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Immunizations

Description

An in-depth report on the purpose of immunizations and recommended schedules.


Alternative Names

Measles; Rubella; Tetanus; Vaccinations; Whooping cough


Hepatitis B

About 350 million people carry hepatitis B virus (HBV) worldwide, and each year 600,000 people die, mostly due to cirrhosis and liver cancers that develop in people with the chronic form of this disease. In the US, more than 1 million people have chronic hepatitis B.

Hepatitis B virus
Hepatitis B is also known as serum hepatitis. It spreads through blood and sexual contact. The infection is seen with increased frequency among intravenous drug users who share needles and among the homosexual population. This photograph is an electronmicroscopic image of hepatitis B virus particles. (Courtesy of the CDC.)

The average lifetime risk for acquiring the infection in the US is about 5%. Most of these infections are acquired during childhood. Pregnant women with hepatitis B can transmit the virus to their babies. Even if they are not infected at birth, unvaccinated children of infected mothers run a 60% risk of developing hepatitis B before age 5. Universal vaccination against this disease during childhood, then, is very important.

Vaccine for Hepatitis B

Several inactivated virus vaccines, including Recombivax HB, GenHevac B, Hepagene, and Engerix-B, can prevent hepatitis B. Twinrix is a vaccine against both hepatitis A and B. They are safe, even for infants and children. Vaccination programs are proving to reduce the risk for liver cancer.

Hepatitis B Vaccine for Early Childhood. Experts now recommend that all infants and children not previously vaccinated be immunized by the time they reach seventh grade. Typical schedules for hepatitis B vaccinations in childhood are as follows:

Hepatitis B vaccine protection lasts at least 8 - 10 years. Booster shots after that may be recommended depending on continuing risk, such as sexual exposure.

Hepatitis B Vaccine for Adults. The following adults are at very high risk and should be vaccinated:

Other people at risk who would benefit from vaccinations include:

The regimen in adults is typically three doses given over 6 months. One study reported that older adults would benefit from a fourth dose without incurring serious side effects. People with alcoholism may need high doses.

A small percentage of people do not develop immunity even after a vaccine has been given repeatedly. A more potent vaccine is proving to be effective for these people; it loses its effect after 5 years in about one-third of those who receive it.

Side Effects of Hepatitis B Vaccine

Soreness. Soreness at the injection site is the most common side effect.

Nerve Inflammation. There have been some reports of nerve inflammation after vaccinations for hepatitis B, and there has been some concern about three studies associating the vaccine with a nonsignificant increase in multiple sclerosis. A 2001 study of 121,700 nurses reported no association between the vaccine and a risk for multiple sclerosis, and an earlier report on 260,000 Canadian adolescents also found no higher incidence. In addition, a review article published in 2006 found no evidence that hepatitis B vaccine is associated with multiple sclerosis, sudden infant death syndrome, or chronic fatigue syndrome.

Because of even a small theoretical risk of nerve damage in infants, some groups oppose the vaccination in children who are not in high-risk groups. Worldwide, 65 million people with chronic hepatitis are expected to die from liver disease and vaccinations are saving lives. For example, in Taiwan, where infection rates are high and infants are at risk for hepatitis B from infected mothers, vaccination programs have significantly reduced the risk for liver cancer. [For more information see In-Depth Report #59: Hepatitis .]


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