Seven year old Tommy, and his 4 1/2 year old brother Joey, were brought in by mom for their yearly school physicals. As September approached, they were tanned after the summer of fun in the sun. That morning they had their haircuts, had been to the dentist, and the last item on mom’s to-do list was a visit to the pediatrician’s office.
Mom had a stack of school forms in her lap that needed to be filled out because Joey was going to start kindergarten. In fact she apologized for all the paperwork but somewhat conceded that at least Tommy was all caught up..."We went through all of this two years ago for his kindergarten exam. He shouldn’t need anything today", she said as she arranged the papers in some sort of order.
Tommy seemed particularly happy to be at the office and seized the opportunity after mom’s comment to be sure that Joey knew exactly how horrible the kindergarten physical was. "Joey, you’re gonna get 5 or 6 shots, and they take blood from you...and then they stick a needle in your arm for a TB test and it really hurts"...he blurted out before mom could stop him. It was too late however, for Joey sat motionless in his chair, petrified, as the color drained from his face.
"Okay, smarty pants," mom said to Tommy who was savoring the moment, "You can go first! Jump up on the table and show Joey that there is nothing to be afraid of". He hopped right up onto the table and was really milking it when he asked in a serious tone exactly how many shots Joey was going to receive. His genuine concern for his brother’s well-being was more than suspect.
Tommy’s confidence wavered a little when he asked me the fateful, rhetorical question..."I’m not gonna get any shots because I’m going into second grade, right?". My lack of response shook his foundation and with trepidation he took a different tack, "I don’t need another shot until the year 2008 because my mom said my tetanus was good for 10 years".
I then proceeded to tell mom about a new recommendation for the hepatitis A vaccine, and that Tommy should definitely get this shot today. Tommy’s jaw dropped and he looked as if he had seen a ghost. He was stunned and speechless. Mom queried, "What, another vaccine?". Then in a feeble and shaky voice, Tommy looked at mom with an incredulous look and said, "Yeah, that’s my question too!", as if by asking the question it would make it not so. What was priceless was little Joey who sat quietly in the corner. He had a smug grin on his face which extended from ear to ear...he looked like the Cheshire cat.
Hepatitis A is the most common cause of viral hepatitis in the United States. It is far more common than hepatitis B or C. It is acquired through contaminated food and water as the infected individual sheds the virus in their stool. Outbreaks have been traced to restaurants/fast food places (food handlers), and day care centers where the attendants change the diapers of their charges. The Center for Disease Control (CDC) estimates that the annual expense of work related absences and medical costs exceeds $200 million.
Hepatitis A has an abrupt onset which may resemble the flu: fever, malaise, nausea, vomiting and abdominal pain. This leads to jaundice whereby the patient ‘s skin becomes yellow and their urine turns a dark brown color (the color of tea). During this time the patient experiences a severe fatigue, lethargy and exercise intolerance. Almost all patients recover from hepatitis A completely, but this may take anywhere from a few weeks to a few months. Infants and toddlers get much milder forms of the disease, and they rarely develop jaundice--nonetheless, they do shed the virus in their stool and are highly contagious.
Earlier this year, the CDC identified 11 states in which the incidence of hepatitis A is more than twice the national average. California is one of these states. The CDC and the Public Health Department recommend that all individuals two years of age or older, who are living in these states, receive the hepatitis A vaccine series which consists of two shots given 6 months apart. This is a well-tolerated vaccine with little side effects. Fewer than 10% of recipients reported pain or redness at the injection site or fever.
Oh yes, Tommy did receive his first hepatitis A vaccine that afternoon much to his chagrin. It proved great theater for little Joey, so much so that I don’t think he even minded getting all of his shots for kindergarten.