Unacceptable Risk

Texas health officials say that mandatory childhood vaccinations against hepatitis B will prevent the spread of life-threatening illness. But which is riskier--the disease or the vaccine?

Like most people, Glenda Matheny didn't know much about hepatitis B, but when the family pediatrician recommended that her then-14-year-old daughter, Breonna, start receiving a three-dose vaccine against the virus, Glenda figured it had to be done.

Breonna handled the first shot without incident. But on January 17, 1995, immediately after she received her second dose of the vaccine, Breonna became extremely ill. Three days later, after her daughter's symptoms--headache, fever, nausea, and general weariness--failed to go away, Glenda took Breonna back to the doctor, who determined that the girl had suffered a "strong local reaction," as well as a "possible systemic reaction," to the hepatitis B vaccine.

The doctor opted not to give Breonna the third and final dose of the vaccine and assured her that the miserable symptoms she was experiencing were temporary and that she would feel just fine before too long.

But she didn't. After four months, Glenda recalls, "we were back to the doctor almost every day." Breonna was missing so much school that she had to withdraw from Houston's Bellaire High, where she was enrolled in the pre-international baccalaureate program for exceptional students. While her friends were meeting boys, going to dances, and otherwise enjoying their teen years, Breonna was taking a correspondence course at home.

And suffering. Breonna loved sports and was an especially good softball player, but after receiving the hepatitis B vaccine, her joints ached so relentlessly that it was futile to even try to play. Besides, just breaking a sweat would often cause Breonna to faint.

Breonna earned her high school diploma late last year. She scored in the high 1300s on her Scholastic Aptitude Test, but college will have to wait because Breonna is still very sick. Some mornings she wakes up with her face so swollen she hardly looks like herself. When that happens, Glenda knows that her daughter, who is 18 now, will probably spend the next three days in bed, too weak to do anything but sleep.

Glenda Matheny couldn't sleep, at least not until she knew what had happened to her daughter's health. She did a little of her own research and discovered, as have others, that hepatitis B actually posed very little risk to Breonna.

According to the Texas Department of Health, the overwhelming majority of the approximately 1,300 new hepatitis B cases reported each year in Texas occur in adults between the ages of 20 and 40, with the highest concentration--more than 60 percent--becoming infected between ages 25 and 30.

Children under the age of 14 account for an average of 37 new cases of hepatitis B each year in Texas. The reason for the low rate of infection among kids is simple: Hepatitis B is what is commonly referred to as a "lifestyle disease" that mostly strikes intravenous drug users, homosexual men, and heterosexuals with multiple partners.

Moreover, the chance of developing chronic hepatitis B, which can lead to cirrhosis and liver cancer, is low, somewhere between 5 and 10 percent for people more than 5 years old. Though younger children are at greater risk of chronic infection, which can lead to cirrhosis and liver disease later in life, as many as 95 percent of all hepatitis B infections pass without incident or serious illness. For most people, acute hepatitis B is typically no worse than a bout with the flu.

Clearly this is not information Glenda Matheny possessed when she agreed to have her daughter vaccinated against hepatitis B.

"The pediatrician had been my pediatrician when I was growing up," Glenda recalls. "He told me that because teenagers were at high risk, my daughter needed to be vaccinated. That was his medical recommendation, and I took it."

Even if she couldn't see it, Glenda Matheny at least had a choice. Most Texas parents don't, at least not since last August, when the state Department of Health began requiring that all children in the state be vaccinated against hepatitis B before they enter kindergarten. The mandate originated with the federal Centers for Disease Control and Prevention, which began recommending universal childhood immunization against hepatitis B in 1991.

Kristin Hamlet of the Texas Department of Health says the CDC recommendation came about after health officials realized they weren't reducing the chance of the disease in higher-risk adult populations.

"The initial strategy was to target adults who were at risk due to social behavior or through drug use or occupational exposures," Hamlet says. "But that wasn't really doing anything to lower the incidence of the disease, because you can't target these people. You can't tell who they are, and they don't tend to come in for preventive health care before they go out and expose themselves to infection."

Hamlet said the state's mandate makes sense because the CDC, which sets vaccine policy for the federal government, estimates that as many as 1.25 million people are chronic carriers in the United States, including about 30,000 children. "Those are the cases we don't have any way of preventing other than through childhood vaccination," Hamlet says.

But the actual reported incidence of the hepatitis B virus in Texas is low, especially among young children. Only 58 new cases were reported between 1993 and 1997 in kids younger than 5, according to state health officials. That's an average of less than a dozen new cases a year, with most of the cases occurring among infants born to infected mothers.

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