Hep B vaccine?

[Guest guest]

Didn't leave home without it.

 

Kim

 

snakeoil.works wrote:

How many of you get the Hep B vaccine when traveling to China? Raise

your hands.

 

ann

----------

 

 

 

Version: 7.1.394 / Virus Database: 268.9.3/374 - Release 6/23/06

 

 

[Guest guest]

Me. I had already had " twinrix " (hep a and b vacs) before going to

India, a few years before and had a topper upper before China. Several

of my classmates had needle stick injuries. I was lucky and didnt.

(Wont help with hep c though.)

Lea.

 

, <snakeoil.works wrote:

>

> How many of you get the Hep B vaccine when traveling to China? Raise

your hands.

>

> ann

> ----------

>

>

>

> Version: 7.1.394 / Virus Database: 268.9.3/374 - Release 6/23/06

>

>

>

[Guest guest]

, <snakeoil.works wrote:

>

> How many of you get the Hep B vaccine when traveling to China? Raise

your hands.

 

For the Hep B vaccine, that question relates entirely to how much

(unprotected) sex you are planning on having with the locals. Hep B

is fairly prevalent in Asia, especially in the older generations, but

it is transmitted by blood and body fluids so controlling the risk of

contraction is your first line of defense. In mainland China, you

definitely want to bring your own acupuncture needles (easy to buy

there) when you go for treatment unless you go somewhere that uses

disposables. Avoid unnecessary transfusions, be safe like you would

at home, but don't worry too much about Hep B unless you are going to

be having unprotected sexual contact.

 

The bigger issue for travellers is Hep A. Hep A is transmitted by the

oral-fecal route (food handling is the issue) and can make you

miserably sick a a month or more if you are unlucky enough to contract

it. Many people going to Asia get the Hep A vaccine and I think it is

a good idea, especially if you'll be spending time in the countryside

or will stay for a long time, travel throughout Asia, like to eat

street food, etc. For a short trip in big cities, I wouldn't worry

about it.

 

Most people don't have a lot of health problems in China. It is easy

to get a gnarly flu or cough there, but most people's belly woes are

generally short-lived and not too severe, if they have any problems at

all. It's not India.

 

Eric

[Guest guest]

When traveling to China?! I got it (and A) just for Los Angeles. ;>)

 

....mm

 

 

<snakeoil.works wrote:

>

> How many of you get the Hep B vaccine when traveling to China? Raise

your hands.

>

> ann

[Guest guest]

Thanks, Eric, and all who responded. Somehow it didn't seem high risk, but maybe

worthwhile.

 

And btw, what is the cost of needles in China, as compared to the US?

 

Thanks again,

ann

 

 

 

, <snakeoil.works wrote:

>

> How many of you get the Hep B vaccine when traveling to China? Raise

your hands.

 

For the Hep B vaccine, that question relates entirely to how much

(unprotected) sex you are planning on having with the locals. Hep B

is fairly prevalent in Asia, especially in the older generations, but

it is transmitted by blood and body fluids so controlling the risk of

contraction is your first line of defense. In mainland China, you

definitely want to bring your own acupuncture needles (easy to buy

there) when you go for treatment unless you go somewhere that uses

disposables. Avoid unnecessary transfusions, be safe like you would

at home, but don't worry too much about Hep B unless you are going to

be having unprotected sexual contact.

 

The bigger issue for travellers is Hep A. Hep A is transmitted by the

oral-fecal route (food handling is the issue) and can make you

miserably sick a a month or more if you are unlucky enough to contract

it. Many people going to Asia get the Hep A vaccine and I think it is

a good idea, especially if you'll be spending time in the countryside

or will stay for a long time, travel throughout Asia, like to eat

street food, etc. For a short trip in big cities, I wouldn't worry

about it.

 

Most people don't have a lot of health problems in China. It is easy

to get a gnarly flu or cough there, but most people's belly woes are

generally short-lived and not too severe, if they have any problems at

all. It's not India.

 

Eric

 

 

 

 

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[Guest guest]

haha. Ever prudent.

ann

 

 

 

 

 

When traveling to China?! I got it (and A) just for Los Angeles. ;>)

 

...mm

 

<snakeoil.works wrote:

>

> How many of you get the Hep B vaccine when traveling to China? Raise

your hands.

>

> ann

 

 

 

 

 

 

 

----------

 

 

 

Version: 7.1.394 / Virus Database: 268.9.3/374 - Release 6/23/06

 

 

 

[Guest guest]

Depends if your going to be working or interning in a hospital

there. And for children I would recommend it, as my little boy fell

over into blood streaked sputum on the pavement more than once, all

it takes is a grazed knee and some handy, bloody spit. And speaking

of blood streaked rheum, the one vaccination that nobody mentioned

was TB. (Its only given to Asian and aboriginal kids as a matter of

course in Australia.) It may not be that effective in adults, but

with kids is worth considering. The first department I landed in

when interning was the respiratory department, filled with

tubercular old people spitting into their hands and showing it to

me.

Regards,

Lea.

, " Eric Brand "

<smilinglotus wrote:

>

> , <snakeoil.works@> wrote:

> >

> > How many of you get the Hep B vaccine when traveling to China?

Raise

> your hands.

>

> For the Hep B vaccine, that question relates entirely to how much

> (unprotected) sex you are planning on having with the locals. Hep

B

> is fairly prevalent in Asia, especially in the older generations,

but

> it is transmitted by blood and body fluids so controlling the risk

of

> contraction is your first line of defense. In mainland China, you

> definitely want to bring your own acupuncture needles (easy to buy

> there) when you go for treatment unless you go somewhere that uses

> disposables. Avoid unnecessary transfusions, be safe like you

would

> at home, but don't worry too much about Hep B unless you are going

to

> be having unprotected sexual contact.

>

> The bigger issue for travellers is Hep A. Hep A is transmitted by

the

> oral-fecal route (food handling is the issue) and can make you

> miserably sick a a month or more if you are unlucky enough to

contract

> it. Many people going to Asia get the Hep A vaccine and I think

it is

> a good idea, especially if you'll be spending time in the

countryside

> or will stay for a long time, travel throughout Asia, like to eat

> street food, etc. For a short trip in big cities, I wouldn't worry

> about it.

>

> Most people don't have a lot of health problems in China. It is

easy

> to get a gnarly flu or cough there, but most people's belly woes

are

> generally short-lived and not too severe, if they have any

problems at

> all. It's not India.

>

> Eric

>

[Guest guest]

Re: Hep B vaccine?

Sat Jun 24, 2006 12:31 am (PST)

>

> How many of you get the Hep B vaccine when

>traveling to China? Raise

>your hands.

 

I got the Hep B series whilst still in school some

years before coming to China, so it seemed more

pertinent to get the Hep A vaccine when I was

preparing to come here.

 

After a few years of practice, I had a conversation

with the public health nurse who gave me my B shots

about needle sticks and viral transmission. She said

that the viral load needed to effect Hep C

transmission would be nearly impssible to occur via

our eensy-weensy acupuncture needles. Hep B

transmission, on the other hand, could indeed happen

(in her informed opinion).

 

--chris

 

" I never let schooling interfere with my education. " (Mark Twain)

 

 

 

 

 

[Guest guest]

I had never heard about the viral load of Hep C being too small to pass on

through

acupuncture needles. I had heard that about HIV however. Do you have any other

sources

for this.

 

Ok, so I have a riddle for Hep B vaccine experts. When I was going to China I

got the first

of the 3 vaccine shots in Los Angeles and thought I would get the rest in

Beijing. However

once I got there I thought perhaps it would be a different strain and somehow

ineffective

or harmful. Because I was studying in this big hepatitis department there I

asked them and

they were stumped as well. What do you think? Do Americans and the Chinese

vaccinate

with the same strain? (I didn't get the 2nd and 3rd shots.)

doug

 

, Chris Flanagan <pokeyflan wrote:

 

>

> After a few years of practice, I had a conversation

> with the public health nurse who gave me my B shots

> about needle sticks and viral transmission. She said

> that the viral load needed to effect Hep C

> transmission would be nearly impssible to occur via

> our eensy-weensy acupuncture needles. Hep B

> transmission, on the other hand, could indeed happen

> (in her informed opinion).

>

> --chris

[Guest guest]

Hi! Ann,

You can try www.cdc.gov and look for traveler's health.

There are lots of immunization information update before traveling.

I would recommend to get immunization in the US before travel to Asia.

I was an RN and midwife in Taiwan before I moved to the US. I knew

that the Hep B vaccination is a bit different than the US. Some of my

patients received the immunization in Asia, but still tested negative

for Hep B antibody. Some people's Hep B vaccination can last about 5 to

7 years. Thus, if you have Hep B vaccination in the past, it may not be

a bad idea to check Hep B titer every 5 to 7 years.

I was told to get immunization in the US, because the different

vaccination manufacture process.

My internal medicine clinic patients asked me those questions all the

time, thus I knew about Hep B or other immunization information. In

fact, the highest season for me to do physical exams and immunization

update is in the summer. I practice Internal Medicine as an adult nurse

practitioner and Acupuncturist in our Internal Medicine clinic.

Ta-Ya

 

Ta-Ya Lee, MSN, CRNP, MAc, LAc, MBA

Johns Hopkins Community Physicians

Wyman Park Internal Medicine

Phone 410-338-3421 Fax 410-338-3413

 

WARNING: E-mail sent over the Internet is not secure. Information sent

by e-mail may not remain confidential.

 

[Guest guest]

According to my infectious disease rotation as an adult nurse

practitioner in the Moor clinic

(HIV clinic) of Johns Hopkins Hospital, Hep B and Hep C virus are much

more infectious than HIV virus. Your risk of getting Hep B or Hep C

from needle stick is much higher than HIV. However, it depend on the

size of the needle and puncture wound area. I knew that when I was in

Taiwan at late 1980's, the Hep B vaccination were made from reduced

strength of life virus. I learned that Hep B vaccination in the US is

made by biomedical engineer, according to my Pharm D friend. Thus,

it's a bit safe to get Hep B vaccination in the US than in Taiwan. If

you didn't get Hep B #2 and #3, you are not sufficient to be protected.

You probably need to have Hep B antibody check before restart the Hep B

vaccination again. Some of my colleagues just restart Hep B vaccination

without checking the titer.

Ta-Ya

 

Ta-Ya Lee, MSN, CRNP, MAc, LAc, MBA

Johns Hopkins Community Physicians

Wyman Park Internal Medicine

Phone 410-338-3421 Fax 410-338-3413

 

WARNING: E-mail sent over the Internet is not secure. Information sent

by e-mail may not remain confidential.

 

[Guest guest]

Thank you Ta Ya,

Well, it seems from this that due to delays and some misunderstandings (which I

won't go into), it is really too late to get adequate protection by starting the

series now, as I am leaving in less than 2 weeks. It seems that only about half

the people I've spoken to have gotten the vaccination prior to China travel. I

won't be working in a hospital and willl provide my own needles for any acu I

get there.

 

Hep B is probably not a concern for me for this trip, rather Hep A. I guess I

will pass for now. Thank you for your input on this.

It does seem strange that the emphasis seems to be on Hep B. That may be b/c Hep

A is considered not an endemic problem in the US, but cautionary for those who

have unprotected sex with a variety of partners. Perhaps the reason more ppl

don't get the vaccines before traveling is that one has to start them a

significant time before the trip to get the full effect with the full series. It

also seems that many THINK they are getting some protection with just the first

shot.

 

Another concern I have on this, of course, relates to the longterm hidden

problems with vaccines - in general and also specifically the hep vaccine. I

wonder if you have any opinion on that. I know mainstream opinion is that they

are eminently safe.

 

ann

 

 

 

 

Hi! Ann,

You can try www.cdc.gov and look for traveler's health.

There are lots of immunization information update before traveling.

I would recommend to get immunization in the US before travel to Asia.

I was an RN and midwife in Taiwan before I moved to the US. I knew

that the Hep B vaccination is a bit different than the US. Some of my

patients received the immunization in Asia, but still tested negative

for Hep B antibody. Some people's Hep B vaccination can last about 5 to

7 years. Thus, if you have Hep B vaccination in the past, it may not be

a bad idea to check Hep B titer every 5 to 7 years.

I was told to get immunization in the US, because the different

vaccination manufacture process.

My internal medicine clinic patients asked me those questions all the

time, thus I knew about Hep B or other immunization information. In

fact, the highest season for me to do physical exams and immunization

update is in the summer. I practice Internal Medicine as an adult nurse

practitioner and Acupuncturist in our Internal Medicine clinic.

Ta-Ya

 

Ta-Ya Lee, MSN, CRNP, MAc, LAc, MBA

Johns Hopkins Community Physicians

Wyman Park Internal Medicine

Phone 410-338-3421 Fax 410-338-3413

 

WARNING: E-mail sent over the Internet is not secure. Information sent

by e-mail may not remain confidential.

[Guest guest]

, <snakeoil.works wrote:

> Well, it seems from this that due to delays and some

misunderstandings (which I won't go into), it is really too late to

get adequate protection by starting the series now, as I am leaving in

less than 2 weeks. It seems that only about half the people I've

spoken to have gotten the vaccination prior to China travel. I won't

be working in a hospital and willl provide my own needles for any acu

I get there.

 

A lot of people would recommend Hep B if you are planning on working

in the acupuncture dept of a Chinese hospital, but if you are just

going in as a patient, bring your own needles and don't worry about

it. In my experiences working in the acupuncture dept (albeit in

Taiwan where all the needles are single-use), there was actually not

much risk of needle sticks. Even though we were inserting needles on

100+ people per shift, we are essentially taking a sterile needle,

inserting it once with clean technique, and moving on. Nurses remove

the needles, so actually the practitioner has minimal exposure to

contaminated needles. I don't think the risk of needle sticks is

inherently higher there, if anything it is lower because you never

touch contaminated needles.

 

Acupuncturists are generally at a higher risk of exposure to Hep B, so

many acupuncturists get the vaccine regardless of where they live and

work. But to me, not taking the precaution when you are needling

patients day in and day out in America but then suddenly jumping for

the vaccine when you are preparing to do a short internship in a

Chinese hospital is kind of silly. It is like regularly having unsafe

sex with people in your hometown in California and then suddenly

starting to use condoms just because you are now dating someone from

South Africa. There are gradations of risk and prevalence of diseases

in different places, but it you are a careful person, be careful

everywhere, not just in far-off places.

 

> It does seem strange that the emphasis seems to be on Hep B. That

may be b/c Hep A is considered not an endemic problem in the US, but

cautionary for those who have unprotected sex with a variety of partners.

 

Just to be clear, Hep A is rarely transmitted by sexual contact unless

the sexual contact involves the oral-fecal route of transmission. Hep

A does not have chronic asymptomatic carriers and is a relatively

short-lived but intense infection that is generally acquired from

contaminated food. I believe that if you are going somewhere where

Hep A is prevalent but you don't have time for the full series of

vaccinations, you can get a gamma globulin shot that will give you

protection for a limited time period. This may be an option to consider.

 

Eric

[Guest guest]

Last time at the Beijing hospital I was carrying around overloaded buckets of

used needles.

It was real stupid to do and I was very, very careful and I was darn scared. I'm

not worried

about the needles before they go in, I'm worried when they come out! Anyway if

it takes a

trip to China to get the shots then next time I plan to be prepared.

 

Hep B is rampant in Asia and I wish I was smart enough to have planned for all

the shots.

My sense is that further shots in China would not have helped me. I also wonder

if those

that got shots in Asia and then were shown to be anti-body negative if they were

tested in

the same place they got the shots. And if that makes a difference. If someone is

in the

contagious stage of Hep B then it doesn't take unprotected sex to pass it on.

Contact can

be enough. For Hep C it is unclear if sex is a reliable route of transmission.

Transferrance

of blood is well recognized as the major way to pass it on.

 

Whoever wrote that HCV is rarely transmitted through needles I wish they would

clarify or

give a source. I would be interested to see it. I see a lot of HCV patients and

am very

careful with everyone.

 

Although Hepatitis A may ruin your trip it doesn't usually, usually... have the

dire

consequences of B or C. Basically we worry about C in America and B in Asia but

that

distinction blurs. I have Asian Hep C patients and people who have never been

outside the

States with B.

 

 

doug

 

 

 

, " Eric Brand " <smilinglotus

wrote:

>

> , <snakeoil.works@> wrote:

> > Well, it seems from this that due to delays and some

> misunderstandings (which I won't go into), it is really too late to

> get adequate protection by starting the series now, as I am leaving in

> less than 2 weeks. It seems that only about half the people I've

> spoken to have gotten the vaccination prior to China travel. I won't

> be working in a hospital and willl provide my own needles for any acu

> I get there.

>

> A lot of people would recommend Hep B if you are planning on working

> in the acupuncture dept of a Chinese hospital, but if you are just

> going in as a patient, bring your own needles and don't worry about

> it. In my experiences working in the acupuncture dept (albeit in

> Taiwan where all the needles are single-use), there was actually not

> much risk of needle sticks. Even though we were inserting needles on

> 100+ people per shift, we are essentially taking a sterile needle,

> inserting it once with clean technique, and moving on. Nurses remove

> the needles, so actually the practitioner has minimal exposure to

> contaminated needles. I don't think the risk of needle sticks is

> inherently higher there, if anything it is lower because you never

> touch contaminated needles.

>

> Acupuncturists are generally at a higher risk of exposure to Hep B, so

> many acupuncturists get the vaccine regardless of where they live and

> work. But to me, not taking the precaution when you are needling

> patients day in and day out in America but then suddenly jumping for

> the vaccine when you are preparing to do a short internship in a

> Chinese hospital is kind of silly. It is like regularly having unsafe

> sex with people in your hometown in California and then suddenly

> starting to use condoms just because you are now dating someone from

> South Africa. There are gradations of risk and prevalence of diseases

> in different places, but it you are a careful person, be careful

> everywhere, not just in far-off places.

>

> > It does seem strange that the emphasis seems to be on Hep B. That

> may be b/c Hep A is considered not an endemic problem in the US, but

> cautionary for those who have unprotected sex with a variety of partners.

>

> Just to be clear, Hep A is rarely transmitted by sexual contact unless

> the sexual contact involves the oral-fecal route of transmission. Hep

> A does not have chronic asymptomatic carriers and is a relatively

> short-lived but intense infection that is generally acquired from

> contaminated food. I believe that if you are going somewhere where

> Hep A is prevalent but you don't have time for the full series of

> vaccinations, you can get a gamma globulin shot that will give you

> protection for a limited time period. This may be an option to consider.

>

> Eric

>

[Guest guest]

Hi Ann,

Hep B and Hep C are much more serious diseases than Hep A. As we

practice acupuncture and other health care professions, we are under

greater risk to expose to the Hep B and Hep C. I consider Hep B and C

are one type of STD, due to body fluid exchange. Unfortunately I saw

too many sad cases expose to Hep B and C. One of my neighbor in Taiwan

who was expose to Hep B, and became acutely ill. He pass away within 3

weeks. He was only in his early 40's. Another good friend of my

family, who live in Shanghai for last 10 years, didn't know he had Hep

C. He though he just gain weight gradually around the waist line at

last couple years. He came back to Taiwan and looked for Internal

Medicine consult, and found he had Cirrhosis. He was diagnosed too

late, within 1 week of came back to Taiwan, he was in " liver coma " . He

pass away at last week.

 

I don't know how long you are going to stay in China. According to

epidemiology study, Chinese have very high prevalent rate of getting

liver cancer. The major reason was Hep B. Thus, I knew that all of the

newborn and prenatal care in Taiwan were heavily emphasis on prevention

of Hep B transmission from moms to babies. All of moms are tested for

Hep B, and all of babies are getting either Hep B vaccination or

immunoglobulin, depend on mom's Hep B status. The Taiwanese government

was able to successfully reduce Hep B infection rate among new born

babies. However, any one who is above age 30 didn't get such benefit,

because the prevention policy began in 1980's. I don't know whether

China have similar policy.

 

Thus, I still think it's not too late to get Hep B vaccination. I just

immunized one of the embassy worker who is traveling to middle east. He

will get booster Hep B when he comes back. You can review my previous

post regarding the differences of Hep B vaccination in Taiwan and US.

It's your call for your own comfort level regard immunization.

 

Ta-Ya

 

Ta-Ya Lee, MSN, CRNP, MAc, LAc, MBA

Johns Hopkins Community Physicians

Wyman Park Internal Medicine

Phone 410-338-3421 Fax 410-338-3413

 

WARNING: E-mail sent over the Internet is not secure. Information sent

by e-mail may not remain confidential.

 

[Guest guest]

I agree with Eric on Hep A is transmitted by oral-fecal route, and tend

to get infection from contaminated food. However I wasn't sure about

getting a gamma globulin shot can give protection, if you didn't expose

to Hep A.

I knew that if mom is tested positive for Hep B antigen (virus

carrier), the new born baby will get immunoglobulin immediately. There

are several levels of blood test to check, such as HBeAg. HBcAg, HBsAg,

Anti-HBc, Anti-HBe, and Anti-HBs. These type of tests will be able to

stage the timing of Hep B exposure. You have to check with local health

department to find out the necessity of getting immunoglobulin without

exposure.

Ta-Ya

 

Ta-Ya Lee, MSN, CRNP, MAc, LAc, MBA

Johns Hopkins Community Physicians

Wyman Park Internal Medicine

Phone 410-338-3421 Fax 410-338-3413

 

WARNING: E-mail sent over the Internet is not secure. Information sent

by e-mail may not remain confidential.

 

[Guest guest]

Hep C is very common among IV drug users and sex workers. I used to

work in the detox clinic in Baltimore for 7 years, and most of my

patients have Hep C or Hep B. A few of my nursing collogues got Hep C

through needle stick or blood transfusion.

Here is the information I checked from Ferri's clinical advisor:

instant diagnosis and treatment:

Transfusion-related non-A,B hepatitis intermediate incubation (6-8

weeks; range 15 to 150 days), between hepatitis A and B.

Epidemiology incident in U.S.: 150,000 new cases per year (37,500,

symptomatic; 93,000, later chronic liver disease; 30,700, cirrhosis);

Approximately 9000 of these ultimately die of HepC infection; it's the

most common (40%) cause of nonalcoholic liver disease in US. 60-70%

among high-risk group (transfused hemophiliacs; IV drug users sharing

needles)

Acute Hep C hepatitis is often (75%) asymptomatic. Persistent

infection is common (50%-70%) following HepC, result in chronic

hepatitis (chronic aggressive or chronic persistent hepatitis), often

characterized by fluctuating ALT levels, cirrhosis (often asymptomatic,

developing in 20% - 50% even after 20 years); or hepatocellular

carcinoma (50% a result of HepC).

www.cdc.gov has all of update information regarding epidemiology.

 

Ta-Ya

 

Ta-Ya Lee, MSN, CRNP, MAc, LAc, MBA

Johns Hopkins Community Physicians

Wyman Park Internal Medicine

Phone 410-338-3421 Fax 410-338-3413

 

WARNING: E-mail sent over the Internet is not secure. Information sent

by e-mail may not remain confidential.

 

[Guest guest]

Thanks Ta-Ya for the this information. For those in LA I'll be teaching a CEU

class about

HCV and HBV on July 16th at Emperors College from 9 AM to 1. It's going to go

over a lot

of this type of background and with a focus on a number of herbal strategies for

Chronic

Hepatitis B and C.

 

I'll just point out a few things. First is that while many current IV drug users

and sex

workers have Chronic Hepatitis most of my patients were short term IV users or

experimenters several decades ago. For that reason we have had an explosion of

diagnosis

in the USA as those in or approaching middle age either start to show signs or

more

usually have routine testing for other issues.

 

Hep B is a DNA strand and is relatively stable as opposed to Hep C which is RNS

(half the

strand), extremely small even for a virus and thus very unstable and easily

mutated. It is

for that reason, I believe, that a HCV vaccine will be a long time if ever in

being developed.

 

The size of the virus is also thought to allow it to " hide " in various parts of

the body for

decades. This makes viral load test or amount of the virus in the body usually

very

unreliable. Many interferon ribaviron treatments show a complete cure for a few

months

and then the virus pops up again.

 

Also although I saw many studies while in Beijing of Hep B cures it seems that

the strategy

for HCV is to minimize the damage on the liver because once inside of the liver

cells, HCV

is very hard to fully irradicate.

 

doug

 

, " Ta-Ya Lee " <tlee19 wrote:

>

> Hep C is very common among IV drug users and sex workers. I used to

> work in the detox clinic in Baltimore for 7 years, and most of my

> patients have Hep C or Hep B. A few of my nursing collogues got Hep C

> through needle stick or blood transfusion.

> Here is the information I checked from Ferri's clinical advisor:

> instant diagnosis and treatment:

> Transfusion-related non-A,B hepatitis intermediate incubation (6-8

> weeks; range 15 to 150 days), between hepatitis A and B.

> Epidemiology incident in U.S.: 150,000 new cases per year (37,500,

> symptomatic; 93,000, later chronic liver disease; 30,700, cirrhosis);

> Approximately 9000 of these ultimately die of HepC infection; it's the

> most common (40%) cause of nonalcoholic liver disease in US. 60-70%

> among high-risk group (transfused hemophiliacs; IV drug users sharing

> needles)

> Acute Hep C hepatitis is often (75%) asymptomatic. Persistent

> infection is common (50%-70%) following HepC, result in chronic

> hepatitis (chronic aggressive or chronic persistent hepatitis), often

> characterized by fluctuating ALT levels, cirrhosis (often asymptomatic,

> developing in 20% - 50% even after 20 years); or hepatocellular

> carcinoma (50% a result of HepC).

> www.cdc.gov has all of update information regarding epidemiology.

>

> Ta-Ya

>

> Ta-Ya Lee, MSN, CRNP, MAc, LAc, MBA

> Johns Hopkins Community Physicians

> Wyman Park Internal Medicine

> Phone 410-338-3421 Fax 410-338-3413

>

> WARNING: E-mail sent over the Internet is not secure. Information sent

> by e-mail may not remain confidential.

>

[Guest guest]

Hi Ta-Ya,

 

I appreciate this discussion, especially as a review of the issues, and hope it

is not too non-CM related for the list.

 

As for me, I am still contemplating the issue for my trip, which will be for 6

weeks.

Since I will not be working in a clinic/hospital, I don't see how my risk for

Hep B is very large. Are you saying that if I come in casual contact with a

person with active Hep B, that puts me at risk?

 

I would have thought Hep A was more of a risk (though not long term), as far as

exposure goes, since it may be transmitted through food improperly handled or

handled by person with hep.

 

And are you saying that if I were to get the first in the series, then I would

get some protection from Hep A or B, if exposed? I am sorry to hear about your

friend's succumbing to the virus. It is always tragic first to contract such a

virus and then to have it slip through the cracks, so to speak, before diagnosis

is made. You did not mention, if you know, how he was exposed.

 

And here's another question: When one gets the vaccination and in the event

that there are symptoms subsequent to the vaccination (the 2 days of

fever/discomfort, or whatever) would it be feasible to manage those with Chinese

herbal formulas?

 

Ann

 

 

Hi Ann,

Hep B and Hep C are much more serious diseases than Hep A. As we

practice acupuncture and other health care professions, we are under

greater risk to expose to the Hep B and Hep C. I consider Hep B and C

are one type of STD, due to body fluid exchange. Unfortunately I saw

too many sad cases expose to Hep B and C. One of my neighbor in Taiwan

who was expose to Hep B, and became acutely ill. He pass away within 3

weeks. He was only in his early 40's. Another good friend of my

family, who live in Shanghai for last 10 years, didn't know he had Hep

C. He though he just gain weight gradually around the waist line at

last couple years. He came back to Taiwan and looked for Internal

Medicine consult, and found he had Cirrhosis. He was diagnosed too

late, within 1 week of came back to Taiwan, he was in " liver coma " . He

pass away at last week.

 

I don't know how long you are going to stay in China. According to

epidemiology study, Chinese have very high prevalent rate of getting

liver cancer. The major reason was Hep B. Thus, I knew that all of the

newborn and prenatal care in Taiwan were heavily emphasis on prevention

of Hep B transmission from moms to babies. All of moms are tested for

Hep B, and all of babies are getting either Hep B vaccination or

immunoglobulin, depend on mom's Hep B status. The Taiwanese government

was able to successfully reduce Hep B infection rate among new born

babies. However, any one who is above age 30 didn't get such benefit,

because the prevention policy began in 1980's. I don't know whether

China have similar policy.

 

Thus, I still think it's not too late to get Hep B vaccination. I just

immunized one of the embassy worker who is traveling to middle east. He

will get booster Hep B when he comes back. You can review my previous

post regarding the differences of Hep B vaccination in Taiwan and US.

It's your call for your own comfort level regard immunization.

 

Ta-Ya

 

Ta-Ya Lee, MSN, CRNP, MAc, LAc, MBA

Johns Hopkins Community Physicians

Wyman Park Internal Medicine

Phone 410-338-3421 Fax 410-338-3413

 

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[Guest guest]

Hi! Ann,

The most important thing is to activate the immunization response by

getting the first dosage of Hep B and Hep A. I look up the adult

immunization recommendation guideline. The second dose of Hep B

vaccine is 1-2 month after the first, the 3rd dose is 4-6 months after

the 1st dose. The Hep A vaccine is 2 doses, separate by 6-12 months.

Thus, you still have enough time to get vaccination before you go to

China.

I wasn't sure how my neighbor got infected with Hep B, because I was

only 10 yrs old when he pass away. My family friend probably got Hep C

through unprotective sex. He was an elder, and I wasn't in any position

to question his wife about him. However, I heard about the medical

student in Taiwan was exposed through needle stick and got infected of

Hep B in 1980's. Unfortunately the student got really sick within 2-3

weeks and pass away. This is the sad story that you read in the

newspaper. As long as you follow the cdc guideline to protect yourself,

you have less risk to get Hep A and B.

Ta-Ya

 

Ta-Ya Lee, MSN, CRNP, MAc, LAc, MBA

Johns Hopkins Community Physicians

Wyman Park Internal Medicine

Phone 410-338-3421 Fax 410-338-3413

[Guest guest]

Thank you again Ta-Ya,

 

I got the first Hep A & B today. Doc printed out the pages for me, with this

extracted explanation:

 

" One month after receiving the first dose of monovalent hepatitis A vaccine,

94%-100% of adults and children will have protective concentrations of

antibody.The final dose in the hepatitis A vaccine series is necessary to

promote long-term protection. "

 

And further: " Many persons will have a detectable antibody to hepatitis A virus

(anti-HAV) response to the monovalent vaccine by 2 weeks after the first vaccine

dose. The proportion of persons who develop a detectable antibody response at 2

weeks may be lower when smaller vaccine dosages are used, such as with the use

of TWINRIX. Travelers who receive hepatitis A vaccine <2 weeks before traveling

to an endemic area and who do not receive immune globulin either by choice or

because of lack of availability likely will be at lower risk of infection than

those who do not receive hepatitis A vaccine or IG. "

 

Full text on Hep A can be found at:

http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=dis & obj=hav.htm

Pages on Hep B and vaccination can be found at:

http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=dis & obj=hbv.htm

General overview of vaccinations for East Asia is at:

http://www.cdc.gov/travel/eastasia.htm

 

 

Thanks to all those who chimed in.

(arm not sore yet;-)

ann

 

 

Hi! Ann,

The most important thing is to activate the immunization response by

getting the first dosage of Hep B and Hep A. I look up the adult

immunization recommendation guideline. The second dose of Hep B

vaccine is 1-2 month after the first, the 3rd dose is 4-6 months after

the 1st dose. The Hep A vaccine is 2 doses, separate by 6-12 months.

Thus, you still have enough time to get vaccination before you go to

China.

I wasn't sure how my neighbor got infected with Hep B, because I was

only 10 yrs old when he pass away. My family friend probably got Hep C

through unprotective sex. He was an elder, and I wasn't in any position

to question his wife about him. However, I heard about the medical

student in Taiwan was exposed through needle stick and got infected of

Hep B in 1980's. Unfortunately the student got really sick within 2-3

weeks and pass away. This is the sad story that you read in the

newspaper. As long as you follow the cdc guideline to protect yourself,

you have less risk to get Hep A and B.

Ta-Ya

 

Ta-Ya Lee, MSN, CRNP, MAc, LAc, MBA

Johns Hopkins Community Physicians

Wyman Park Internal Medicine

Phone 410-338-3421 Fax 410-338-3413

 

 

 

 

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[Guest guest]

Hi,

Even with a few weeks to go to travel , you can have about 2

vaccinations for hep A and B on an accelerated course. Even one shot

will give a percentage of immunity. Better than nothing. IMO if a

disease is faecal-orally transmitted then I want to be vaccinated

against it when travelling to certain places. China has had some brutal

Hep A outbreaks attributed to shell fish, but really, outbreaks aside, if

youre eating out or from street stalls then you can get hep A anytime.

(And then theres Chinese public toilets.....)

As for needle stick injuries in the hospitals, we had to take the needles

out as well as put them in, and people tend to put many needles

between their fingers when removing them. So you get people walking

around with a bunch of used needles sticking out from their hands, with

a room full of patients pushing and shoving, while youre tripping over

their grandkids or their pet dog that they brought along.

Then there was the needle " sterilization " which was pretty

questionable. That same hospital now apparantly uses single-use

needles, but when I was there, a classmate had a look at

the " autoclave room " and discovered that whilst the nurses were

dutifully putting the needle trays through the machines, the machine he

looked at wasnt plugged into the wall.

Regards,

Lea.

[Guest guest]

One aspect of this discussion that interests me is that no one has

asked about or mentioned any risks with the Hep B vaccination(s).

While I certainly understand the high risk situation in traveling to

China, I wonder if receiving any vaccination should be taken lightly.

 

 

On Jun 27, 2006, at 9:37 PM, wrote:

 

> Hep B is rampant in Asia and I wish I was smart enough to have

> planned for all the shots.

> My sense is that further shots in China would not have helped me. I

> also wonder if those

> that got shots in Asia and then were shown to be anti-body negative

> if they were tested in

> the same place they got the shots. And if that makes a difference.

> If someone is in the

> contagious stage of Hep B then it doesn't take unprotected sex to

> pass it on. Contact can

> be enough. For Hep C it is unclear if sex is a reliable route of

> transmission. Transferrance

> of blood is well recognized as the major way to pass it on.

 

 

 

 

[Guest guest]

I'm sure if you have any information we would like to hear it. There have been

reports of

higher incidence of MS after HBV vaccines. Studies I've seen from 1998 and 2004

are

contridictory as a number of factors including the age of the groups makes a big

difference in statistical outcome. Given that we are in a profession where an

eventual

needle stick is, if not a given, then highly likely, the statistical probability

is much higher

even if HBV vaccines were to prove to give a higher incidence of MS, which they

haven't.

Good call on mentioning the risks. Now that you have, do you want to commit

yourself to

an opinion?

doug

 

, " " <zrosenbe

wrote:

>

> One aspect of this discussion that interests me is that no one has

> asked about or mentioned any risks with the Hep B vaccination(s).

> While I certainly understand the high risk situation in traveling to

> China, I wonder if receiving any vaccination should be taken lightly.

>

>

> On Jun 27, 2006, at 9:37 PM, wrote:

>

> > Hep B is rampant in Asia and I wish I was smart enough to have

> > planned for all the shots.

> > My sense is that further shots in China would not have helped me. I

> > also wonder if those

> > that got shots in Asia and then were shown to be anti-body negative

> > if they were tested in

> > the same place they got the shots. And if that makes a difference.

> > If someone is in the

> > contagious stage of Hep B then it doesn't take unprotected sex to

> > pass it on. Contact can

> > be enough. For Hep C it is unclear if sex is a reliable route of

> > transmission. Transferrance

> > of blood is well recognized as the major way to pass it on.

>

>

>

>

[Guest guest]

I have a patient whose wife has Hep B " chronic active state " , been married

for 10 years, he didn't get hep B vaccine because doesn't believe in having

vaccines, all doctors tell him he must get the vaccine.

 

After 10 years he still does not have hep B.

 

Any reason why that may be?

 

Heiko

 

 

 

 

 

 

 

On Behalf Of

Saturday, July 01, 2006 11:32 AM

 

Re: Re: Hep B vaccine?

 

 

 

One aspect of this discussion that interests me is that no one has

asked about or mentioned any risks with the Hep B vaccination(s).

While I certainly understand the high risk situation in traveling to

China, I wonder if receiving any vaccination should be taken lightly.

 

 

On Jun 27, 2006, at 9:37 PM, wrote:

 

> Hep B is rampant in Asia and I wish I was smart enough to have

> planned for all the shots.

> My sense is that further shots in China would not have helped me. I

> also wonder if those

> that got shots in Asia and then were shown to be anti-body negative

> if they were tested in

> the same place they got the shots. And if that makes a difference.

> If someone is in the

> contagious stage of Hep B then it doesn't take unprotected sex to

> pass it on. Contact can

> be enough. For Hep C it is unclear if sex is a reliable route of

> transmission. Transferrance

> of blood is well recognized as the major way to pass it on.