We deal with vaccinations. Part 22. Hepatitis A

2024 Author: Seth Attwood | [email protected]. Last modified: 2023-12-16 15:55

1. If children and adults are vaccinated against whooping cough to protect babies, and babies are vaccinated against rubella to protect unborn babies, then infants are vaccinated against hepatitis A to protect adults.

2. CDC Pinkbook

In children under 6 years of age, 70% of hepatitis A cases are asymptomatic. In older children and adults, the disease is symptomatic, and in 70% it is accompanied by jaundice. The transferred infection gives lifelong immunity.

Risk groups for hepatitis A include homosexuals, drug addicts, travelers to endemic countries, and workers with infected primates.

Two vaccines are available in the US, Havrix (GSK) and Vaqta (Merck), which were licensed in 1995-6. Vaccines are 94-100% effective. There is also a hepatitis B vaccine (Twinrix).

Both vaccines contain aluminum (225-250 mcg). Havrix contains aluminum hydroxide and Vaqta contains AAHS (the same type of aluminum as Gardasil). Both vaccines are grown on human fibroblast cells (MRC-5).

Unlike hepatitis B and C, hepatitis A is an intestinal infection transmitted by the fecal-oral route and does not become chronic.

Less than 10% of infected children under 6 years of age are diagnosed with hepatitis A.

Indians get sick 19 times more often than whites, Hispanics - 3 times more often.

3. WHO position paper on hepatitis A vaccines - June 2012

The incidence of hepatitis A depends on socioeconomic conditions. With increasing incomes, and with access to clean water and adequate sanitation, the incidence decreases.

In endemic countries, almost everyone carries asymptomatic infection during childhood, which effectively prevents clinical hepatitis in adolescents and adults. In these countries, WHO does not recommend universal vaccination.

4. Type A viral hepatitis: epidemiology, diagnosis, and prevention. (Lemon, 1997, Clin Chem)

Hepatitis A kills 70-80 people a year in the United States, and it is almost exclusively people over the age of 50. Severe hepatitis A is more likely in people with alcoholic liver disease or chronic hepatitis.

Some of the vaccinated people developed Guillain-Barré syndrome, but it is not known exactly if this is due to vaccination.

5. Hospitalization and mortality due to hepatitis A in Taiwan: a 15-year nationwide cohort study. (Chen, 2016, J Viral Hepat)

In Taiwan, the indigenous population has been vaccinated against hepatitis A since 1995. One study found that the incidence in Taiwan had more than tripled due to vaccination, despite the fact that only 2% of the population was vaccinated, and most of those vaccinated lived in the mountains and on isolated islands.

Another study found that only 0.4% of the unvaccinated population had antibodies to hepatitis A, from which the authors conclude that hygiene rather than vaccination is responsible for reducing the incidence. With improvements in hygiene, the incidence has shifted from children to older ages.

6. Seroprevalence of Hepatitis A Twelve Years After the Implementation of Toddlers' Vaccination: A Population-Based Study in Israel. (Bassal, 2017, Pediatr Infect Dis J)

Israel was the first country in the world to add hepatitis A vaccine to the national immunization schedule in 1999. Within three years, the incidence of hepatitis A has dropped by more than 98% in vaccinated children and by 95% in the general population.

Before vaccination began, 47% of the Jewish population had antibodies, and 12 years later, 67% had antibodies. Among the Arab population, 83% had antibodies before vaccination, and after 12 years, 88% had antibodies. That is, as in Taiwan, it is not a fact that only the vaccine was responsible for reducing the incidence.

7. Only in two European countries vaccination against hepatitis A is included in the national calendar (Greece and Austria), and only in Greece the vaccine is funded by the state.

8. Is travel prophylaxis worth while? Economic appraisal of prophylactic measures against malaria, hepatitis A, and typhoid in travelers. (Behrens, 1994, BMJ)

Vaccination against hepatitis A and typhoid is not economically feasible for those traveling to endemic countries, and malaria pills are economically feasible.

Only 1 in 2000 contracted hepatitis A while traveling, and in 90% of cases the disease was easy.

In England, it is estimated that hepatitis A vaccination prevented 0.29 deaths per year.

9. Cross sectional retrospective study of prevalence of atopy among Italian military students with antibodies against hepatitis A virus. (Matricardi, 1997, BMJ)

Recruits in Italy, who had antibodies to hepatitis A, suffered from asthma and allergic rhinitis 2 times less often than soldiers who did not have antibodies.

Recruits who had older brothers also suffered from allergies less often, which suggests that hepatitis A is not the only infection that lowers the risk of allergic diseases.

In Italy, hepatitis A was endemic in the 1970s, usually contracted in childhood, and was asymptomatic.

Other studies have also shown in recent decades an inverse relationship between antibodies to hepatitis A and allergies in different countries. In the United States in the 1970s, the older generation was more likely to have antibodies to hepatitis A than the younger generation, while the younger generation had more atopic diseases.

10. The prevalence of atopy in children with antibodies against hepatitis A virus and hepatitis B virus. (Kocabaş, 2006, Turk J Pediatr)

Children who did not have antibodies against hepatitis A had asthma and allergic rhinitis 9 times more often. Those who did not have antibodies against hepatitis B had allergic diseases 5.9 times more often. 1 more].

11. Clearance of HCV RNA following acute hepatitis A superinfection. (Cacopardo, 2009, Dig Liver Dis)

It is believed that superinfection (infection that develops against the background of another infection) of hepatitis A in chronic patients with hepatitis B and C, leads to liver failure and a high probability of death. However, it has also been reported that hepatitis A infection can lead to complete or temporary recovery from chronic hepatitis. The mechanisms of this phenomenon are unknown.

It describes the case of a 24-year-old drug addict who had chronic hepatitis C. He ate raw fish and contracted hepatitis A, after which he had chronic hepatitis C.

Most likely, interferon gamma (a cytokine secreted by Th1 cells) is responsible for this, the level of which significantly increased after infection.

Cases of suppression of hepatitis B during hepatitis A have also been reported: [1], [2], [3].

12. Studies in Hodgkin's syndrome; the association of viral hepatitis and Hodgkin's disease; a preliminary report. (Hoster, 1949, Cancer Res)

Until 1966, all types of hepatitis were simply called viral hepatitis.

It describes 3 cases of viral hepatitis in patients with Hodgkin's lymphoma. Two of them also had lymphoma after hepatitis A, but the third died.

Inspired by this discovery, the authors infected 21 volunteers with Hodgkin's lymphoma with hepatitis. According to preliminary results at the time of this writing, 13 of them had hepatitis and 7 of them had improved symptoms of lymphoma. At the time of this writing, no one has died.

13. Before the vaccine was licensed, the incidence of hepatitis A in the United States was approximately 1 in 10,000 and the death rate was 1 in 3 million. In 1999, vaccinations were introduced in 11 states where the incidence was higher than 1 in 5,000.

In 2006, the vaccine was added to the national immunization schedule. The incidence of hepatitis A at this time was 1 in 100,000 and the death rate was 1 in ten million. And almost all of the deceased were people over 50, with concomitant diseases.

14. Autoimmunity and hepatitis A vaccine in children. (Karali, 2011, J Investig Allergol Clin Immunol)

There are no accepted criteria for the diagnosis of autoimmune diseases due to vaccination. Autoimmune diseases begin long after vaccination, and because of this, it is difficult to establish a causal relationship. Vaccines contain adjuvants, preservatives, antigens, and other ingredients, each of which can trigger or exacerbate autoimmune reactions.

The authors vaccinated 40 children against hepatitis A, and 25% of them developed autoantibodies (antibodies to their own antigens), one developed temporary leukopenia (a decrease in the number of leukocytes). One year after vaccination, two children still had autoantibodies.

15. In the Vaqta clinical trials, aluminum was used as a placebo.

In 1-10% of vaccinated children, within 14 days after vaccination, conjunctivitis, otitis media, anorexia, insomnia and other diseases were observed, and in adults also menstrual irregularities and back pain.

In 0.7% of those vaccinated, serious negative cases were reported, and in 0.1%, according to the researchers, they were associated with the vaccine.

The Havrix clinical trials used the hepatitis B vaccine as a placebo.

Serious negative cases were observed in 0.9% of those vaccinated.

16. Hepatitis A virus infections and outpeaks in asylum seekers arriving to Germany, September 2015 to March 2016. (Michaelis, 2017, Emerg Microbes Infect)

In 2015-16, the number of hepatitis A cases in Germany, which was constantly decreasing, increased by 45%, and the average age of patients dropped significantly. It turned out that this was due to the million refugees that Germany had accepted.

17. Hepatitis A outpeak in the USA. (Nelson, 2018, Lancet Infect Dis)

In 2001, an advisory committee for San Diego, California stressed the need to increase the number of public toilets in the city center.

In 2010, a funding plan for these toilets was developed.

In 2016, two toilets were installed. One of them was subsequently closed due to running costs and fears of crime, and only one toilet remained operational in 2017. There were a total of 8 public toilets in San Diego, but only three were available 24 hours a day.

In San Francisco, where homelessness is comparable to that of San Diego, there are 25 public toilets, all open 24 hours a day.

In 2017, an outbreak of hepatitis A began in the United States, affecting mostly homeless people in San Diego, where more than 500 fell ill and 20 died. Since then, 16 portable toilets have been installed.

For fear of hepatitis A, authorities are arresting those distributing food to homeless people in suburban San Diego.

18. Outpeak of hepatitis A associated with men who have sex with men (MSM), England, July 2016 to January 2017. (Beebeejaun, 2017, Euro Surveill)

In 2016-17, large cities in Europe were swept by a wave of outbreaks of hepatitis A. The vast majority of cases were homosexuals.

In England, 37 cases have been reported.

19. Hepatitis A outpeak in Barcelona among men who have sex with men (MSM), January-June 2017: A hospital perspective. (Rodríguez-Tajes, 2017, Liver Int)

In the Barcelona hospital, 46 cases were reported, of which 96% were among men, and 67% identified themselves as homosexuals. The authors write that oral-anal contact during sex is a major risk factor, that the last outbreaks in Europe were between 2008 and 2011, and that because of these outbreaks, hepatitis A has come to be classified as an STD.

20. Ongoing outpeaks of hepatitis A among men who have sex with men (MSM), Berlin, November 2016 to January 2017 - linked to other German cities and European countries. (Werber, 2017, Euro Surveill)

Flash in Berlin. 38 cases, 37 men, 30 reported homosexual relationships. The woman also reported same-sex relationships.

One of the patients was vaccinated 11 months before the onset of the disease.

Here an outbreak is reported in Rome and the surrounding area, 513 cases, of which 87.5% are men. [1] It reports an outbreak in Tel Aviv, 19 cases, of which 17 are homosexuals. [1] It reports that a total of 1,500 cases of hepatitis A have been reported in 16 European countries, and 2,660 unconfirmed cases, mostly among homosexuals.

It reports that from January to August 2017, there were 11,212 cases of the disease in Europe, mostly among homosexuals.

WHO is also reporting an outbreak among homosexuals in Chile.

21. Hepatitis A outpeak among men who have sex with men (MSM) predominantly linked with the EuroPride, the Netherlands, July 2016 to Fepuary 2017. (Freidl, 2017, Euro Surveill)

It all started with a gay pride parade in Amsterdam in 2016, which attracted half a million visitors. A total of 48 cases were reported among men in the Netherlands.

22. Hepatitis A outpeak in HIV-infected MSM and in PrEP-using MSM despite a high level of immunity, Lyon, France, January to June 2017. (Charre, 2017, Euro Surveill)

An outbreak of hepatitis A in Lyon in the first half of 2017. 46 cases, of which 38 are men, 33 are homosexuals, and 15 are infected with HIV. Most were vaccinated or had antibodies.

According to the current model, 70% of those with immunity are enough to prevent hepatitis A infection among homosexuals. The authors conclude that 70% is not enough.

It has also been reported that since it is possible to contract hepatitis A from reusing needles, slamming (intravenous drug use during anal intercourse), a practice that is gaining popularity among some groups of homosexuals, can also increase the risk of the disease. More: [1], [2].

23. Hepatitis A Outpeak Among Men Who Have Sex With Men in a Country of Low Endemicity of Hepatitis A Infection. (Chen, 2017, J Infect Dis)

Hepatitis A outbreak in Taiwan. More than 1000 cases, of which 70% are homosexuals, 60% are infected with HIV, and over 60% were infected with syphilis, gonorrhea or shigellosis.

Nowhere is it mentioned that in all of these outbreaks, anyone died of hepatitis A.