Archived Responses: 

Hep B vaccine for adults traveling to Asia

March 2010

We have arranged a large family trip to South Korea in a few months, but just found out that SK has a very high rate of Hep B (which apparently is 100 times more transmissable than HIV and can lead to very deadly liver cancer) and that the CDC recommends all travelers get the Hep B vaccine. No problem, except that it takes 6 months for the full course of vaccination, and we are going sooner than that. I have read that there is an expedited schedule that provides some protection, but isn't as complete as the full 6 month schedule. So we have to decide whether to cancel our tickets and postpone our family trip (which may upset our in-laws, etc.) or to just go and risk it. We travel regularly and I don't usually worry about getting sick, but Hep B/potential liver cancer seems extraordinarily dire. Have any BPNers had to deal with this? What did you do? Should we stay or should we go?

You are right that Hep B is much more transmissible than HIV. And a person become infected with Hep B the same way; thru bodily fluids. So your risk of getting infected while in South Korea depends a bit on what you do. If you do not have sex with an infected person or do not need a blood transfusion, then you will not have to worry about becoming infected. If you really want to have all your bases covered, find out the blood types of all your family and that way if there is a medical emergency, someone can donate the needed blood. Go and have fun! Ann
Something to keep in mind is that Hepatitis B is not transmitted casually - http://www.hepb.org/hepb/transmission.htm -- which should alleviate some concerns. Also remember that vaccinations are not risk-free either. I developed a certain auto- immune condition close in time to my Hepatitis B vaccines (which I took because I was travelling to Korea) and if I had to do it again, I would not take them. gloria
I think you are over reacting. According to the CDC website:

Hepatitis B virus is not spread by sharing eating utensils, breastfeeding, hugging, kissing, holding hands, coughing, or sneezing.

...and here's the context that HepB ''is 100 times more transmissable than HIV'':

Can Hepatitis B be spread through sex? Yes. Among adults in the United States, Hepatitis B is most commonly spread through sexual contact and accounts for nearly two-thirds of acute Hepatitis B cases. In fact, Hepatitis B is 50-100 times more infectious than HIV and can be passed through the exchange of body fluids, such as semen, vaginal fluids, and blood.

http://www.cdc.gov/hepatitis/B/index.htm In other words, make your in-laws happy and go! Asia Fan

Hepatisis B is a very serious and deadly disease, but similar to HIV, it is NOT - I repeat - NOT transmitted casually. So, unless you are planning on using unsterile needles, having unprotected sex or anything that results in direct blood-to-blood contact... I think you are OK. Definitely would not warrant canceling a trip. Educate yourself about the transmission of a disease BEFORE worrying about receiving the diagnosis. http://www.hepb.org/hepb/transmission.htm Someone who works with Hep B+ individuals

Hepatitis A Vaccine

Dec 2003

I'd like to know what information people have heard about the Hepatitis A vaccine. Our pediatrician has brought it up to us a few times, and each time I have declined, thinking this isn't really an illness we'd be exposed to. Also, I've asked some friends and their pediatricians haven't brought this up as part of their children's routine care. But given the recent Hepatitis A outbreak, I'm now more concerned. Are pediatrician's generally recommending this? How long has it been out/what's the info. on it? Thank you! (Please note: I have given my children all their vaccines, except for this and chickenpox, so this is not a post about the pros/cons of vaccines.) anon

After college and before settling down, I traveled the world, including to some places that had high incidence of Hepatatis A. Before traveling to several places and while I was in some regions, I had the dreaded (painful and not-too-long-lasting) Gamma Globulin shot to prevent Hepatitis A. I would love my children to travel as I did, without having repeated Gamma shots. That is why I chose for my children to have the Hepatitis A vaccine. LC
Our pediatrician did not recommended the Hep A vaccine as part of standard care, but we did have our (then) 2.5 yr old vaccinated because we travel frequently to Greece. That was 2.5 years ago, and we've experienced no problems as a result of the vaccine. anon
As a pediatrician, I recommend the Hep A vaccine but don't push it the way I would some of the others that I feel very strongly about. It is not required for schools. As a Californian, you and your child are at higher risk for getting Hep A through restaurant food, daycare, etc. (it can be passed through poor handwashing--ie fecal-oral) just because the rate in this state is higher than many other places. The disease can be nasty (painful, hospitalizations) and sometimes fatal although it doesn't usually result in death. The vaccine has very few side effects (most people have nothing, a few get a day of poor appetite, headache). pedimama
The Hepatitis A vaccine has been used routinely in California for kids over 2 for several years (and prior to that has a very long history of being used as a trav! el vaccine). One of the reasons it has become a routine vaccine in California is that Hepatitis A actually is quite common in California (though less so, since using the vaccine). Hepatitis A had been more common in the western states of the US, and many states in the east hadn't been using it routinely (though if Pennsylvania wasn't, they probably will now!) It still is around -- there was a child with Hepatitis A in a daycare in Oakland a few months ago. It's also very safe -- the only side effect is a headache, but even that usually only occurs in adults. anon
For objective professional information readily available at a click of your mouse...don't take it from me, see the web information available from the US Centers for Disease Control & Prevention (CDC). For example, to find information on the hepatitis A vaccine follow the following trail:
The CDC ''Health Topics A to Z home page'': http://www.cdc.gov/health/default.htm Information about all immunization topics: http://www.cdc.gov/nip/ A ''quick reference disease chart'' for immunization information: http://www.cdc.gov/nip/diseases/disease-chart-public.htm A vaccine ''information sheet'' for hepatitis A http://www.cdc.gov/nip/publications/VIS/vis-hep-a.pdf

Where to Find Thimeresol-Free Hep B Vaccine?

Nov 2004

I am a member of Kaiser, which only carries the multi-dose Hep B vaccine that contains thimeresol. Does anyone know of a location/clinic where their vaccine doesn't contain mercury and I can get the vaccine for my (almost) 2-year old, and you don't have to be a member? I'm not looking for a discussion about vaccines or thimeresol, I just need to find a provider or place where I can access the Hep B vaccine without this preservative. I am willing to pay for the vaccine, if necessary. Thanks for the help. Michelle

Are you sure it has thimerosal? Our Kaiser pediatrician told us that all the children's vaccines they use, except flu, are thimerosal-free. David

Hepatitis B Immunization

Jan 1999

This past Friday, my family and I were watching 20/20 and became very interested in the series discussing children and the Hep B shot. Apparently several young children reacted badly to the immunization and some even died. Although the doctors that spoke for the immunization shot, explained that those children who had a bad reaction did so for specific and unusual circumstances. I am still concerned for the well being of my son. So far, he has received his two first doses of the shot, and in February he is due for his third. He had no reaction to the first two, just the typical pain around the area and a slight fever. I realize that all schools require children to be up to date with their shots (which he is), but I am interested in first finding out what are possibilities for my son to have a bad reaction. For many years, I've had no doubts on what my son's Pediatrician recommended for him. But now I am wondering if maybe I should be a bit more stern and ask lots of questions. Can any parent provide me with any information on where I can do more research on this issue? Or if any parent can share their experiences with this issue I would really appreciate it? Maybe I am overreacting, but I can't be too careful with my son's health. Thank you! Monica

I thought the message below might be of interest to the parent who expressed concerns about the Hepatitis B vaccine. Apparently, many are quite outraged about that 20/20 segment and feel it unfairly casts suspicion on the vaccine. Laura

For those continuing to follow this thread, the news story on hepatitis B vaccine did air on ABC's 20/20 News Program on Friday, January 22, 1999. As anticipated it presented anecdotal reports of individuals who suffered coincident illnesses, syptoms, or death near, and in some not so near, to the receipt of a dose of hepatitis B vaccine. A molecular biologist, Dr. Bonnie Dunbar, Baylor College of Medicine, was also featured expressing concern about adverse events as she observed immune problems develop in a relative and others following vaccination.(1)

The reporter who presented this segment, Sylvia Chase, questioned the logic of universal HB immunization strategy in lieu of reports of adverse reactions occurring temporally with administration. The broadcast portrayed universal coverage as an unnecessary intrusion from big government. More on this is available from ABC's web site at the following URL (accessed 1-25-99): http:www.abcnews.go.com/sections/living/DailyNews/hepb2020.html

Other reports continue to appear since the 20/20 broadcast as Reuters has posted an article, Hepatitis B vaccine in children questioned which is available at: http://www.medscape.com/reuters/tue/t0125-3f.html These reports will likely generate questions by the general public and health care workers which can be answered by pulling in resources provided earlier to the list from the CDC web site.

In the US each year 4,000-5,000 deaths are attributed to hepatitis B infection, 130,000 cases of new HBV occur annually, and 1.25 million people have chronic HBV. The World Health Organization(WHO) further estimates global prevalence of 350 million chronic carriers of HBV and 1 million deaths/year. One question raised is why universal immunization in countries with relatively low endemicity? Van Damme, Kane and others from the WHO have answered this by pointing out the incidence of new infections and the burden of acute and chronic disease place hepatitis B among the most important communicable diseases...mortality from HBV was five times that from _H. influenzae type B_and 10 times that from measles before routine vaccination of children was introduced. (2) Van Damme and others go on to point out the failure of immunization campaigns aimed only at high risk groups. Adverse events such as multiple sclerosis, rheumatoid arthritis, and a number of other intercurrent conditions have been alleged to be associated with receipt of HB vaccine. Under scientific scrutiny none of these holds up; save for rare episodes of anaphylaxis these vaccines are very safe and effective.(3-5) Instead there is misinterpretation of reports in the U.S. Vaccine Adverse Event Reporting System(VAERS) as demonstrating causality - this system incorporates all reports which are confounded by its passive nature and is not intended to establish causality.

Last, the following was just published in MMWR, which may, in part, be prompting all the attention on this vaccine. This remains the correct strategy, in my opinion. Update: Recommendations to Prevent Hepatitis B Virus Transmission United States, was published as a Notice to Readers in the January 22, 1999, issue of the MMWR. available at: http://www.cdc.gov/

1. Marshall E. A shadow falls on hepatitis B vaccination effort. Science 1998;281(31 July): 630-1.

2. Van Damme P, Kane M, Meheus A, et al. Integration of hepatitis B vaccination into national immunization programmes. BMJ 1997;314:1033-7.

3. Niu MT, Rhodes P, Salive M, et al. Comparative safety of two recombinant hepatitis B vaccines in children: data from the VAERS and VSD. J Clin Epidemiol 1998;51(6):503-10.

4. WHO. Expanded programme on immunization(EPI). Lack of evidence that hepatitis B vaccine causes multiple sclerosis. Weekly Epidemiological Record 1997(23 May);72:149-52.

5. Lemon SM, Thomas DL. Vaccines to prevent viral hepatitis(review). N Engl J Med 1997;336(3):196-204. Russell N. Olmsted, MPH,CIC Epidemiologist, Infection Control Services

Thomas G. Robins, MD, MPH
Associate Professor of Occupational Medicine, University of Michigan School of Public Health
Department of Environmental and Industrial Health
1420 Washington Heights
Room M6007 SPH II 2029
Ann Arbor, MI 48109-2029

I've spent some time researching the Hep B vaccine. It's the one vaccine I did't have done on schedule for my daughter who is now 2 years old. I too was alarmed by the 20/20 story. After much agonizing deliberation, I have decided to claim a philosophical exemption to the vaccination requirements which is allowable by law under the California Public health Code. From what I've read, since widespread use of the vaccine is relatively new (15 years or so) and adverse reactions that have occurred are usually reported within a few days after the administration of the vaccine, it's hard to determine the possible long term negative effects. Many people (several nurses who were vaccinated as adults) now have MS like symptoms and auto-immune responses which they feel (but cannot prove)are related to the vaccine. A very interesting and credible web site to check out is: hhtp://aspin.asu.edu/msnews/dunbar.htm. There are several pro vaccination choice sites on the web. Unfortunately I didn't bookmark them ,but a search under Hep B vaccine will turn them up. As a health care worker, I have seen people die from diseases resulting from chronic active hepatitis B. It's a terrible disease, but from what I have read, the chances of my daughter having a bad reaction to the vaccine are greater then her getting the disease (which is spread in the same ways that AIDS is spread...although it is much more contagious.....but unlike HIV, most people recover from Hep B.) The vaccination was banned in France except for newborns. French scientists believe there is an association between beginning the vaccine after 2 months of age and developing diabetes.

While I think a strong public health case can be made for the Hep B. vaccine, certain individuals could possibly be at higher risk for complications. What tipped the scales for me is that both my husband and I have auto immune diseases and my daughter already has some pretty severe allergies and a condition which may be auto-immune related. Although CDC and other public health organizations claim the vaccine is safe, all the anecdotal horror stories give me pause and I would like to see these cases be thoroughly studied before I subject my daughter to possible risk.

Incidentally, the manner in which the vaccine was researched and developed is often used as a case study in medical ethics text books Institutionalized mentally retarded children in New York were injected with live virus to give them the disease! Joyce

The vaccination was banned in France except for newborns. French scientists believe there is an association between beginning the vaccine after 2 months of age and developing diabetes.
Could the person who posted this please elaborate as to when it was banned? As of late July '98, when I read an article in L'Express about the vaccine,it was being routinely given to middle-schoolers in France, and government officials were saying that the risks of adverse effects from the vaccine were many times lower than the risk of adverse effects from contracting the disease. Jennifer
The following is from http://www.909shot.com In October 1998, France became the first country to end hepatitis B vaccination requirements for school children after reports of chronic arthritis, symptoms resembling multiple sclerosis and other serious health problems following hepatitis B vaccination became so numerous that the Health Minister of France suspended the school requirement. There was a much more extensive website about the French ban but I unfortunately could not find it again. If you have any other information regarding the vaccine or whether or not it was indeed banned in France, please post it. Joyce
The word from France is at: http://www.sante.gouv.fr/htm/actu/hepat_b/index.htm
In French, of course. My French is a little weak, but I think M. Kouchner is saying vaccination remains recommended for babies, adolescents, and adults at risk. I would love to see a more complete (and reliable)translation. John
To confirm John's translation: yes, your translation is correct. Sorry I don't have time to do a complete translation, but I did want to add that the reason why the French gov't still recommends vaccinating newborns is twofold: 1) there is no evidence of the vaccine causing neurological damage in children under 5 (however, I didn't read this closely enough to determine whether they were referring to children vaccinated before age 5 or children under age 5 showing symptoms of neurological damage). 2) they didn't want to discourage universal vaccination. Jennifer
Most preschools require a list of immunizations which conforms with the list of immunizations that are required by the state law - including hepatitis B. What most preschools don't tell you: you can ask for an extra form where you sign that for personal reasons or something like that you don'n want to have immunized your child and that you will take the entire responsability of the health of your child which in fact you do anyway.

We had decided not to have the Hepatitis B shot for our son and when we came to California for one year we did not want to revise our decision just get our son into a preschool. So we were happy to solve the issue just by a signature. In our opinion, immunizations are a very difficult and personal decision. Get as much information as you can and decide then. Consider possible allergies, personal situation, time needed to take care of a sick child, risks of infections, overseas-trips et cetera. Georg

Hepatitis C

Oct 2004

Does anyone out there have any experience with Hepatitus C and any form of treatment, conventional or otherwise. My sister has been diagnosed with this ddisease,probably the result of a blood transfusion in the late 70s. She is terrified of the conventional treatment which is interferon, yet she is afraid to rely on alternative approaches, and has no information about alternatives. The doctor says the treatment has only a 50-60% chance of working. Yet she has been told that with not doing anything there could be anywhere from a 10 to 33% chance of serious damage to her liver. My sister has no liver damage so far, and no symptoms,except that her few muscle and joint aches could possibly be symptomatic for her. (She is 56 years old. As her 55 year old sister without Hepatitus, I have LOTS of muscle and joint aches.) We would appreciate any insights or helpful information that would help my sister decide how to treat her illness.

My younger sister has had Hepatitis C for a number of years. She had quite a bit of liver damage prior to the current treatment method of using interferon, and she was in line for a liver transplant. About 2 years ago she participated in a study using interferon. It made her quite ill; she said it was like having the flu for months, and she had to take off from work whenever she was doing the interferon treatments. She is the director of a non-profit in Arkansas. But it really worked. She's had a clean bill of health at all of her checkpoints the last 2 years. There is always the chance that things may change, so she will have to keep up with the twice-a-year checks all her life, but she feels great and is able to work and be productive. She said the interferon was pretty bad but the alternative is much worse. If you want, send me email and I can put you in touch with her.
I have both hepatitis C (HCV) and type 1 diabetes. I have decided to not do any conventional treatment for the HCV. With type 1 I have to pay attention to what I eat etc., so that works well for the HCV as well. Most of the time I feel healthy, I don't have any symptoms of liver disease, and my test results are normal or close to normal for both conditions. Not drinking alcohol is critical - so your sister would benefit from doing that (I'm sure her doctor told her). From what you've said, it seems that doing the conventional medical treatment would most likely cause more harm than benefit (since there are so many serious side effects). It is an individual choice, one that is difficult to make, but once I made it, I was at peace with it. Most peoplewho have HCV die with it, not from it. It can be quite serious, but given your sister's situation, as long as she continues to take good care of herself, it is likely that it will never be a major problem. (I'm not a doctor, I'm only speaking from personal experience.) Your sister needs to decide what is best for her with the advice of a good doctor. Alternative treatments like massage, chiropractic, and accupuncture can be very helpful. The biggest hurdle is dealing with the emotional issues related to having a chronic condition. I've found that psychotherapy has been the most helpful treatment of all. Melanie
There is a great website and free manual called ''Hepatitis C: Choices'' about the different treatment options for Hep C. (western med, chinese med, homeopathic, etc.) http://www.hepcchallenge.org/manual/sitemap.htm or http://www.hepcchallenge.org and click on the free download. (I think acupuncture and herbs can treat Hep C.) lori
I have a very good family friend that has Hep C from transfusion as well (Hemophelia). He started the interferon last year and before the treatment was through had no trace of hep C (He is also HIV+)!! He wouldn't be considered free and clear until 6 months after last treatment but that just passed and he has been classified as Hep C free!! He was VERY fortunate and had no side effects, this guy swims the bay every day, very healthy and was able to maintain that lifestyle while going through the treatment.

I also have three family members that do weekly interferon for MS. One cousin says that she has mild to moderate side effects the saturday after she takes the shot (every Friday afternoon). All of my relatives state that the side effects are mild enough that ibuprophen works..... LogicalMama

HEP C is a serious concern....as a nurse, i had an HIV+/HEP C positive needle stick, back before the ''cocktail'' of meds was available for HIV. i was much more concerned with the HEP C part than the HIV part I'd seriously consider the Interferon if it were my experience. Get a second opinion or a third of a virologist/immunologist. Blessings for and to your friend oonagh
I have some experience with Hepatitis C. It's a disease that kills some people (usually those who engage in high risk behaviors over long periods of time) while others can have it for decades, never experience a symptom, live a long life, and die of completely unrelated causes. The fact that your sister has no detectable liver damage and few, if any, symptoms is great news. I was told that I had Hep C after I donated blood about 5 years ago. I was experiencing no symptoms at all. A liver biopsy revealed some scarring in my liver. My gastroenterologist said that because the scarring was not severe, some docotors might say wait, do another biopsy in five years and see if the damage gets worse. However, he recommended that I do the combination interferon & ribaviron treatment, and I went ahead with it. I stuck with it for the full 48 months, and it was successful. The treatment was grueling and I have since come to understand that the success rate reflects the fact that many people start the treatment and do not finish. A small number of folks do not respond at all; since they monitor your blood monthly, this is discovered early on. I ended up having to take 9 months off from work, including 3 after the treatment was done. Fortunately, I had disability insurance, and my husband was able to really step up his childcare role (he took sole responsibility most of the time). So there's the good and the bad of my experience. I assume that your sister has seen a specialist since she must have had a liver biopsy to determine that she has no liver damage. Based on what my doctor told me, my guess is that my doctor would recommend that your sister wait and check her liver in a few years. She may be one of those who can live symptom-free for the rest of her life. On the other hand, I think it's probably better to go through the treatment when one is younger vs. older. If she chooses the treatment, I recommend that she try to arrange for disability insurance and a lot of support, particularly with childcare if she has young children. Best of luck. anon