ABC's of hepatitis, The

NEA Today, Apr 1995

Raymond Koff, M.D., is a professor at the University of Massachusetts Medical School and chair of the Department of Medicine at Metro West Medical Center in Framingham and Natick. Formerly with the Centers for Disease Control and Prevention, he has done extensive research on the spread, prevention, and treatment of hepatitis B.

Many people think of hepatitis as a serious--but not deadly--illness travelers get from unsafe foods. Are they wrong?

Hepatitis means inflammation of the liver. There are five kinds of viral hepatitis--A, B, C, D, and E--all contagious diseases that attack the liver.

Hepatitis A is known as a traveler's disease, generally caused by eating food contaminated with human excrement. While it can cause weeks of disabling illness, it rarely is fatal.

With hepatitis B, we're talking about a much more serious and insidious disease. While most people who get it recover on their own, a small percentage develop chronic liver disease which can lead to scarring of the liver (cirrhosis) and cancer.

Hepatitis B kills 5,000 people in this country per year and is more common and more infectious than AIDS.

Why do you refer to it as insidious?

There already are 1.2 million Americans actively infected with hepatitis B. Many of them don't even know they have it. People can carry the disease and spread it without ever having any symptoms themselves.

There will be 200,000 new cases this year in the United States alone. Some of these people will suffer flu-like or other symptoms for weeks or months or develop the more chronic problems I mentioned. Most will never know they carry the infection unless they're tested for it.

Some 2 to 5 percent of teenagers and adults can't clear the infection from their bodies naturally and are walking time bombs for the spread of the disease.

How can you catch hepatitis B?

People who are exposed to the blood or bodily fluids of an infected person are at risk.

Is there any good news?

Yes. Hepatitis B is an entirely preventable disease. Anyone not already infected who gets a series of three vaccinations is protected. The potential exists to totally eradicate the disease if we could immunize everyone. That's not financially feasible or practical, so we have to target certain groups.

It is current policy in the U.S. that all pregnant women be screened for the virus and that all newborns be immunized either shortly after birth or at two months when other inoculations generally are given.

But many people don't have access to health care.

That's why catch-up programs are so important. State law in Massachusetts, for example, requires children entering kindergarten in September 1996 to be vaccinated.

In Framingham, I've been involved in a very successful school-based program for the past two years, providing the series of three vaccinations to all 11-year-olds who need it.

The Advisory Committee on Immunization Practices of the U.S. Public Health Service is about to recommend that all 11-year-olds receive these catch-up vaccinations, and there's good evidence that a school-based program like the one in Framingham will work.

Why target that age group?

The idea is to protect children from a disease they're much more likely to get later, between the ages of 15 and 40, when sexual transmission becomes a greater risk as does drug use and the potential sharing of needles and syringes.

Who else in schools should be immunized?

If I had my druthers, I'd do universal immunization, but that's not feasible given that the vaccine is expensive (as much as $150 for the three-shot series). If I had teenage children, I would get them vaccinated.

What about school employees?

There's little risk for the spread of hepatitis B in school activities, so vaccination for most school employees' is not generally recommended.

Aside from school nurses (who I'm sure already are getting vaccinations), I would recommend inoculation for those staff members working with developmentally challenged students--they've got a greater risk of exposure to various secretions.

What role can teachers and parents play in combating the spread of hepatitis B?

A number of medical groups and other organizations, including the NEA, are involved in national educational campaigns about hepatitis B. These efforts are crucial because most Americans still don't know about hepatitis B, how one can get it, or about the vaccinations that can prevent it. I urge teachers and parents to get involved in this effort.

Also, where there are sex and health education classes in schools, information about hepatitis B should be included. Because there is so much focus on other sexually transmitted diseases, hepatitis B often is ignored.

Resources

For more information, contact:

* NEA Health Information Network, 1201 16th St., N.W., Washington, DC 20036, 202/822-7570.

* National Coalition for Adult Immunization--Hepatitis B Action Group, 4733 Bethesda Ave., Suite 750, Bethesda, MD 20814.

* American Liver Foundation, 800/223-0179.

* National Foundation for Infectious Diseases 301/656-0003.