Hepatitis B: Available Vaccine Safe but Underused

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HEPATITIS B Available Vaccine Safe but Underused

Usually when a vaccine is found for a disease, the number of cases drops dramatically. But that hasn't happened with hepatitis B, a viral disease that attacks the liver.

According to the federal Centers for Disease Control, reported cases of acute hepatitis B continued to increase after the first vaccine was introduced in 1982 and reached a peak in 1985. CDC adds that even though the number of cases reported has decreased "modestly" since 1985, the number of new cases each year is still higher than before the vaccine was introduced. What happened?

Vaccination Strategy

Current public health efforts to prevent the disease have focused on vaccinating people in high-risk groups. Those at greatest risk are:

* intravenous (IV) drug abusers

* heterosexuals with multiple partners

* homosexual men

Other risk groups include:

* health-care workers

* children born to immigrants from China, Southeast Asia, and other areas where hepatitis B is very common.

This focus on high-risk groups has met with mixed success. In a New England Journal of Medicine editorial that appeared last November, Jay H. Hoofnagle, M.D., a researcher with the National Institutes of Health, explains that "Even in health care workers, the most easily reached and medically aware high-risk group, hepatitis B vaccination programs have not been completely successful: recent surveys show that less than 50 percent of the health care workers at high risk of contracting hepatitis B have received an adequate course of vaccination against the virus."

Even though fewer than half of health-care workers have been vaccinated, the number of cases of hepatitis B in that group dropped 75 percent between 1981 and 1988, according to a study by CDC published in the March 2 issue of the Journal of the American Medical Association. The study's authors, Miriam J. Alter, Ph.D., chief of epidemiology in CDC's hepatitis branch, and colleagues, say this drop is probably a direct result of immunization efforts and greater adherence to safe blood-handling procedures.

In addition to the drop in cases for health-care workers, the cases of hepatitis B have dropped 62 percent among homosexuals, "most likely as a result of a modification of high-risk behavior," according to the CDC study. But, during the same period, cases in IV drug abusers increased 80 percent.

Though these declines in cases are encouraging, vaccination efforts to reach some high-risk groups have been thwarted by the public's lack of knowledge about the disease's risks, the lack of government programs, the cost of the vaccine, and the inability to reach most of the high-risk populations, according to CDC.

Lack of knowledge is definitely part of the problem when it comes to health-care workers, says Jim Paturas, president of the National Association of Emergency Medical Technicians. According to a telephone survey last July commissioned by SmithKline Beecham, Philadelphia, which manufactures one of the hepatitis B vaccines, 26 percent of health-care workers don't think their jobs increase their risk of hepatitis B infection. Many health-care workers are "not in tune with the risk they are presented with daily," says Paturas. He adds that efforts to inform health-care workers about the risks of the disease must be increased.

Easier to Catch Than AIDS

Although health-care workers and others at risk may not be getting--or may be ignoring--information geared to them about the dangers of hepatitis B, there is no lack of scientific information. How the hepatitis B virus is spread is fairly well understood.

Like AIDS, most cases can be traced to contact with infected blood, unprotected sexual intercourse, and needle-sharing among IV drug abusers. Infants born to infected mothers may be infected when they pass through the birth canal. …