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Am Fam Physician. 1998;57(7):1500

to the editor: After reviewing the article on immunizations,1 we agree that updating family physicians about the changes in the recommended schedule for vaccine administration is vitally important. Although the article extensively covers the need for hepatitis B vaccines, it makes only brief mention of hepatitis A vaccines. We believe that hepatitis A vaccination warrants more attention than it received in this article.

Everyone is at risk for hepatitis A, especially international travelers and people living in areas with an outbreak. In fact, the U.S. Centers for Disease Control and Prevention (CDC) recommends hepatitis A vaccination for international travelers, since more than one half of Americans who travel outside the United States visit hepatitis A endemic regions (e.g., Mexico, parts of the Caribbean and Asia, South and Central America).2 Additionally, the CDC recommends that patients with chronic liver disease be vaccinated for hepatitis A and hepatitis B.

Every year, approximately 10 million persons worldwide are infected with the hepatitis A virus. Hepatitis A is the only foodborne illness preventable by vaccination. The need for hepatitis A vaccination has been underscored further by the rash of outbreaks that have occurred across the country in the past year. One of the most serious outbreaks ocurred in Michigan in April 1997, when 260 persons contracted hepatitis A after eating contaminated strawberries. Even more recently, in September of 1997, also in Michigan, 46 more persons were infected with the virus through a local deli's coleslaw. A 67-year-old man who was infected died as a result.

More than 100 Americans die of hepatitis A each year, yet nearly one quarter of them have never even heard of the disease.3 Not only is it vital for physicians to seriously consider vaccinating patients who are at risk for hepatitis A infection, it is also important for them to discuss this option with all of their patients. For more information on hepatitis, call the Hepatitis Foundation International, toll-free, at 800-891-0707.

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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