Thursday, September 01, 2005
By Byron Spice, Pittsburgh Post-Gazette
An editorial to be published tomorrow in the New England Journal of Medicine calls for vaccinating all children against hepatitis A, citing the outbreak that sickened 600 patrons of a Beaver County Chi-Chi’s restaurant two years ago as evidence of the need.
Incidence of the liver disease has reached historic lows within the United States and vaccination now is recommended only for people considered at high risk.
But Drs. Jules Dienstag and Loriana Di Giammarino of the Harvard Medical School argue in their editorial that the low incidence of hepatitis A paradoxically leaves most Americans vulnerable to sporadic foodborne outbreaks, such as the Chi-Chi’s incident.

In areas of the world where hepatitis is endemic, children are routinely infected, resulting in a usually non-fatal disease but leaving them with lifetime immunity. In the United States, children are infrequently exposed to the virus so they remain susceptible to the disease as adults, when hepatitis tends to be more severe.
The editorial accompanied a report by federal and state health officials regarding the Beaver County outbreak, which was tied to contaminated green onions from two Mexican farms.
The idea of immunizing all children against hepatitis A is not new and has been advocated by hepatitis specialists for years. No action has been taken, though Curtis Allen, a spokesman for the Centers for Disease Control and Prevention, yesterday said that the Advisory Committee on Immunization Practices, which sets national guidelines for vaccine use, may take up the issue in October.
“The issue often comes down to cost-benefit ratios and competition for other initiatives,” said Dr. Phil Rosenthal, a pediatric liver specialist at the University of California, San Francisco.
The Pennsylvania experience, Dienstag and Di Giammarino contend, provides evidence of just how vulnerable adults have become — 18 percent of those exposed fell sick and one out of four people who were sickened ended up in the hospital. At least three people died; the journal lists three deaths, though the death of a fourth patient months later is included in media reports.
Vaccinating all children instead of only those at high risk would not be cheap, the Harvard doctors acknowledged, but half of all people who get hepatitis have no known risk factors and it is impossible to eliminate or predict foodborne outbreaks.
And the costs of treating patients with severe disease and the public health costs for responding to outbreaks are considerable. It cost $46,000 to treat people sickened in a 1992 Denver outbreak, they noted, but 15 times that much for mass administration of immune globulin to keep the disease from spreading to the larger population.
(Science editor Byron Spice can be reached at 412-263-1578.)