Dear Dr. Theriot: My husband and I have a two year old daughter. When she was born, she received the hepatitis vaccine. I remember that it was three shots. I was told that she would be protected for life against hepatitis. We are going to Mexico this spring and a friend, who is a nurse, said that we should ALL get gamma globulin shots so that we don't get hepatitis. Isn't my daughter already protected?
Answer: This is an excellent question. First of all, let's look at what hepatitis is. It is an inflammation of the liver. In children it is invariably caused by one of several different viruses. In adults, it can be caused by viruses, alcohol or drugs. The four major viruses that cause hepatitis are hepatitis A, B, C (non A-nonB), and D.
The symptoms of hepatitis are extremely variable. Some forms produce sub-clinical illness which means that one has hepatitis, but no symptoms whatsoever. Other types can make a person quite ill with fever, jaundice (yellow skin), weight loss, nausea and vomiting.
There are approximately 400,000 cases of hepatitis in the United States annually. About half are caused by hepatitis B, 40% by hepatitis A, and the rest by hepatitis C, and D.
Your daughter was immunized against hepatitis B which is a much more serious type of hepatitis. It can cause permanent liver damage. Hepatitis B can be transmitted by coming in contact with bodily fluids such as contaminated saliva, blood or semen. It can also be passed from infected women to their unborn child. That is why all pregnant women are screened at the end of pregnancy, and all newborns are tested. The risk factors for hepatitis B closely parallel those for AIDS: I.V. drug use, handling blood products or body fluids, sexual promiscuity and homosexual behavior.
Hepatitis A can be transmitted from person to person, or through contaminated water and foods. Since the virus is shed into the feces, the infection can be easily spread in a day-care setting where diapers are openly changed, or in a situation where food handlers do not wash their hands properly. Drinking water can become contaminated as can certain shellfish. Often times, outbreaks in a community can be traced to a single restaurant. Hepatitis A can make a person ill for a few weeks, but in most cases there is complete recovery.
When your friend mentioned getting the gamma globulin shots, she was referring to protection against hepatitis A. When traveling to an endemic area, there are two main ways to offer protection: 1) the hepatitis A vaccine which is a series of two shots, or 2) a gamma globulin shot which can offer protection for a number of weeks. Since your daughter is not protected against hepatitis A, either of these two options would be perfectly acceptable. I suggest that you discuss these with her doctor. He may want to check with the Public Health Department to see if the areas that you will be visiting are endemic for hepatitis A. Regardless of these options, one can not stress enough the importance of being careful about what you eat and drink when in another country.
Hepatitis C and D are of little clinical significance in the pediatric population, and will not be discussed here.