Published Date: 1998-10-11 23:50:00
Subject: PRO> Hepatitis A, food-borne - USA (Maryland)(04)
Archive Number: 19981011.2006
HEPATITIS A, FOODBORNE - USA (MARYLAND) (04)
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See Also
Hepatitis A, food-borne - USA (Maryland) 980924162637Hepatitis A, food-borne - USA (Maryland)(02) 980926204900
Hepatitis A, food-borne - USA (Maryland)(03) 980929162602
[1
Date: Tue, 29 Sep 1998 21:16:22 -0400
From: "Bill Graney" <wmgraney@bellatlantic.net>
Readers can find current opinion on Hep A in CDC's MMWR Prevention of
Hepatitis A through Active or Passive Immunization, Recommendations of
the Advisory Committee on Immunization Practices. There is also an
excellent summary for consumers. Both are available at:
http://www.cdc.gov/ncidod/diseases/hepatitis/a/
Post-exposure prophylaxis with Hep A vaccine is not approved and is not
supported by clinical trials that I could find. There is chimpanzee
data
indicating some value and the Thai studies suggested that effective
levels
of antibody develop by day 19. This leaves almost 3 weeks without
protection from a disease with an incubation period of 2 to 4 weeks.
In fact, Hep A vaccine may have a role in community prophylaxis after
the start of an outbreak, but that is to protect uninfected individuals.
All that being said, it's too bad that a real shortage of gamma-globulin
persists, attributed to withdrawal of products for fear of various
contaminations, manufacturing/quality control difficulties, as well as
the difficulties with licensing facilities in the U.S.
Just wash your hands a lot.
--
Bill Graney, M.D.
Collegeville, PA
<wmgraney@bellatlantic.net>
***
[2
Date: Tue, 29 Sep 1998 15:05:16 -0700
From: "DeBolt, Chas" <Chas.DeBolt@METROKC.GOV>
In response to the request for literature references regarding the use
of Hepatitis A vaccine to protect "those who ate at the restaurant, i.e.
who were exposed", please see on page 246 in the 1997 Red Book
(Report of theCommittee on Infectious Diseases, American Academy
of Pediatrics):
"HAV vaccine for postexposure prophylaxis: Available data are
insufficient to recommend HAV vaccine alone for postexposure
prophylaxis. However, several studies and clinical trials suggest
that HAV vaccine, with or without concurrent IG administration,
may provide effective postexposure prophylaxis by inducing
protective serum antibody concentrations before the
usual 4-week incubation period for HAV infection."
--
Chas De Bolt, RN MPH
Vaccine-preventable diseases epidemiologist
Prevention Division
Seattle King County Department of Public Health
999 Third Avenue, Suite 900
Seattle, Washington 98104-4099
Phone: (206) 296-4774
Fax: (206) 296-4803
E-mail: chas.debolt@metrokc.gov
***
[3
Date: Tue, 29 Sep 1998 17:36:21 -0400
From: "Dr. Patricia \"Trish\" Somsel" <SOMSELP@mercyhealth.com>
Dr Arnold Monto, School of Public Health, University of Michigan, has
been looking into the efficacy of immunization as post-exposure
protection. The impetus is the [high cost of immune globulin, its
[lack of availability, and the difficulties of maintenance of the
antisera in more remote areas of the world.
Having been involved from many different perspectives in the outbreak in
our county last year (remember the tainted strawberries in the school
lunch program?) I can understand the impetus to provide immune globulin.
Over 300 school kids, parents and other secondaries were sickened in
this
county, leading to sizable health care costs (hospitalization for some,
lab
tests for the others), lost wages (parents who had to stay home when
kids
couldn't attend school or day care) and public outcry. 11 000 doses of
immune globulin were administered. No one died but many were very ill
for a couple of weeks because they did not experience this
illness as toddlers; the cost to a society such as ours where so many
homes have two wage earners is enormous when serious illness interferes
with normal life.
This came on the heels of an outbreak two years previously begining in
a large day care [center and spreading into families from asymptomatic
children. Thus there is a strong movement in Calhoun County for an
immunization initiative for kids 2-15. Many parents will be lining up
also,
even though no one anticipates such a large outbreak again, here or
anywhere else in the US.
--
Trish Somsel, Dr.P.H.
Microbiologist/Epidemiologist
Regional Medical Laboratories, Inc.
Chair, Calhoun County Board of Health
<SOMSELP@mercyhealth.com>
***
[4
Date: Wed, 7 Oct 1998 18:57:37 -0700
From: "Zents, James" <JZents@phelpsdodge.com>
Hep A vaccine gives rise to protective titers of antibody in less than
48 hours and hepatitis A has an incubation period of 2 to 6 weeks. In
theory, anyway, this means that post exposure vaccination should be
effective. It would be nice to see some research on this but I don't
expect anyone to do the work anytime soon. At least consider this
suggestion however -- we need to consider the risk of gamma-globulin as
well.
--
James Zents
<JZents@phelpsdodge.com>
[So there is no consensus as to whether post-exposure vaccination does
any good in preventing hepatitis A. On that inconclusive note, this
thread is cut - Mod JW
.....................jw
--
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