Despite recommendations, few people with chronic hepatitis C are being vaccinated against the hepatitis A virus.
In most people, the hepatitis A virus causes a relatively mild, short-lived infection. But in people with hepatitis C, a hepatitis A infection can be much more serious — even deadly.
Although the hepatitis A vaccine has been available since 1995, a surprisingly low number of people with hepatitis C were vaccinated, the researchers write. Their study appears in the new issue of Hepatology.
Testing and Vaccinating
Edward J. Bini, MD, MPH, and his colleagues identified 1,193 patients who were diagnosed with hepatitis C in the year 2000. Bini is a physician with the New York University School of Medicine.
Follow-up information was collected through June 30, 2002, to establish the number of patients who were tested for hepatitis A and the number who actually received the hepatitis A vaccine. A blood test looking for antibodies to the virus can determine if someone is immune to the hepatitis A virus.
Patients were considered to be vaccinated if they received one or more doses of the vaccine. A second dose of hepatitis A vaccine is typically given 6 to 18 months after the first shot.
Less than 54 percent of patients were tested for hepatitis A antibody despite having been seen an average of 10 times by their doctor. Almost half of these were susceptible to hepatitis A infection.
Yet only 94 patients received the hepatitis A vaccine and of these, 45 received only one dose.
A total of three hepatitis C patients also developed hepatitis A infection, one of whom died of liver failure.
All of them were known to be susceptible to hepatitis A - but none had received the vaccine.
"The low rates of hepatitis A testing and vaccination are striking given the presence of recommendations since 1996 to vaccinate these individuals against hepatitis A, the long duration of follow-up, and the high number of visits with their primary care provider," Bini writes.
Why So Low?
What accounts for the low vaccination rates? There could be a variety of reasons, according to the researchers:
—Patient refusal (believing they weren't at risk for hepatitis A infection)
—Doubts about the vaccine's effectiveness or misconceptions about its side effects
—Lack of knowledge on the part of doctors
—Lack of resources
—A need to address more pressing health issues during medical visits
How Hepatitis A Is Spread
Hepatitis A is usually spread by putting food or objects contaminated with the stool of a person with hepatitis A in the mouth. Hepatitis A is most common in areas of the world where there are poor sanitary conditions or where good personal hygiene is not observed.
In the U.S., hepatitis A is spread mainly among people who have close contact with someone who has the virus. You can become infected with hepatitis A if you:
—Eat food prepared by someone who does not wash his or her hands well after using the bathroom or changing a diaper
—Don't wash your hands after changing a diaper
—Eat raw or undercooked shellfish that was harvested from waters contaminated with raw sewage
—Have sexual contact with your partner's anus
Symptoms Sometimes Nonexistent
People infected with hepatitis A may not ever develop outward symptoms. But symptoms — potentially serious — are much more likely to occur in people with liver disease, such as hepatitis C.
Usually, symptoms appear without warning. They may include:
—Loss of appetite
—Jaundice (yellowing of the skin and eyes)
SOURCES: Bini, E. Hepatology, September 2005; vol 42: pp. 688-695. News release, John Wiley & Sons, Inc. WebMD Medical Reference From Healthwise: "Hepatitis A."