Do I Need The Hepatitic B Vaccine If I Have Hepatitis C?

I have hepatitis C. What do you think of the hepatitis B vaccine and do I need to get it?

There are three common viruses that cause hepatitis and are named hepatitis A, B, and C. Actually quite a few other viruses can cause a “hepatitis” — an inflammation of the liver — but have different names because their predominant symptoms affect other parts of the body. Probably the most common of these is the Epstein-Barr virus, or EBV, which causes mono. When we first catch mono, and 90 percent of adults have had it, it almost always causes a hepatitis. Doctors seldom test for it, and usually don’t mention it, but it can be seen on blood tests.

But getting back to the question, of the three common hepatitis viruses, vaccinations have been developed to prevent two of them, both hepatitis B and hepatitis A. The hepatitis A vaccine is given as a single shot with a 12-month booster, while the hepatitis B vaccine requires three shots spread over a period of 6 months. The hepatitis A vaccine that I am referring to is a true vaccine, that is it stimulates a person’s body to develop antibodies which prevent infection when one is exposed to the virus in food or water.

Many readers may remember that it was common in the past to give gamma globulin shots to prevent hepatitis A. Gamma globulin, made from pooled plasma obtained from many donors, contained the antibody against hepatitis A and made the recipient temporarily immune (for about 3 months) to catching the infection. This was referred to as passive immunity, and it lasted only as long as the gamma globulin remained intact in the body. Follow-up shots were required to maintain the passive immunity.

The hepatitis A vaccine, widely used only since about 1992, appears to be 100 percent protective; it remains effective at least five years, and perhaps much longer. It is, therefore, clearly the method to use to immunize against this hepatitis. Hepatitis A is spread through food and water, and is very common in the underdeveloped world. It is estimated that 3 out of 1000 travelers to high-risk countries will develop hepatitis A per month that they are there. Hepatitis A is rarely fatal in a healthy individual, although it can make them quite sick for several weeks. In someone with chronic hepatitis C, however, the infection can be very severe, and may produce what is called fulminant hepatitis, almost always fatal unless a liver transplant can be done.

The hepatitis B vaccine is also very protective, inducing immunity to infection in about 96 percent of people who receive the series of three injections. This immunity does wane over time; and, after five years, between 20 to 30 percent will have lost their immunity. There is at present no official advisory to give people routine boosters, but boosters are quite safe, and I would certainly suggest that anyone with hepatitis C receive them. Hepatitis B often produces mild disease in healthy people, but like hepatitis A, can produce much more severe disease — even fulminant hepatitis in people already infected by hepatitis C.

Therefore, I would advise you to arrange to be vaccinated against both hepatitis A and hepatitis B, and to follow up with boosters against hepatitis B every 5 years. Your doctor may wish to test you first to see if you’ve already had one of the infections. If you have, then vaccination against that form of hepatitis would not be helpful, although it would not be harmful. The question of testing is often resolved based on the costs of doing the tests versus the costs of giving a vaccine which might not be necessary.

I receive many questions from people with hepatitis C asking about diets or herbal preparations or alternative, natural treatments for this condition. My reference book on natural medicines lists no treatments for this or other forms of hepatitis. It is well established, however, that alcohol can increase the liver damage seen in hepatitis C, and will probably cause damage in chronic hepatitis B as well. I therefore strongly advise my patients with either form of chronic hepatitis to quit drinking totally, not even one beer per month. I know that many specialists will not consider treating someone with hepatitis C until the person has been free of alcohol for one year.

I have had one patient who in a misguided attempt to treat her hepatitis C naturally took mega doses of vitamins, including niacin. The result of this was to cause her enzyme levels to quadruple over the course of a month or so. When she stopped the niacin at my urging, her enzyme levels returned to their previous low levels. Niacin is known to have this effect on the liver, and should be avoided in someone with chronic hepatitis, either C or B.

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