The lowdown on hepatitis vaccines, past and present

       DEAR DR. ROACH: I have some questions about hepatitis vaccines. I live in Los Angeles, and have recently seen a few articles in the local paper about an outbreak of hepatitis A in the area. I went to my hospital and requested the hepatitis A vaccine. I was given the first of a two-shot vaccine, and was told to come back in six months for the second shot. I asked the nurse how long the vaccine would protect me after I took the second shot, and she didn’t know the answer to my question.
       My next question involves the hepatitis B vaccine. In 1991, I was working in a Veterans Affairs hospital and took the three-shot series of the hepatitis B vaccine. When getting my hepatitis A shot, I asked if my hepatitis B vaccine was still good after 25 years. They drew blood to check titers. A week later, the hospital emailed me and said my titers were low and to come in for a booster shot, which I got. How come they didn’t just give me the three-shot series again instead of a booster shot? How many years will this hepatitis B booster shot protect me?
       Are they working on a vaccine for hepatitis C? I eat out a lot, and restaurant employees may or may not practice good hygiene. A vaccine seems like a good precaution for people to take, in this day and age. What do you think? — D.A.S.
       ANSWER: Hepatitis A vaccine is recommended for travelers to areas with high rates of hepatitis A. Two doses are administered, with the second dose given between six and 12 months after the first. Although we used to tell people that they needed a booster shot 10 years after the completed series, it appears that the protection from the vaccine is long-lasting, and a booster is not recommended.
       For the current outbreak in San Diego, the Centers for Disease Control and Prevention recommends vaccination for homeless individuals; staff and public workers who have close contact with homeless or illicit drug users; and food handlers for adult populations. The rate of hepatitis A in the U.S. and Canada is small enough that I think it is not necessary for people with no particular risk factors to get it.
       Hepatitis B vaccine is recommended for all adults. Ninety-five percent of people will have a good response, as measured by antibody levels in the blood (“titers”). Those with low titers are recommended to have a booster. This may relate to people with immune system disease, people with certain DNA factors (HLA type B8, SC01, DR3, for those interested), people with celiac disease, and if the first vaccine was technically compromised (such as being out of date, stored improperly or given the wrong way). Fifteen to 25 percent of people who lack adequate titers will get them after one booster dose; 50 percent will after three doses. People who still don’t respond should be tested for having hepatitis B disease. Most people are thought to have lifetime immunity after the vaccine: People with HIV infection and those on dialysis are exceptions and should have a booster.
       I have read about progress on a hepatitis C vaccine, which would be a major advance and much more cost-effective than the current treatment, which cures almost all who have hepatitis C but is very expensive.
       The booklet on hepatitis explains the three different kinds. Readers can obtain a copy by writing:
       Dr. Roach
       Book No. 503
       628 Virginia Dr.
       Orlando, FL 32803
       Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.
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       Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.
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