Debate Growing Over Hepatitis Vaccination for Children, Young Adults
Fur and Oreo walk San Francisco’s streets, passing out clean needles and condoms to thousands of intravenous drug users.
It used to be mostly about stopping the spread of HIV. Now the two recovering drug addicts are part of a growing effort to get the city’s young addicts immunized for hepatitis A and B, the latter of which spreads like HIV but is about 100 times more contagious.
“Some kids don’t want to hear it at first, especially the younger ones,” says Fur, who’s 24. “But I just tell them, ‘Hey, hepatitis is just as slow and painful a disease as HIV.’ ”
The Centers for Disease Control and the American Academy of Pediatrics recommend that all newborns, infants and children--especially sexually active teenagers--be vaccinated against hepatitis B. But some people, like Kathy Rothschild of Illinois, are fighting the move.
“What are the chances of my child getting it from another child?” said Rothschild, who is leading a campaign to fight mandatory hepatitis B vaccination of fifth-graders in Illinois. “It’s like zero. It doesn’t exist.”
Fur and Oreo, her 20-year-old boyfriend, are part of a UC San Francisco study aimed at getting intravenous drug users younger than age 30 tested and immunized.
Although this study targets a particularly high-risk population, there is a national trend to immunize young people for hepatitis A and B, prompted by the CDC.
Doctors say both liver-attacking diseases are preventable, like polio, which is all but nonexistent in this country.
“I wholeheartedly feel that we should vaccinate,” says Dr. Judith O’Donnell, a professor and infectious diseases expert at Allegheny University Hospitals in Philadelphia.
Doctors nationwide say they are particularly worried about hepatitis B, which can become a chronic condition that leads to liver disease and sometimes death. It is spread by bodily fluids, such as blood, semen and saliva.
Hepatitis A, most commonly spread when fecal matter is present in food or water, doesn’t become chronic, according to the CDC. The most recent national outbreak was spread by strawberries.
For hepatitis C, a newer blood-borne strain that is less understood, there is no vaccine.
Rothschild’s campaign has put fifth-grade hepatitis B vaccinations on hold in Illinois. She started the fight after she received a letter from their Glenview school saying that her 10-year-old daughter, Beth, must receive the vaccine.
Now she’s trying to get Illinois added to the list of 15 states that allow a “philosophical exemption” for parents who don’t want their kids vaccinated.
She and others say too few children contract hepatitis B to justify the cost of immunizing every kid.
“Parents are drawing a line in the sand,” says Barbara Loe Fisher, co-founder and president of the Virginia-based National Vaccine Information Center, which also sponsors an anti-vaccine group called Dissatisfied Parents Together. “They’ve been good soldiers and have given vaccines to our children in the past few decades. And now they’re saying, ‘You know, this doesn’t feel right.’ ”
Fisher’s group, which includes parents whose children have had adverse reactions to vaccines, is fighting what she calls a trend to vaccinate without enough research.
The hepatitis B vaccine should be given only to people in high-risk groups--such as health care workers, intravenous drug users and the “sexually promiscuous,” Fisher said.
Opponents also question whether the vaccine, which needs two booster shots a few months after the first shot, would last long enough to protect children in their teen-age years.
New research is showing that only one booster shot may be needed, O’Donnell said.
“Obviously, we cannot force people to undergo vaccination. It’s a voluntary thing,” she said.
But parents shouldn’t assume that their children won’t be sexually active as teenagers, she said: “I think they are probably a bit naive about what their children may or may not be doing.”
The Hepatitis Foundation International also warns that hepatitis B could be contracted from something as simple as unsanitary body piercing or blood-to-blood contact during sports.
About 140,000 to 320,000 Americans get hepatitis B every year, according to the CDC. Of those, about half have symptoms and as many as 10% become carriers, some without realizing it.
Health care workers worry in particular about teenagers because, unlike newborns who are now routinely vaccinated for hepatitis, most haven’t been vaccinated.
“It’s a big concern,” says Dr. Chris Stoehr of the San Francisco Public Health Department.
In San Francisco, there were 23 reported cases of hepatitis B last year for those under age 30; the youngest was 17. The actual number is probably higher, especially among those who use drugs and live on the streets.
The city of San Francisco is worried enough about the problem that it has donated expensive hepatitis vaccine and medical staff to the UCSF study in large part because it is reaching a high-risk population--the estimated 3,000 injection drug users in San Francisco who are younger than 30.
For “Bood,” an 18-year-old homeless man, the benefits of getting vaccinated have been twofold.
“Money and free immunization--can’t beat that,” said the Philadelphia native, who gets $10 for testing and each time he returns for the series of three hepatitis B shots.
