Immunization Schedule, Adults (cont.)
Hepatitis A and B
Hepatitis is inflammation of the liver. It may be caused by medications, toxins, alcohol, or viruses. The inflammation results in injury to liver cells. The injured liver may be unable to perform functions such as toxin removal, processing of nutrients, removal of old red blood cells, or production of bile to aid in fat digestion.
Viral hepatitis is caused by the hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), hepatitis E virus (HEV), and hepatitis G virus (HGV). However, the only vaccines available are for hepatitis A and B.
Some people with viral hepatitis may have no symptoms. Others have a severe form that leads to death in a few days. Many are somewhere in between. Initially, fatigue, muscle and joint aches, upper respiratory tract symptoms (nasal discharge or sore throat), and loss of appetite occur. Nausea and vomiting are frequent. A slight fever generally is present. Pain is usually present in the upper right part of the abdomen. Five to 10 days later, jaundice (yellowing of the skin and whites of the eyes) may be present. Hepatitis can last just a short time, with symptoms going away after two to three weeks, or it can become a chronic, lifelong disease.
- Hepatitis A: Also known as infectious hepatitis, hepatitis A does not become a long-term illness. Transmission occurs via a fecal-oral route due
to such things as contaminated food or water or improper hand washing. The virus is in the stool of infected persons and if swallowed by another person may cause disease. This is more likely in crowded or unsanitary conditions. Close contact with infected people is also a mode of transmission. Death seldom occurs from hepatitis A. Especially in children, hepatitis A tends to show no symptoms. Symptoms are often more severe in adults.
- Who gets the vaccine: travelers outside the United States (except for Western Europe, New Zealand, Australia, Canada, Japan); food handlers; people with chronic liver disease; illicit drug users; men who have sex with men; certain laboratory workers; and health-care workers.
- When given: Two doses are required, given at least six months apart.
- Side effects: The vaccine is very safe and effective, but mild allergies may occur. Anyone who has had a previous reaction should avoid the vaccine. Safety for pregnant women has not been determined. Breastfeeding women may take the vaccine.
- Hepatitis B and D: Also known as serum hepatitis, this form can be found in blood, saliva, semen, and vaginal secretions. The virus is transmitted via blood transfusions, sexual contact, or contaminated needles. It is common in homosexual men and IV drug users. Infected mothers can also pass it on to their babies at the time of delivery. Between 1-10% of people with this form of hepatitis will develop chronic hepatitis. These people have a 25-40% greater risk of developing cirrhosis and liver cancer. Hepatitis D can only occur when there is also infection with Hepatitis B. Hepatitis D is uncommon in the United States, except in those requiring multiple transfusions or in IV drug users.
- Who gets the vaccine: Primary vaccination now takes place during infancy. If not immunized during childhood, the following at-risk people should receive the vaccine: all adolescents; and high-risk adults (those who have household contact with infected people; sex partners of infected people; heterosexuals with multiple sex partners in less than six months; IV drug users; people with recently diagnosed sexually transmitted diseases; people on hemodialysis for kidney failure; health-care workers exposed to blood products; inmates of correctional facilities).
- When given: Three doses are needed. After the first dose, four weeks are needed between doses #1 and #2 and eight weeks needed between doses #2 and #3.
- Side effects: Soreness at the site of injection is common. There have been reports of nerve inflammation.
Gregory L Walker, MD, FACEP, Ped EM
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