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CDC Panel Recommends Hepatitis A Vaccine for Children and Whooping Cough Shots for Adults
  NY Times
Published: October 27, 2005
ATLANTA, Oct. 26 - Every toddler in the country should be immunized against hepatitis A, and every adult should receive booster doses of whooping cough vaccine, a panel advising the federal Centers for Disease Control and Prevention unanimously recommended Wednesday.
Shots for hepatitis A, a liver disease that is rarely fatal but is easily spread, "should be integrated into the routine childhood vaccination schedule" and given between 1 and 2 years, the panel said.
It also urged that adults ages 19 to 65 have the booster against whooping cough, also called pertussis, 10 years after their last shot against the disease. They could receive the vaccine at the same time as their booster against tetanus and diphtheria, because a newly licensed vaccine - Adacel, made by Sanofi Pasteur - offers protection against all three diseases.
The C.D.C. usually adopts the recommendations of the panel, known as the Advisory Committee on Immunization Practices, as do a number of professional groups. Though the recommendations are not binding, doctors generally follow them.
Using estimates made by the disease centers, the panel said routine hepatitis A immunization would prevent up to 180,000 infections and 30,000 illnesses each year among children and adults, advancing the goal of eliminating the disease in this country. Adverse reactions to the vaccine are reported as rare.
Each vaccine has a dual aim: to protect the recipient from illness and to prevent transmission of an infection to other people.
"By protecting personal and public health, they are vaccines at their best," Dr. William Schaffner, chairman of preventive medicine at Vanderbilt University, said in an interview. He represented two professional groups, the National Foundation for Infectious Diseases and the Infectious Diseases Society of America, at the meeting.
The panel said its recommendation for pertussis was intended to reduce the chance that adults will give the disease to infants who are too young to be immunized or who have completed only part of the vaccination series. The disease can be fatal for infants.
Although whooping cough has declined over the years in the United States, waning immunity has led to recent outbreaks in middle schools and high schools. A number of adults who have developed the disease have suffered rib fractures that led to life-threatening conditions like a collapsed lung, and the severe coughing can last for months among adults.
The current whooping cough vaccine recommendations for children remain unchanged: a series of five shots beginning at two months and continuing until preschool.
About 65 percent of younger adults already get the tetanus-diphtheria boosters. The figure drops to 50 percent among middle-aged adults and to about 35 percent among those 65 and older. Adults often receive boosters in emergency rooms after stepping on rusty nails, cutting themselves or suffering other wounds.
In recommending hepatitis A shots for toddlers, the panel cited the success of a vaccination program in 17 states that had had a high incidence of the disease: Alaska, Arizona, Arkansas, California, Colorado, Idaho, Missouri, Montana, Nevada, New Mexico, Oklahoma, Oregon, South Dakota, Texas, Utah, Washington and Wyoming.
Since the program began, the incidence of hepatitis A in those states has fallen to levels lower than those in what were considered low-incidence states. In 1999, two-thirds of the hepatitis A cases occurred in the 17 high-incidence states; now only one-third do.
Of the 180,000 hepatitis A infections each year, up to 30,000 produce illness, including nausea, vomiting, jaundice and fever. Although many more infected people do not experience symptoms recognizable as hepatitis, they still can transmit the virus to others.
The hepatitis A vaccine was first licensed in 1995, and the Food and Drug Administration has approved two versions for 1-year-olds.
Dr. Tracy Lieu, a panel member from Harvard Pilgrim Health Care in Boston, said the policy of recommending immunizations only in certain states was no longer sustainable, in part because hepatitis A had declined so much in those states that "the rationale for continued vaccination does not make sense to people."
"Anecdotal evidence suggests that states may lose support for continued vaccination," Dr. Lieu said in a presentation to the meeting.
Computer models indicate that the incidence of hepatitis A will increase if all children are not immunized, Dr. Lieu said. Children play an important role in transmitting the hepatitis A virus. The virus can also be spread through contaminated water and food.
The panel also recommended that older children who have not been vaccinated against hepatitis A get shots in a "catch-up" plan.
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