Hepatitis A Vaccine Urged for Hep C Patients
{{#rendered}} {{/rendered}}Despite recommendations, few people with chronic hepatitis C are being vaccinated against the hepatitis A virus.
In most people, the hepatitis A virus causes a relatively mild, short-lived infection. But in people with hepatitis C, a hepatitis A infection can be much more serious — even deadly.
Although the hepatitis A vaccine has been available since 1995, a surprisingly low number of people with hepatitis C were vaccinated, the researchers write. Their study appears in the new issue of Hepatology.
{{#rendered}} {{/rendered}}Hepatitis A Drops Dramatically With Vaccine
Testing and Vaccinating
Edward J. Bini, MD, MPH, and his colleagues identified 1,193 patients who were diagnosed with hepatitis C in the year 2000. Bini is a physician with the New York University School of Medicine.
{{#rendered}} {{/rendered}}Follow-up information was collected through June 30, 2002, to establish the number of patients who were tested for hepatitis A and the number who actually received the hepatitis A vaccine. A blood test looking for antibodies to the virus can determine if someone is immune to the hepatitis A virus.
Patients were considered to be vaccinated if they received one or more doses of the vaccine. A second dose of hepatitis A vaccine is typically given 6 to 18 months after the first shot.
Turning the Corner in Hepatitis C Treatment
{{#rendered}} {{/rendered}}Few Vaccinated
Less than 54 percent of patients were tested for hepatitis A antibody despite having been seen an average of 10 times by their doctor. Almost half of these were susceptible to hepatitis A infection.
Yet only 94 patients received the hepatitis A vaccine and of these, 45 received only one dose.
{{#rendered}} {{/rendered}}A total of three hepatitis C patients also developed hepatitis A infection, one of whom died of liver failure.
All of them were known to be susceptible to hepatitis A - but none had received the vaccine.
"The low rates of hepatitis A testing and vaccination are striking given the presence of recommendations since 1996 to vaccinate these individuals against hepatitis A, the long duration of follow-up, and the high number of visits with their primary care provider," Bini writes.
{{#rendered}} {{/rendered}}Who Is at Risk for Hepatitis C?
Why So Low?
What accounts for the low vaccination rates? There could be a variety of reasons, according to the researchers:
{{#rendered}} {{/rendered}}—Patient refusal (believing they weren't at risk for hepatitis A infection)
—Doubts about the vaccine's effectiveness or misconceptions about its side effects
—Lack of knowledge on the part of doctors
{{#rendered}} {{/rendered}}—Lack of resources
—A need to address more pressing health issues during medical visits
{{#rendered}} {{/rendered}}How Hepatitis A Is Spread
Hepatitis A is usually spread by putting food or objects contaminated with the stool of a person with hepatitis A in the mouth. Hepatitis A is most common in areas of the world where there are poor sanitary conditions or where good personal hygiene is not observed.
In the U.S., hepatitis A is spread mainly among people who have close contact with someone who has the virus. You can become infected with hepatitis A if you:
{{#rendered}} {{/rendered}}—Eat food prepared by someone who does not wash his or her hands well after using the bathroom or changing a diaper
—Don't wash your hands after changing a diaper
—Eat raw or undercooked shellfish that was harvested from waters contaminated with raw sewage
{{#rendered}} {{/rendered}}—Have sexual contact with your partner's anus
Diagnostic Tests for the Hepatitis C Virus
Symptoms Sometimes Nonexistent
{{#rendered}} {{/rendered}}People infected with hepatitis A may not ever develop outward symptoms. But symptoms — potentially serious — are much more likely to occur in people with liver disease, such as hepatitis C.
Usually, symptoms appear without warning. They may include:
—Fever
{{#rendered}} {{/rendered}}—Tiredness
—Loss of appetite
—Nausea
{{#rendered}} {{/rendered}}Abdominal discomfort
—Jaundice (yellowing of the skin and eyes)
By Patti Connor, reviewed by Michael W. Smith, MD
{{#rendered}} {{/rendered}}SOURCES: Bini, E. Hepatology, September 2005; vol 42: pp. 688-695. News release, John Wiley & Sons, Inc. WebMD Medical Reference From Healthwise: "Hepatitis A."