The quiet epidemic

By Andrea Makshanoff, On-line Forty-Niner

April 13,1998

Some medical advisers are recommending that young adults get vaccinated against hepatitis B; but is the disease really a risk?

 

In the national annals of organizations such Centers for Disease Control and the American Liver Foundation, keywords like "quiet," "growing," and "silent epidemic" are linked with the disease known as chronic viral hepatitis B.

 

Each year in the United States, it is estimated that 140,000 to 320,000 people will get hepatitis B. Seventy percent of infections will be in young adults, and 5,000 to 6,000 people will die of an illness caused by hepatitis B, according to Center for Disease Control statistics.

 

The nation's medical advisers such as the Advisory Committee on Immunization Practices, the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) recommend routine hepatitis B vaccines, which have been available only since 1982, to combat what they see as an epidemic in the making

 

Sarath Gunatilake, a medical doctor who teaches in the Cal State Long Beach health science department, said that it is 100 times more easily passed from person to person than the AIDS virus."

 

"It is much stronger - it can live outside the body for days," Gunatilake said.

 

The CDC reports that the most frequently reported risk factors for hepatitis B are heterosexual activity (41 percent), drug use (15 percent), homosexual activity (9 percent), household contact (2 percent) and health care employment (1 percent). However, close to one-third of infected persons have no identifiable source for their infections.

 

American College Health Association (AHA), the principal leadership organization of university health services, strongly recommends that all students be vaccinated against hepatitis B prior to college entry.

 

According to CDC literature, hepatitis B is a primarily known as blood-born viral microorganism that attacks the liver. The virus can cause life-long infection, cirrhosis, liver failure and cancer, and death. There is some indication that saliva and other body fluids can also carry the disease.

 

Frequently changing roommates, high sexual activity and the common trends of getting pierced, tattooed and manicured make college students prime candidates for contracting hepatitis B.

 

Dr. John Dorman, a Stanford University student health center physician who is the designated speaker on hepatitis B at the ACHA convention in June 1998, said that today the disease has the potential to reach the height of measles outbreaks on campuses in the 1960s.

 

Then, like today, younger children were being routinely vaccinated, while the older were not. Dorman said that the measles outbreaks were so serious that at one Christian Science college, five students died.

 

At Stanford, Dorman said he follows the ACHA guidelines for college students. The disease is more common and more contagious than HIV, and is transmitted the same way, sexually, he said. Heterosexual activity is a threat when young and college-aged adults have more than one partner in the last six months. Household contact such as sharing a roommate's toothbrush or razor is a risk, when that person is a carrier of hepatitis B.

 

Despite recent medical reports warning against the risks, CSULB Student Health Services does not follow the ACHA guidelines on hepatitis B immunization.

 

Without a computerized tracking system at Health Services, there is no way to tell how many hepatitis B cases have been diagnosed, but Renee Twigg, director of Student Health Services, said she does not believe there is a problem.

... close to one-third of infected persons have no identifiable source

for their infections.

Dr. Rebecca Wills, Student Health Services chief physician, said that in cases when hepatitis B case is diagnosed, the center treats the patient, reports the case to the Long Beach health department, and then the information is filed with the individual's records. A master file of communicable cases in not kept.

 

The biggest factor is not giving the hepatitis B vaccine Twigg said is the cost -- $105 for the series.

 

"It's just not cost effective. Students will not pay for it," Twigg said.

 

Wills said that is is difficult to get a student to even pay for a $9 chlamydia test, and that the storage requirements for the vaccine are difficult.

 

"The state of California doesn't require it,." Wills said. "We follow the state guidelines on vaccinating for measles, mumps and rubella.

 

"The three-injection hepatitis B immunization series must be taken over six months, with the second shot one month after the first, and the third shot five months afterward.

 

Twigg said that in such a long series, it is likely that many students would not comply with the immunization schedule since a student may not even be on campus in six months after the first injection.

 

At the Long Beach Department of Health and Human Services, the vaccine is in stock and is routinely given to children, but an adult or teenager cannot receive it.

 

John Aguirre, epidemiologist supervisor at the Long Beach department, said that the rate of acute hepatitis B in Long Beach has actually declined in the last six years.

 

According to Aguirre's data, the trend of hepatitis B has been definitely downward. In 1997, there was a mere 1.9 cases in Long Beach.

 

Aguirre said that the introduction of the hepatitis B vaccine and AIDS education emphasizing condom use has been effective in dropping hepatitis B cases, and they are depending on it to continue.

 

According to an age-specific data extraction supplied by Aguirre, 53 percent of all cases in Long Beach occurred in persons 29 years and younger.

 

However, Aguirre said, "It doesn't necessarily mean hepatitis B is not out there."

 

A CDC 1996 report based on National Notifiable Disease Surveillance System data, said a significant and prolonged decline of hepatitis B cases in 38 states, which have reported decreases an average of 27 percent.

 

In the West, however, the incidence of the disease has been higher and with more variation, or up and down swings.

 

For some physicians, this is enough to recommend the vaccine for all young adults.

 

Dr. Kevin Cook, a physician at the University of Santa Barbara student health center with a masters in public health, said there is no question who should be immunized against hepatitis B.

 

"I recommend vaccination in junior high school, or when someone is sexually active, and does the ACIP and pediatricians association," Cook said.

 

Cook's comments echo further the warnings of the CDC and recommendations of ACHA.

 

"That is how strongly I feel about it," Cook said. "There is no need to have this problem if everyone has access to the vaccine."

 

Cook said that one can get the disease, not have the symptoms and yet be a carrier.

 

"A lot of folks who get hepatitis B become carriers, say 12 percent/ About 10 percent or so of these will go on to develop liver cancer and die," Cook said.

 

Since 1990, national policy, has been to routinely vaccinate infants and children against hepatitis B, starting immediately at birth, two months before the polio or diphtheria-tetanuspertussis vaccine is recommended.

 

More recently, the campaign to vaccinate against hepatitis B, has been extended to older children, the 11- to 12-year-old, before they become teenagers and young adults.

 

Vaccinating infants will eliminate the need to vaccinate teenagers and at-risk adults, according to reports.