For educational purposes only

http://www.denverpost.com/news/news0110c.htm

Hepatitis shot for frequent diners? By Michael Booth Denver Post Staff Writer Jan. 10, 2001 - Pick the exotic travel destination where some Denver public health nurses recommend a hepatitis A vaccine for all adults who want to avoid the debilitating disease:

A) Puerto Vallarta, Mexico

B) Calcutta, India

C) Colorado Boulevard, Colfax Avenue or 17th Street

If you chose all of the above, you'd be correct. Some of the people who give out shots at Denver's public health clinics recommend that any adult who frequently eats at restaurants in the metro area should be vaccinated, though local and national hepatitis experts say that may unnecessarily alarm the public, and an official of a restaurant trade group bristles at the suggestion.

When the nurses give out flu shots, they also may recommend the hepatitis A vaccine along with asking if the patient's tetanus shots and other immunizations are up to date.

Colorado, like other Western states, has a higher than average incidence of hepatitis A. And Denver, and other areas with a high level of immigration, tends to have even higher rates. While the nurses' supervisor said Denver's official policy does not urge the vaccine for all adults, Mona Bedell added that individual nurses or clerks have seen how well the vaccine works and may be more enthusiastic about recommending it to everyone.

"It's just a good health recommendation, in terms of routine immunization for adults," said Bedell, director of Denver's immunization clinic. "It is passed, or can be passed, through contaminated food or water. That's why we recommend it for people who eat out a lot because a lot of people handle their food. The more you eat out, the higher the risk."

Some health workers endorse the two-stage vaccination because it can give safe and years-long protection against the disease, far longer than the months-long immunity to hepatitis A afforded by globulin shots traditionally given to people recently exposed to the virus. At between $30 and $60 for the shot and a booster six months later, some consider it cheap insurance against a virus that is more prevalent in the Western states than other parts of the country. Denver also has encouraged local restaurants to immunize all their employees against hepatitis A to help prevent them from spreading the virus to patrons, Bedell said.

But the local restaurant industry was upset that anyone might recommend the vaccine for people who "eat out often."

"That's ridiculous," said Pete Meersman, president of the Colorado Restaurant Association. "Denver is no different than any other city, and food-service workers are no different than any other types of workers."

Either recommendation, for the general adult population or restaurant workers in particular, goes beyond guidelines developed by the federal Centers for Disease Control and Prevention in Atlanta, and seems to go overboard in warning the public about the disease, experts said. "When we recommend it for different groups, it's because they are at identifiably increased risk," said Dr. Beth Bell, a medical epidemiologist in the hepatitis branch of the Centers for Disease Control.

"That's not to say an individual person with an individual provider might not want to get this same vaccine" in the same way that many adults who are not in the highest risk categories decide to get a flu shot each year, she said.

But, she added, "we don't have any data to suggest that people who eat out a lot are at higher risk."

A Kaiser-Permanente doctor who wrote a textbook on hepatitis disagreed more bluntly. "That's bizarre to say going out to eat, you need hepatitis A vaccine," said Dr. Ted Bader, a gastroenterologist with the state's largest HMO. "We haven't reached that level, and CDC hasn't reached that level of recommendation. That would be needlessly alarming for people."

Bader also dismissed the idea that immunizing restaurant workers was a good policy or would make much difference, saying their volatile career paths would make effective immunization nearly impossible. Hepatitis A is a liver disease that causes a mild, flu-like illness, yellow or jaundiced skin or eyes, and severe stomach pains and diarrhea.

Many patients have to be hospitalized, and the disease is spread easily within households or among risk groups through personal contact, food or drinking water.

Michael Booth can be reached at mbooth@denverpost.com or 303-820-1686.

-- K (infosurf@yahoo.com), January 12, 2001