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What you need to know about the HVB vaccine

Chris Miller

Beginning June 1, 1999, the CDC indicates that each health-care provider who administers any vaccine that contains hepatitis B (or Haemophilus influenzae type b [Hib], varicella [chickenpox], measles, mumps or rubella vaccines), shall, prior to administration of each dose of the vaccine, provide a copy of the relevant vaccine information to the person (or parent/guardian) who is to receive the vaccine. The relevant information for the hepatitis B vaccine, according to CDC, is presented below and provides a good update for all dental health-care workers.

Why get vaccinated? Hepatitis B is a serious disease. The hepatitis B virus (HBV) can cause short-term (acute) illness that leads to:

- Loss of appetite

- Diarrhea

- Tiredness

- Jaundice (yellow skin or eyes)

- Pain (muscles, joints and stomach).

It also can cause long-term (chronic) illness that leads to:

- Liver damage (cirrhosis)

- Liver cancer

- Death

About 1.25 million people in the U.S. have chronic HBV infection. Each year, it is estimated that 200,000 people, mostly young adults, get infected with HBV. More than 11,000 people have to stay in the hospital because of hepatitis B, and 4,000 to 5,000 people die from chronic hepatitis B, Hepatitis B vaccine can prevent hepatitis B. It is the first anti-cancer vaccine because it can prevent a form of cancer.

How is the hepatitis B virus spread? HBV is spread through contact with the blood and body fluids of an infected person. A person can get infected in several ways, such as:

- During birth when the virus passes from an infected mother to her baby

- By having sex with an infected person

- By injecting illegal drugs

- By being stuck with a used needle on the job

- By sharing personal items, such as a razor or toothbrush with an infected person.

People can get HBV infection without knowing how they got it. About one-third of hepatitis B cases in the U.S. have an unknown source.

Who should be vaccinated? When? Everyone 18 years of age and younger, and adults over 18 who are at risk should be vaccinated. Adults at risk for HBV infection include people who have more than one sex partner, men who have sex with other men, drug users, health-care workers, and others who might be exposed to infected blood or body fluids.

People should get three doses of the hepatitis B vaccine according to the following schedule. If one misses a dose or gets behind schedule, the next dose should be taken as soon as possible. There is no need to start over.

For children, adolescents, or adults:

(1) The first dose is given anytime.

(2) The second dose is given 1-2 months after the first dose.

(3) The third dose is given at least two months after the second dose and at least four months after the first dose (4-6 months after the first dose).

For infants whose mother is infected with HBV: The first dose is given within 12 hours of birth.

* The second dose is given at 1-2 months of age.

* The third dose is given at 6 months of age, but not before.

For infants who?s mother is not infected with HBV: The first dose is given at birth to 2 months of age.

* The second dose is given at 1-4 months of age (at least 1 month after the first dose).

I The third dose is given at 6-18 months of age, but not before.

All three doses are needed for full and lasting immunity. The hepatitis B vaccine may be given at the same time as other vaccines.

Who should not get the vaccine, or should wait? People should not get hepatitis B vaccine if they have ever had a life-threatening allergic reaction to baker?s yeast (the kind used for making bread) or to a previous dose of hepatitis B vaccine. People who are moderately or severely ill at the time the shot is scheduled usually should wait until they recover before getting the hepatitis B vaccine, and ask the doctor or nurse for more information.

What are the risks from hepatitis B vaccine? A vaccine, like any medicine, is capable of causing serious problems, such as severe allergic reactions. The risk of hepatitis B vaccine causing serious harm, or death, is extremely small. Getting the hepatitis B vaccine is much safer than getting hepatitis B disease. Most people who get hepatitis B vaccine do not have any problems with it.

Y Mild problems: Soreness where the shot was given, lasting a day or two (up to 1 out of 11 children and adolescents, and about 1 out of 4 adults)

Y Mild to moderate problems: Fever (up to 1 out of 14 children and adolescents, and 1 out of 100 adults)

Y Severe problems: Serious allergic reaction (very rare)

What if there is a moderate or severe reaction? First, look for any unusual condition, such as a serious allergic reaction, high fever, or behavior changes. Signs of a serious allergic reaction can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heartbeat, or dizziness. If such a reaction were to occur, it would be within a few minutes to a few hours after the shot. If a reaction does occur, call a doctor or get the person to a doctor right away. Tell the doctor what happened, the date and time it happened, and when the vaccination was given. Ask the doctor, nurse, or health department to file a Vaccine Adverse Event Reporting System (VAERS) form or call VAERS at 1-800-822-7967.

In the rare event that one has a serious reaction to a vaccine, a federal program has been created to help pay for the care of those who have been harmed. For details call the National Vaccine Injury Compensation program (NVIC) at 1-800-338-2382 or visit the NVIC Web site at http://www.hrsa.dhhs.gov/bhpr/vicp.

You can learn more about the hepatitis B vaccine by contacting your doctor, your local or state health department?s vaccination program, or the CDC (1-800-232-2522). The National Immunization Program?s Web site is http://www.cdc.gov/nip. The CDC?s hepatitis branch Web site is http://www.cdc.gov/ncidod/disease/hepatitis/.

References available upon request.

Chris Miller is director of Infection Control Research and Services and professor of oral biology at Indiana University.

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