Medical Center in Woodland Hills, newborns are immunized against hepatitis B, first in the delivery room and then at two subsequent checkups. Children less than 1 year old who have not been immunized are given the vaccine too, said Linda Frerking, nurse practitioner and pediatrics department administrator. But the facility isn’t routinely immunizing older children unless they fall in a high-risk group, she said. “There are a vast number of children and some limited resources; therefore we have to focus on the greatest need,” she said.
Where cost is an issue or when the vaccine is in short supply, those with the greatest priority for the immunization include newborns with mothers who are hepatitis B-positive or are drug users, children of parents in the health-care field--lab technicians, doctors, dentists, nurses--who might be exposed to the disease, those who have had more than one sex partner in the previous six months, or those with a recent episode of a sexually transmitted disease, Stern said.
Richter said more parents are asking about the vaccination, and she is giving it to elementary school-age children when their parents request it. The only downside to the vaccine, she said, is a slightly tender arm for a few days after the injection.
“Children can get the immunization at any age,” said Richter, “but the goal is to get the kids immunized before they get exposed to hepatitis B.”
Where to go
Information: For a free brochure on hepatitis B, call (800) HEP-B-873; for a copy of the American Academy of Pediatrics’ complete hepatitis B immunization recommendation, call the academy publications office, (800) 433-9016.
