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Old 02-11-2008, 12:42 AM - Thread Starter
 
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I know this has been done before, but I wanted to have a discussion about some very specific points concerning this disease and get any information people have/looked at when they made the decision on this one.

This vaccination never crossed my mind really until travel came into the picture and I started reading about the Hep A zones and how all our destinations are high zones. Growing up and in college, I always thought Hep A was just another liver inflamation disease. When I came to MDC, I researched more and found it to be more like food poisoning....but there were aspects that still make me worry a bit.

Mainly:

-the duration of the disease (some places say 3-8 weeks?)
-The jaundice and liver issue rates
-relapses if you get it-last over a 9 month period
-the outbreaks I have read about (mainly the one in 2003: http://www.cdc.gov/mmwR/preview/mmwrhtml/mm5247a5.htm)


Did any of you consider these kinds of things? what are your thoughts?

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Old 02-11-2008, 01:17 AM
 
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One thing I keep coming back to with Hep A is that to get it- you're talking fecal-oral transmission. I am rather icked out by anyone's poop in my food... whether or not there is a vaccine for ONE thing I can catch that way.

I would work instead on making sure that my food was reliable and poop-free.

-Angela
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Old 02-11-2008, 03:39 AM
 
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I really like looking at seroepidemiology to figure out what the chances are for various stuff.
By middle age, one out of three of us has been infected with hepA. So, between me, angela, and carrie...one of us has probably had it and never knew what it was.
Whoever it was probably got "sick" to some extent, but not enough to get a diagnosis.
By the time you're a lot older (I think over 60?) it's 2/3rds who've been infected. And again, I don't know too many folks who know when they had HepA. I guess it's one of those "that time my guts were weird for 3 weeks" type things.

Reported cases are always going to over-estimate symptom severity for something like this. The people who get freaky jaundice and are seriously ill will go to the doc and get diagnosed and reported.

I, being older, am much more likely to have a bad case than my kid, and I don't want to get vaxed for it. I'd rather just take my chances with the virus. Most adults apparently feel the same way. But anyway, I'm not going to vax my kid for something I don't want to vax myself for.

Now, compare that to something like the HPV vaccine...IF it actually worked the way it's supposed to (and I don't think it does, but just creating a hypothetical) I would go back in time and vax myself for that if given the opportunity. If it actually was 70% effective against cervical cancer (which it's not...again...this is hypothetical)...THAT would be worth it.
But HepA? Nope. I just don't care about hepA.
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Old 02-11-2008, 03:45 AM
 
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Originally Posted by mamakay View Post
I really like looking at seroepidemiology to figure out what the chances are for various stuff.
By middle age, one out of three of us has been infected with hepA. So, between me, angela, and carrie...one of us has probably had it and never knew what it was.
Whoever it was probably got "sick" to some extent, but not enough to get a diagnosis.
By the time you're a lot older (I think over 60?) it's 2/3rds who've been infected. And again, I don't know too many folks who know when they had HepA. I guess it's one of those "that time my guts were weird for 3 weeks" type things.
Those are some very interesting numbers.... hhmmm... I never cared enough about Hep A (and the vax is so new, it was after my most intensive research) that I had never seen those numbers. So 1 in 3 by middle age. Huh.

thanks for sharing.

-Angela
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Old 02-11-2008, 04:02 AM
 
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here's a thingie on it...

http://www.ncbi.nlm.nih.gov/sites/en...indexed=google

Quote:
The prevalence of antibody to hepatitis A virus in the general US population was 38.2%, based upon testing of 9516 participants from the second National Health and Nutrition Examination Survey conducted from 1976 to 1980. Prevalence increased steadily with age, ranging from 11% in persons < 5 years of age to 74% in persons > or = 50 years old.
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Old 02-11-2008, 10:33 PM
 
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One in three does not mean that one of you three could have had it and not known it. You all could never have had it. Yes you could have had a mild case of it. Or you can get a really bad case of it, like me.

I have had it and it sucked big time and my liver was affected and I had jaundice. I was sick for weeks. I can never donate an organ or blood, ever.

So, my kids will get it at school age. Since it is unlikely that they will get it under school age as we do not eat out often and my dh is hyper about food hygeine, I do not worry about it at home. I worry about it at school or out and about. Also, it is worse in teens and adults. I had it at 18.
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Old 02-11-2008, 10:45 PM
 
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Originally Posted by delphiniumpansy

I worry about it at school or out and about.
It is not common for a child to catch Hep A at school, from what I understand.

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Old 02-11-2008, 11:04 PM
 
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One in three does not mean that one of you three could have had it and not known it.
Yes, it does.

And this...
Quote:
74% in persons > or = 50 years old.
Do you really think 3 out of 4 people over the age of 50 remember when they had HepA?
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Old 02-12-2008, 12:00 AM
 
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I had it when I was about 10. I was living in Africa and there was something of an outbreak of it. I am not sure what that means as I was a child but my father got sick and so did out doctor's oldest daughter and other people. It was NOT a fun time for me. I was diagnosed and had lots of blood draws which was rather traumatic for me.

But I don't intend to vax my daughter with Hep A despite my own experience with the disease.
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Old 02-12-2008, 12:05 AM
 
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Originally Posted by mamakay View Post
Yes, it does.

And this...


Do you really think 3 out of 4 people over the age of 50 remember when they had HepA?
mamakay, when statisticians say that one in three people have something, they do not mean that you can take three people and find that one of them has it. They mean on average, one in three out of the populace as a whole.

I do not buy into your argument that people do not remember when they had hep A. I will never forget. I am sure those people who got sick from tainted spinach a few years back will never forget.
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Old 02-12-2008, 12:13 AM
 
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they do not mean that you can take three people and find that one of them has it. They mean on average, one in three out of the populace as a whole.
When it's one third of the population who has had it within a certain age group, there's a pretty good chance that...one out of three people sampled from that age group will have had it. Not every time, but a pretty good chance. For a margin of chance screwing it up, maybe it would be better to pick 6 or 8 random people within the age group and then there's an extremely high likelihood that one will have had it.

Do you really think 3/4th of the people over age 50 remember having had HepA?
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Old 02-12-2008, 12:24 AM - Thread Starter
 
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Remebering really isn't an issue in my mind. My worry is that one of our children might contract this because of either travel to high risk zone, which we do 2-3 times a year, or some kind of break out here and have this illness for 2 or more weeks and then the chance of relapsing over 9 month period. I guess I kinda feel like I bought into the "food poisoning" thing and now I am being presented with evidence that it's a lot more than that (even if you original illness was like food poisoning, you can relapse through 9 months?)

I admit that really does make me think.

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Old 02-12-2008, 12:29 AM - Thread Starter
 
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I also read recently that the relapsing is more common in children and, inaddition, only 70% of cases in children are non symptomatic, when I had thought that it was a lot higher than that...


eta: and that 70% is the highest number Ive seen, many things im looking at put it much lower.

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Old 02-12-2008, 12:44 AM
 
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It's in toddlers that it's usually asymptomatic, and as they get older, the rate of symptomatic infection goes up.

How common is relapsing? And is that per reported case or including the unreported ones?
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Old 02-12-2008, 12:49 AM - Thread Starter
 
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Just some of the stuff I have in my history right now:

Quote:
In addition, relapse is possible with hepatitis A. This usually occurs within three months of the initial onset of symptoms. Although relapse is more common in children, it does occur with some regularity in adults.

On average, the time to full recovery takes about 2 months, but 10-15 percent of persons have a prolonged or relapsing course lasting up to six months (Gilkson, et al., 1992; Willner, et al., 1998).
http://www.about-hepatitis.com/hepatitis_symptoms_risks


(2 months on average for recovery? also scarey)

CDC Yellow Book:

Quote:
The incubation period for hepatitis A averages 28 days (range 15-50 days). Hepatitis A typically has an abrupt onset of symptoms that can include fever, malaise, anorexia, nausea, abdominal discomfort, dark urine, and jaundice. The likelihood of having symptoms with HAV infection is related to the infected person’s age. In children younger than 6 years old, most (70%) infections are asymptomatic; if illness does occur, its duration is usually less than 2 months. No chronic or long-term infection is associated with hepatitis A, but 10% of infected persons will have prolonged or relapsing symptoms over a 6- to 9-month period. The overall case-fatality rate among cases reported to CDC is 0.3%; however, the rate is 1.8% among adults older than 50 years of age (1).

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Old 02-12-2008, 01:04 AM - Thread Starter
 
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Prolonged forms of HAV infection are atypical forms of diseases which occur in up to 24% cases.
http://www.ncbi.nlm.nih.gov/sites/en...indexed=google

Quote:
Seven (11.9%) of the 59 patients in our study
had a relapse of acute hepatitis A,
http://www.kliinikum.ee/ikt/doc/oppe...A_hepatiit.pdf

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Old 02-12-2008, 01:08 AM
 
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Those are all reported/diagnosed cases, though. What % of cases get reported vs. not reported?
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Old 02-12-2008, 01:11 AM - Thread Starter
 
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Well, I guess I'm looking at this and thinking "well, there are probably MANY unreported cases, but those people who do not report it may still suffer relapses and just think it's another bout of really bad food poisoning" or something like that.

But the CDC one says "10% of infected persons" so I don't know if that's overall or what.

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Old 02-12-2008, 01:18 AM - Thread Starter
 
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I'd also like to know more about all these lines saying "average recovery is two weeks to two months" or "most are recovered by two months"

that seems like a LONG time....can there be symptoms for two months?? or does that just mean they showed no immune system signs of the disease aftrer two months?

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Old 02-12-2008, 01:23 AM
 
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I really wish the pink book was referenced sometimes. You can't always tell what they mean by that kind of wording.
I strongly suspect that the worst cases will both end up reported and be "relapse" cases, though. But it's hard to say for sure without seeing the original research.
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Old 02-12-2008, 01:38 AM - Thread Starter
 
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I have gone back through many hep A threads and none of them seem to discuss these issues (length of disease and the relapse point). I think this would be a very important issue to think about, and I am a little upset at myself for having not looked into it more before I fed Dh the "food poisoning" line and he came back at me with all this stuff


I am going to do more research in the coming days and see what I dig up. Maybe i can find some more studies that give a better idea on the relapse rate in all cases, whether or not the idea of children relapsing more is supported by research, and the symptoms seen in this 2 month recovery period.

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Old 02-12-2008, 01:55 AM
 
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How many cases a year do you think there really are/were?
If 75% of the population shows evidence of previous infection by age 50, it would seem that in the past, there must have been about 1-2 million cases a year on averge?
Does that sound about right to you?
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Old 02-12-2008, 02:22 AM
 
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Quote:
Originally Posted by delphiniumpansy View Post
One in three does not mean that one of you three could have had it and not known it. You all could never have had it. Yes you could have had a mild case of it. Or you can get a really bad case of it, like me.

I have had it and it sucked big time and my liver was affected and I had jaundice. I was sick for weeks.
Word.

Quote:
I can never donate an organ or blood, ever.
That is not true for Hep A, only B or C.
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Old 02-12-2008, 02:25 AM
 
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Originally Posted by carriebft View Post
I'd also like to know more about all these lines saying "average recovery is two weeks to two months" or "most are recovered by two months"

that seems like a LONG time....can there be symptoms for two months?? or does that just mean they showed no immune system signs of the disease aftrer two months?
I was VERY sick (even with treated with TCM and being very healthy at the time) for a month - jaundice, nausea, fever, lack of appetite, sleep all. the. time - and then was tired for another month. Dh was run down for months after he got it. Ds who we caught it from hardly seemed sick. It was only in retrospect that we realized what had been up with him.

I would say from personal experience that it's a vaccine I would pass on for kids. But if I reached adulthood and was not immune, living in an area with a high rate of infections would make me think long and hard about taking it for myself.
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Old 02-12-2008, 11:21 AM - Thread Starter
 
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My husband has gotten the shot, but I do not think I have. I am thinking about just getting me and the kids checked for immunity and only really going deeper into the issue if need be. It's a done deal if the shot would be useless to us.

mom2seven: wow, it does seem like I let myself be lead astray about what this disease can do.

I wouldn't even think twice about this I don't think if I didn't feel like I was putting them at risk a few times a year by traveling. I'm also going to look into whether or not I can get some more info on "high risk" areas, maybe some access to actual numbers.

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