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A Cup of Health with CDC
December 15, 2006
A Comprehensive Immunization Strategy to Eliminate Transmission of HBV in the US

[Announcer] This podcast is presented by the Centers for Disease Control and
Prevention. CDC – safer, healthier people.

[Matthew Reynolds] Welcome to A Cup of Health with CDC, a weekly broadcast of the
MMWR, the Morbidity and Mortality Weekly Report. I’m your host, Matthew Reynolds.

Each year, Hepatitis B kills about 700,000 people worldwide. In the past twenty years in
the U.S., there has been a growing awareness of the impact of hospitalizations,
cancers, and deaths that have resulted from Hepatitis B. The virus that causes Hepatitis
B is often spread at birth from mother to child. It can also be spread among adults
during unprotected sex and as a result of blood exposure during health care or from
certain behaviors, such as injection-drug use. The virus can scar or destroy liver tissue
and lead to liver failure and liver cancer.

Fortunately, a vaccination program for infants started more than twenty years ago. This
has led to a drop in new Hepatitis B cases in the past ten years, especially in children
and teens. However similar declines have not occurred among adults because many
adults at risk for this infection remain unvaccinated.

To protect more adults from Hepatitis B, CDC researchers have updated the Hepatitis B
immunization recommendations for adults. Here to discuss these recommendations and
tell us more about Hepatitis B is Dr. John Ward from CDC’s Division of Viral Hepatitis
Thanks so much for joining us, Dr. Ward.

[Dr. Ward] Thanks, Matthew. It’s great to be here.

[Matthew Reynolds] What can be done to prevent Hepatitis B?

[Dr. John Ward] Fortunately, we have a variety of interventions that are very effective in
preventing this deadly viral infection. We, in this country, screen the blood supply so
that blood donations that harbor this virus are eliminated from the transfusion pool
before recipients receive them. We have issued recommendations so that people
understand the behaviors that lead to transmission of Hepatitis B. These behaviors are
very similar to the behaviors that transmit HIV, which include unprotected sexual contact
and exposure to blood, in some of the ways that you mentioned. But particularly it's
particularly important for persons in certain occupations like health-care workers and
persons who practice certain behaviors such as injecting-drug use. But the subject
today is really to emphasize probably the most important and effective intervention we
have for this infection, which is vaccination. We've had a vaccine for over 25 years now
and we have made remarkable progress in preventing this infection because of the
availability of this vaccine.

[Matthew Reynolds] Well, how safe is this vaccine and does it work?

[Dr. John Ward] The Hepatitis B vaccine is very safe. We've had a Hepatitis B vaccine
licensed for use in the United States since 1981, so we have a long experience in using
it, and it's demonstrated itself to be very safe. In addition, it's also very effective. In fact,
for persons who receive all three doses, which are the number of doses recommended
for the full series, 95 percent of them will be protected from infection with this virus. It's
fantastic in public health when you have an intervention that is so safe, as well as so
effective, that you can recommend it for use by millions of people.

[Matthew Reynolds] Well, you mentioned millions of people. Are there specific groups or
populations that you have in mind that should be vaccinated against Hepatitis B?

[Dr. John Ward] In 1991, CDC embarked upon a goal to eliminate Hepatitis B
transmission in the United States. And the first order of business was to protect infants
who were being born to mothers who were infected with this virus because of their high
risk of developing chronic Hepatitis B themselves. And so, beginning at that time, all
children were recommended to receive this vaccine as infants, and then progressively
since that time, older children and teenagers were recommended to receive this vaccine
as a catch-up strategy so that those children would also be protected even though that
vaccine was not available earlier in their lives. Throughout that time period, adults who
had the behaviors that we've been discussing have also been recommended to receive
this vaccine. So, specifically, adults who have sexual activity with multiple partners,
particularly behaviors that result in unprotected sexual contact, adults who have
exposures to blood by virtue of their occupation, such as health-care workers or public
safety workers, or have certain behaviors, such as injecting-drug use, that put them in
contact with the blood of others. And then, also, family members of persons with chronic
Hepatitis B, because even incidental contact through activities such as contact with
toothbrushes or shaving razors and that type of thing will also result in transmission, so
those close persons with close contact should also be vaccinated. Unfortunately, the
vaccination coverage has remained low for these groups throughout this time period
and so these new recommendations are designed to change that and protect more
adults from becoming infected.

[Matthew Reynolds] Well, if I go to my doctor, do I have to talk about the reason I think
I’m at risk for Hepatitis B infection in order to receive the vaccination?

[Dr. John Ward] We do not recommend that that is a requirement for a person to receive
Hepatitis B vaccine as an adult. We're encouraging physicians to bring up these risk
behaviors with their patients because, not only are they risk behaviors for Hepatitis B,
but they're also risk behaviors for other important infections, such as syphilis or HIV,
and those are important to address as well. But we also recognize that adults may not
want to share this information with their physicians for whatever reason, and we
certainly do not want that to be a barrier to adults receiving the vaccine who really need
it. And so we are very emphatic and very clear when we say is that all an adult really
has to do to receive this vaccine is go to their physician and ask for it.

[Matthew Reynolds] What about those people who already have Hepatitis B? Is there
anything that can be done for them?

[Dr. John Ward] Fortunately, persons with chronic Hepatitis B have treatment options
that were not available even several years ago. CDC estimates that between one and
one and a half million persons in this country are living with chronic Hepatitis B, placing
them at risk for progression to liver failure, cirrhosis, and even liver cancer. So it's very
important for those persons to be diagnosed with their infection and then to be referred
for treatments, which have been shown to reverse the severe consequences of liver
disease and provide hope that persons with chronic infection can live a full life in spite of
this infection. Diagnosing persons with chronic Hepatitis B provides another opportunity
to identify those around them who are unvaccinated and at risk for becoming infected,
and bringing them in and vaccinating them so that they don't unknowingly transmit
infection to others.

[Matthew Reynolds] Dr. Ward, thanks for talking with us today.

[Dr. John Ward] Thank you very much.

[Matthew Reynolds] That’s it for this week’s show. Don’t forget to join us next week.
Until then, be well. This is Matthew Reynolds for A Cup of Health with CDC.

[Announcer] To access the most accurate and relevant health information that affects
you, your family, and your community, please visit www.cdc.gov.