Prevention of Viral Hepatitis.
Despite the availability of vaccines against hepatitis A and B, acute viral hepatitis due to these agents continues to be among the most commonly reported notifiable infectious diseases in the United States. Currently available hepatitis A and B vaccines are highly immunogenic and well tolerated, but vaccine coverage needs to be expanded. Use of the hepatitis A vaccine in children age 2 years and older should be more widespread than is currently the case. Hepatitis A vaccine has been shown to be cost effective when given to children in regions with high attack rates and to patients with chronic hepatitis C. Routine newborn immunization against hepatitis B has been a successful approach to disease control and is among the most cost-effective interventions. Use of the hepatitis B vaccine for all sexually active individuals with more than one sex partner should be recommended for this sexually transmitted disease. The availability of a combined hepatitis A and B vaccine should facilitate vaccine coverage in those individuals at risk for both infections. For those hepatitis infections for which no vaccine is currently available, namely hepatitis C, D, and E, reducing exposure risk by modifying lifestyle behaviors is the only control measure available. Early education and counseling about high-risk behaviors for the acquisition of blood-borne hepatitis viruses needs to be expanded to young children and adolescents. The eventual eradication of hepatitis virus infections through universal immunization is plausible for those agents for whom human beings are the only host and effective vaccines have been developed. If hepatitis E is shown to be a zoonosis with an extensive reservoir in pigs, eradication of this agent may be very difficult.
Koff
Raymond S.
RS
Division of Gastroenterology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA. koffr@UMMHC.org