Vaccine could save many -- and wipe out the disease

The vaccine would mean two more shots for children.
KNIGHT RIDDER NEWSPAPERS
PHILADELPHIA -- Outbreaks of hepatitis A like the one that has sickened more than 500 people near Pittsburgh could be prevented if all children were vaccinated against the viral disease, experts said.
Hepatitis A vaccines have been available since 1995, but the federal government's vaccine committee recommends routine immunization only for children in 11 Western states where there have been higher-than-average hepatitis A rates.
The hepatitis A vaccine would add two more shots to the already heavy schedule of vaccinations that children get; they now receive up to 20 shots against 11 infectious diseases by the time they're 2 years old. Many public health experts think it would be worth it.
"As illustrated by our recent outbreak, an outbreak of hepatitis A can occur anywhere in the United States at any time," said Dr. David Greenberg, director of a vaccine research center at Children's Hospital of Pittsburgh. "Vaccinating all children in the United States would help prevent many more cases of hepatitis A than just concentrating on the highest-risk states, which is current policy."
More than 500 people have been sickened, and three have died in a hepatitis A outbreak traced to a Chi-Chi's restaurant in Beaver County, Pa., about 25 miles northwest of Pittsburgh.
Health investigators for the state and the Centers for Disease Control and Prevention in Atlanta have not identified the source of the outbreak, but one possibility is that produce, perhaps green onions, or scallions, brought into the restaurant, was contaminated.
The hepatitis A virus is spread by the "fecal-oral route," through person-to-person contact or ingestion of contaminated food or water. The virus is shed in feces, and if an infected person does not wash his hands after using the bathroom, viral particles can get onto food, utensils and other objects the person handles. Fruit and vegetables also can be contaminated during irrigation, harvesting, processing or packaging.
It is estimated that about 100,000 people each year in the United States are infected with hepatitis A each year; about 100 people die. Symptoms include fatigue, fever, nausea, diarrhea, abdominal pain and jaundice, though sometimes people don't even know they are infected.
About hepatitis A
Hepatitis A is the most common hepatitis -- about one-third of American have been infected -- but because many people don't get very sick and they make a full recovery, it doesn't get as much attention as hepatitis B, a blood-borne virus for which all children in the United States are vaccinated that can cause chronic liver disease, and hepatitis C, another blood-borne virus that is a major reason for liver transplants in this country.
Adding the hepatitis A vaccine, which protects against infection, to the lineup of childhood shots, would have a beneficial ripple effect, experts say, because not only do children get hepatitis A, but they quietly spread the disease since they may have no symptoms or only minor ones.
The hepatitis A vaccineis already recommended for high-risk groups, such as travelers to countries with poor sanitary conditions; people with chronic liver disease or a clotting factor disorder; men who have sex with men; people who inject illicit drugs, and children in communities with repeated hepatitis A outbreaks.
People anywhere can get the vaccine for themselves or their children. But insurance companies usually won't pay for vaccines not officially recommended by the federal government's vaccine panel.
"It comes down to money," said Paul Offit, chief of infectious diseases at Children's Hospital of Philadelphia and a former member of the federal vaccine panel. He said that when the committee evaluates the benefits of any new vaccine, a criterion is "Is it cost effective?"