Hepatitis C

Hepatitis C

Hepatitis C virus is the most common chronic blood borne infection in the United States with an estimated 4.1 million American infected. World-wide there is an estimated 170 million persons chronically infected. The number of new infections per year has declined from 240,000 in the 1980s to 26,000 in 2004.

Potential risk factors include contact with infected blood, instruments or needles - such as IV drug users, health care workers, or public safety workers. Additional potential risk factors include intranasal cocaine use, tattooing and body piercing. Before 1992 the hepatitis C virus was also transmitted through blood transfusions. All blood is now tested for the presence of the virus. The risk post-transfusion has been estimated to be reduced to 0.001% per unit transfused.

Because infection with the virus can be asymptomatic or have vague symptoms, as many as 60% of individuals infected are unaware that they carry the virus. Many are found as a result of routine blood tests. Chronic hepatitis C is a slowly progressive disease that may gradually advance over 10-40 years. When it is acquired in later life there is some evidence that it may progress faster. In those with cirrhosis due to hepatitis C there is an associated increase in the chance of developing hepatocellular carcinoma. Drinking alcohol can make the liver disease worse.

There is no vaccine to prevent hepatitis C. The best prevention is not to use IV drugs, not to share needles, razors, or toothbrushes. Think about the risks if you are thinking about getting a tattoo or body piercing; and get vaccinated against hepatitis B.

According to the Centers for Disease Control and Prevention (CDC), there is an association between sexual exposure to someone with a history of hepatitis, or exposure to multiple sex partners and contraction of hepatitis C. Women with hepatitis C do not need to avoid pregnancy or breast-feeding according to the CDC. Expectant and new parents should be advised that approximately 5 out of every 100 infants born to HCV infected females might be infected. HCV-positive mothers should consider abstaining from breast-feeding if their nipples are cracked or bleeding.

Currently there are FDA-approved treatments for hepatitis C. Hepatitis C positive patients should be evaluated by their physicians for liver disease.

References:
1. The American Liver Foundation Fact Sheet on Hepatitis C http://www.liverfoundation.org/
2. Center for Disease Control Fact sheet on Hepatitis C. http://www.cdc.gov/
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Childhood Vaccines: What They Are and Why Your Child Needs Them

Childhood Vaccines: What They Are and Why Your Child Needs Them

What is a vaccine?
A vaccine is a medicine that's given to help prevent a disease. Vaccines help the body produce antibodies. These antibodies protect against the disease.
Vaccines not only help keep your child healthy, they help all children by stamping out serious childhood diseases.

Are vaccines safe?
Vaccines are generally quite safe. The very small risk of serious problems from vaccines is far outweighed by the protection they provide. Vaccines have made many serious childhood diseases rare today. Talk to your family doctor if you have any questions.

Do vaccines have side effects?
Some vaccines may cause mild temporary side effects such as fever, or soreness or a lump under the skin where the shot was given. Your family doctor will talk to you about possible side effects with certain vaccines.

What is the flu vaccine?
The flu vaccine is a shot. Your child can't get the flu from the vaccine because it contains viruses that are dead. This vaccine is given at the beginning of the flu season, usually in October or November. Because flu viruses change from year to year, it is very important for your child to get the shot each year so that he or she will be protected.
The flu vaccine is safe for children 6 months of age and older. If your child is between 6 and 23 months of age, it's especially important for him or her to get the flu vaccine each year. Children in this age group are more likely to have complications from the flu.

What is the DTaP vaccine?
The DTaP vaccine is 3 vaccines in 1 shot. It protects against diphtheria, tetanus and pertussis. It's given as a series of 5 shots.
Diphtheria is a disease that attacks the throat and heart. It can lead to heart failure and death. Tetanus is also called "lockjaw." It can lead to severe muscle spasms and death.
Pertussis (also called "whooping cough") causes severe coughing that makes it hard to breathe, eat and drink. It can lead to pneumonia, convulsions, brain damage and death.
Having your child immunized when he or she is young (which means making sure he or she gets all of the DTaP shots) protects your child against these diseases for about 10 years. After this time, your child will need booster shots.

What is the Td vaccine?
The Td vaccine is used as a booster to the DTaP vaccine. It helps prevent tetanus and diphtheria. It's given when your child is 11 years old or older and every 10 years throughout life.

What is the IPV vaccine?
The IPV (inactivated poliovirus) vaccine helps prevent polio. It's given 4 times as a shot. It has replaced the older oral polio vaccine.
Polio can cause muscle pain and paralysis of one or both legs or arms. It may also paralyze the muscles used to breathe and swallow. It can lead to death.

What is the MMR vaccine?
The MMR vaccine protects against the measles, mumps and rubella. It's given as 2 shots.
Measles causes fever, rash, cough, runny nose and watery eyes. It can also cause ear infections and pneumonia. Measles can also lead to more serious problems, such as brain swelling and even death.
Mumps causes fever, headache and painful swelling of one or both of the major saliva glands. Mumps can lead to meningitis (infection of the coverings of the brain and spinal cord) and, very rarely, to brain swelling. Rarely, it can cause the testicles of boys or men to swell, which can make them unable to have children.
Rubella is also called the German measles. It causes slight fever, a rash and swelling of the glands in the neck. Rubella can also cause brain swelling or a problem with bleeding.
If a pregnant woman catches rubella, it can cause her to lose her baby or have a baby who is blind or deaf, or has trouble learning.
Some people have suggested that the MMR vaccine causes autism. However, good research has shown that there is no link between autism and childhood vaccinations.

What is the Hib vaccine?
The Hib vaccine helps prevent Haemophilus influenza type b, a leading cause of serious illness in children. It can lead to meningitis, pneumonia and a severe throat infection that can cause choking. The Hib vaccine is given as a series of 3 or 4 shots.

What is the varicella vaccine?
The varicella vaccine helps prevent chickenpox. It is given to children once after they are 12 months old or to older children if they have never had chickenpox or been vaccinated. Booster shots may be given if found necessary by further research.

What is the HBV vaccine?
The HBV vaccine helps prevent hepatitis B virus (HBV), an infection of the liver that can lead to liver cancer and death. The vaccine is given as a series of 3 shots. The HBV vaccine and Hib vaccine can also be given together in the same shot.

What is the pneumococcal conjugate vaccine?
The pneumococcal conjugate vaccine (PCV) protects against a type of bacteria that is a common cause of ear infections. This bacteria can also cause more serious illnesses, such as meningitis and bacteremia (infection in the blood stream). Infants and toddlers are given 4 doses of the vaccine. The vaccine may also be used in older children who are at risk for pneumococcal infection.

What is the meningococcal conjugate vaccine?
The meningococcal conjugate vaccine (MCV4) protects against 4 strains ("types") of bacterial meningitis caused by the bacteria N. meningitidis. Bacterial meningitis is an infection of the fluid around the brain and spinal cord. It is a serious illness that can cause high fever, headache, stiff neck and confusion. It can also cause more serious complications, such as brain damage, hearing loss or blindness.
Children should get the MCV4 vaccine at 11 to 12 years of age. Children older than 12 who have not received the vaccine should receive it before starting high school.

When should my child be vaccinated?
Recommendations about when to have your child vaccinated change from time to time. You can get a copy of the most current vaccination schedule on the World Wide Web from an organization such as the American Academy of Family Physicians or the American Academy of Pediatrics, or you can ask your family doctor. Vaccinations usually start when your child is 2 months old and most are finished by the time he or she is 6 years old.

Are there any reasons my child should not be vaccinated?
In some special situations, children shouldn't be vaccinated. For example, some vaccines shouldn't be given to children who have certain types of cancer or certain diseases, or who are taking drugs that lower the body's ability to resist infection. The MMR vaccine shouldn't be given to children who have a serious allergy to eggs.
If your child has had a serious reaction to the first shot in a series of shots, your family doctor will probably talk with you about the pros and cons of giving him or her the rest of the shots in the series.

Talk to your doctor if you have any questions about whether your child should receive a vaccine.

Written by familydoctor.org editorial staff.

Source
American Academy of Family Physicians
Reviewed/Updated: 03/05Created: 1996

This article provides a general overview on this topic and may not apply to everyone. To find out if this article applies to you and to get more information on this subject, talk to your family doctor.

Vaccine Shortages

Vaccine Shortages

Sometimes the amount of a certain vaccine cannot keep up with the number of people who need it. Vaccine shortages can affect certain areas of the country or the country as a whole. A shortage may last a few days to several months.
In the past, the United States has seen shortages of flu vaccines, pneumococcal conjugate vaccines (PCV), tetanus vaccines (including the DTaP vaccines given to children as a part of their regular immunizations) and others.

What causes vaccine shortages?
A vaccine shortage can occur for many reasons. Some of the factors may be:
- The company that makes the vaccine is not able to produce the vaccine fast enough.
- The company decides to stop making the vaccine for business reasons.
- The vaccine's supplier is not able to send out the vaccine quickly enough.
Often, a combination of these factors causes a vaccine shortage in one or more areas of the country.

What happens during a vaccine shortage?
Your family doctor will receive information about the shortage, how long it will last and what to do until new supplies arrive. Typically, the vaccine supply is not completely wiped out -- there are just fewer doses than usual. During this time, doctors give vaccines first to the people who need them most. This list may include the elderly, very young children, pregnant women, people with certain medical problems and people who plan to travel to other countries. Other people are put on a waiting list and are called in to the doctor's office when the vaccine is available.

How can I get more information?
If you have any questions about vaccine shortages, talk to your family doctor. He or she can give you information about the ways a shortage might affect you, your family and your community.
The Centers for Disease Control and Prevention's National Immunization Program Web site (see "Other Organizations" in the right column of this handout) contains information about current vaccine shortages in the United States. The Web site is reviewed and updated weekly.

Written by familydoctor.org editorial staff.

Source
American Academy of Family Physicians
Reviewed/Updated: 11/05Created: 9/02

This article provides a general overview on this topic and may not apply to everyone. To find out if this article applies to you and to get more information on this subject, talk to your family doctor.

Preventing the Flu

Preventing the Flu

What is influenza?
Influenza (also called "the flu") is a viral infection in the nose, throat and lungs. About 10% to 20% of Americans get the flu each year. Some people get very sick. Each year, about 130,000 people go to a hospital with the flu, and 20,000 people die because of the flu and complications.
The flu may cause fever, cough, sore throat, a runny or stuffy nose, headache, muscle aches and tiredness. Some people describe the flu as being like the worst cold of their life. Most people feel better after 1 or 2 weeks. But for some people, the flu leads to serious, even life-threatening, diseases, such as pneumonia. Influenza vaccine (the flu shot) is recommended for people who are more likely to get really sick to protect them from the flu.

Who is at higher risk?
Some people have a higher risk of flu complications, like pneumonia. If you are in any of these groups, you should get the flu vaccine every year:
- All children aged 6 to 59 months
- All adults aged 65 years and older
- All women who are or will be pregnant during the flu season
- Residents in nursing homes and long-term care facilities
- Individuals who have long-term health problems
- Children aged 6 months to 18 years who are on chronic aspirin therapy
- Health care workers who have direct contact with patients
- Caregivers and household contacts of children less than 6 months of age

How can I avoid getting the flu?
The best way to avoid getting the flu is to get the influenza vaccine each fall, before the flu season. The vaccine is available by shot or by nasal spray. The vaccines work by exposing your immune system to the flu virus. Your body will build up antibodies to the virus to protect you from getting the flu. The flu shot contains dead viruses. The nasal-spray vaccine contains live but weakened viruses. You cannot get the flu from the flu shot or the nasal-spray vaccine.

Some people who get the vaccine will still get the flu, but they will usually get a milder case than people who aren't vaccinated. The vaccine is especially recommended for people who are more likely to get really sick from flu-related complications.

Is there anyone who shouldn't get the flu shot?
Yes. The following people should talk to their doctor before getting the flu shot:
- People who have had an allergic reaction to a flu shot in the past
- People with an allergy to eggs
- People who previously developed Guillain-Barré Syndrome (a reversible reaction that causes partial or complete loss of movement of muscles, weakness or a tingling sensation in the body) within 6 weeks of getting a flu shot

Is there anyone who shouldn't get the nasal-spray vaccine?
Yes. The following people should talk to their doctor before getting the nasal-spray vaccine:
- Children less than 5 years of age
- Adults 50 years of age and older
- People with long-term health problems
- People with weakened immune systems
- Children aged 6 months to 18 years who are on chronic asprin therapy
- People with a history of Guillain-Barré syndrome
- Pregnant women
- People who have had an allergic reaction to a flu vaccine in the past or to eggs

If I get the flu vaccine, can I still get the flu?
Yes. Even with a flu vaccine, you aren't 100% protected. Each year, the flu vaccine contains 3 different strains (kinds) of the virus. The strains chosen are those that scientists believe are most likely to show up in the United States that year. If the choice is right, the vaccine is 70% to 90% effective in preventing the flu in healthy people under 65 years of age. If you're older than 65, the vaccine is less likely to prevent the flu. Even if you get the flu after being vaccinated, your flu symptoms should be milder than if you didn't get the vaccine. You'll also be less likely to get complications from the flu.

Is the vaccine safe?
Yes. The flu vaccine is safe. There are very few side effects. If you got the flu shot, your arm may be sore for a few days . You may have a fever, feel tired or have sore muscles for a short time. If you got the nasal-spray vaccine, you may have a runny nose, headache, cough or sore throat.

Can I get the flu vaccine if I am pregnant or nursing?
If you are pregnant during flu season, you cannot get the nasal-spray vaccine. However, it is recommended that women who will be pregnant during flu season get the shot. Pregnancy can increase your risk for complications from the flu.
It is also safe to get the flu shot while breast feeding your baby. The flu shot cannot cause you or your nursing baby to get sick.

What are antiviral flu drugs?
Antiviral flu drugs are prescription medicines that can be used to help prevent and/or treat the flu. There are four antiviral flu drugs: amantadine (one brand name: Symmetrel), oseltamivir (brand name: Tamiflu), rimantadine (brand name: Flumadine) and zanamavir (brand name: Relenza). All 4 of these antiviral drugs have been approved to treat the flu. If you take one of these drugs within 2 days of getting sick, it can lessen your symptoms, decrease the amount of time you are sick and make you less contagious to other people. However, most healthy people who have the flu get better without using an antiviral flu drug. Your doctor will decide whether one of these medicines is right for you.
Three of the antiviral flu drugs have also been approved to prevent the flu. These drugs are not a substitute for the influenza vaccine. They are most often used for flu prevention in institutions where people at high risk for flu complications are in close contact with each other, such as nursing homes or hospitals. For example, during a flu outbreak in a nursing home, residents and staff might be given the flu vaccine and an antiviral drug to prevent the flu until the vaccine takes effect.

Where can I learn more about the flu vaccine?
For more information, you can call the Centers for Disease Control and Prevention's National Immunization Information Hotline at these numbers:
1-800-232-2522 (English)
1-800-232-0233 (Spanish)

Written by familydoctor.org editorial staff.