It's Worth a Shot

By Christine Gorman

Going back to school used to be a simple matter. Buy some shoes, grab a few pencils and head on out the door. But your academic survival kit isn't complete nowadays if you're missing the vaccination against hepatitis B, a virus that can destroy the liver. Not only do more and more schools across the U.S. recommend the shots, but 22 states now require it for enrollment in kindergarten or first grade. Not to be outdone, the American College Health Association is launching a campaign this fall that features extreme-sports athletes like Olympic snowboarder Barrett Christy urging university students to roll up their sleeves.

The vaccination is a great idea, even if your memory of freshman English is receding as fast as your hairline. Hepatitis B strikes more than 200,000 Americans each year and kills 6,000, making it the third most deadly vaccine-preventable disease in the U.S., after flu and pneumonia. There are, of course, other viruses that take a toll on the liver. But hepatitis A, which is transmitted via contaminated water and food (think raw oysters and salad bars), doesn't usually cause permanent damage. And there is as yet no vaccine for hepatitis C, which is transmitted during sexual intercourse, among other ways.

Probably the biggest misconception about hepatitis B is that only drug users or prostitutes contract it. While it is true that most adults become infected through sex or exposure to contaminated needles, perhaps a third of all cases cannot clearly be linked to such causes. "Nature isn't tidy," says Dr. William Schaffner of the Vanderbilt University School of Medicine. "We had a case of two people who only worked together. One had hepatitis B, though he didn't know it, and the other didn't. On a single occasion, they drank from the same Coke. It happened at just the right time in the incubation cycle so that the second person became infected."

Timing is critical in other ways as well. About 90% of adults are eventually able to shake off a hepatitis-B infection, while the other 10% become chronic carriers and face a greater risk of liver damage, liver cancer and death. Things get much worse when children are involved. About 90% of infected infants (who usually get the virus before birth) become chronic carriers.

It made a lot of sense back in 1991 for the Centers for Disease Control to target its vaccination efforts at children under the age of two. But researchers then found that 75% of new cases of hepatitis B in the U.S. occur in those between the ages of 15 and 39. So last year the CDC advised that all children up to the age of 18 get vaccinated. But remember: the disease can strike at any age. Thus most people will benefit from getting the shots. (One exception: those allergic to yeast, which is used to make the vaccine.)

The vaccine, given in three doses over six months, carries potential minor side effects, such as soreness and fever. And there have been reports of adults developing multiple sclerosis after vaccination, although most experts regard those outcomes as unfortunate coincidences. The vaccine is one of the safest inoculations available. Considering the often devastating consequences of hepatitis-B infection, particularly for young people, you and your children are better off getting the shots than taking your chances.

For more on hepatitis B, see time.com/personal E-mail Christine at [email protected] but please no personal questions, which are better suited to your health-care provider.