Newspaper article St Louis Post-Dispatch (MO)

Shot at Hepatitis Prevention with Alternative in Short Supply, Vaccine Gains Popularity

Newspaper article St Louis Post-Dispatch (MO)

Shot at Hepatitis Prevention with Alternative in Short Supply, Vaccine Gains Popularity

Article excerpt

Linn Smith watched for two years as a band of hepatitis A made its way across the Midwest toward this tourist-dependent city.

At the same time, she watched as immune globulin - medicine used to stifle the infection in exposed people - was gobbled up by the U.S. military and a manufacturer's recall, leaving local health department cabinets near empty.

A case of the contagious disease in a food service worker could be explosive in a city where about 60,000 visitors each day pass through restaurants, concession booths and ice cream stands. And Smith had reason to fear, as hepatitis A cases in southwest Missouri were on their way to rising 400 percent over the previous year. "I truthfully thought, `What am I going to do if I don't have any IG and they send me a war to fight?' " said Smith, head of Branson's health department. She turned to the only weapon she could find: a year-old vaccine that is gaining in popularity as Branson and other tourism-driven communities contemplate making it mandatory for food-service workers. Hepatitis A is passed orally or through human waste, usually by people who do not practice good hygiene. It causes inflammation of the liver and symptoms may include fatigue, abdominal discomfort, poor appetite, vomiting, fever, dark urine and jaundice. Food service workers make up less than 5 percent of hepatitis A cases, but even one case can turn into a logistical nightmare when authorities try to warn those who may have been exposed - especially when those people are tourists on the move. Couple that task with the low supply and rising costs of immune globulin, and preventing rather than curing a problem becomes all the more important, Smith said. The hepatitis A vaccine was given federal approval about a year ago, b ut the federal Centers for Disease Control and Prevention in Atlanta does not recommend it for everyone, as it does for polio or measles, in part because of the cost and because the disease is treatable. The first shot of vaccine gives a person immunity for one to 10 years. A booster shot can make that immunity last a lifetime. The hepatitis A vaccine shots given in Branson cost $40 each, more initially than the immune globulin shots, but the lifetime immunity would make the vaccine cheaper in the long run. The disease center is starting to recommend the vaccine for international travelers and the military is slowly making the transition from immune globulin to the vaccine, said Dr. Craig Shapiro, a disease center epidemiologist. The price of immune globulin has skyrocketed in the past few years. In 1990, a dose cost about 50 cents. …

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