[nukkad] Digest 263/Comp Res.

[Dr Taher Kagalwala <>]

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Tip of the day:  If you are patient in one moment of anger, you will escape
a hundred days of sorrow.  - Chinese Proverb
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Dear Nukkies,

Hi to all. 
I am not a great typist, but the amount of comments I
have to passs are many, so please excuse thetypos.

Nayana:
Hi there!
Net Geek describes me as " the elderly wise  doctor"
I assure you , I am just 42, very very young..but
alas!
Happily married...and definitely not ' wise ' for, I
have still a lot to learn.
Welcome to Nukkad.Be heard/read, do not be passive. I
am sure you will enjoy.
Secondly , you wrote:(cut,copy,paste):


WE SHOULD MAKE LOVE MANY TIMES BUT
WITH THE SAME
PERSONCouple should talk a lot to each other.

Please don't be so graphic about your love life, we
are scandalised.

Majid to MCG: Good advice to tell the Dr. to cool off,
hope he listens.


Vivek's query re. Hepatitis B Vaccine:
Universal Hepatitis B vaccination is recommended only
for newborns and not for adults such as you. Only the
following persons need to take the vaccine as they are
at risk for contracting the disease:( link:
www.cdc/govmmwr/preview/mmwrhtml/
000033405.htm )

Universal Vaccination of Infants Born to
HBsAg-Negative Mothers 

Hepatitis B vaccination is recommended for all
infants, regardless of the HBsAg status of the mother.
Hepatitis B vaccine should be incor- porated into
vaccination schedules for children. The first dose can
be administered during the newborn period, preferably
before the infant is discharged from the hospital, but
no later than when the infant is 2 months of age
(Because the highest titers of anti-HBs are achieved
when the last two doses of vaccine are spaced at least
4 months apart, schedules that achieve this spacing
may be preferable However, schedules with 2-month
intervals between doses, which conform to schedules
for other childhood vaccines, have been shown to
produce a good antibody response  and may be
appropriate. The develop- ment of combination vaccines
containing HBsAg may lead to other schedules that will
allow optimal use of combined antigens. 

Vaccination of Adolescents 

All adolescents at high risk of infection because they
are injecting drug users or have multiple sex partners
(more than one partner/6 months) should receive
hepatitis B vaccine. Widespread use of hepatitis B
vaccine is encouraged. Because risk factors are often
not identified directly among adolescents, universal
hepatitis B vaccination of teenagers should be
implemented in communities where injecting drug use,
pregnancy among teenagers, and/or sexually transmitted
diseases are common. Adolescents can be vaccinated in
school-based clinics, community health centers, family
planning clinics, clinics for the treatment of
sexually transmitted diseases, and special adolescent
clinics. 

The 0-, 1-, and 6-month schedule is preferred for
vaccinating adoles- cents with the age-appropriate
dose of vaccine.

Vaccination of Selected High-Risk Groups 

High-risk groups for whom vaccination is recommended
include: 

Persons with occupational risk. HBV infection is an
occupational hazard for health-care workers and for
public-safety workers who have exposure to blood in
the workplace. The risk of acquiring HBV infections
from occupational exposures depends on the frequency
of percutaneous and permucosal exposure to blood or
blood-contaminated body fluids. Any health-care or
public-safety worker may be at risk for HBV exposure,
depending on the tasks he or she performs. Workers who
perform tasks involving contact with blood or
blood-contaminated body fluid should be vaccinated .
For public-safety workers whose exposure to blood is
infrequent, timely postexposure prophylaxis should be
considered rather than routine preexposure
vaccination. 

For persons in health-care fields, vaccination should
be completed during training in schools of medicine,
dentistry, nursing, laboratory technology, and other
allied health professions, before trainees have their
first contact with blood. 

Clients and staff of institutions for the
developmentally disabled. Susceptible clients in
institutions for the developmentally disabled, as well
as staff who work closely with clients, should be
vaccinated. Susceptible clients and staff who live or
work in smaller residential settings with known HBV
carriers should also receive hepatitis B vaccine.
Clients discharged from residential institutions into
community programs should be screened for HBsAg so
that appropriate measures can be taken to prevent HBV
trans- mission. These measures should include both
environmental controls and appropriate use of vaccine.


Staff of nonresidential day-care programs for the
develop- mentally disabled (e.g., schools, sheltered
workshops) attended by known HBV carriers have a risk
of infection comparable with that of health-care
workers and therefore should be vaccinated . The risk
of infection for other clients appears to be lower
than the risk for staff. Vaccination of clients in day
care programs may be considered. Vaccination of
classroom contacts is strongly encouraged if a
classmate who is an HBV carrier behaves aggres- sively
or has special medical problems (e.g., exudative
dermatitis, open skin lesions) that increase the risk
of exposure to his or her blood or serous secretions. 

Hemodialysis patients. Hepatitis B vaccination is
recommended for susceptible hemodialysis patients.
Vaccinating patients early in the course of their
renal disease is encouraged.Higher dose is required. 

Recipients of certain blood products. Patients who
receive clotting-factor concentrates have an increased
risk of HBV infection and should be vaccinated as soon
as their specific clotting disorder is identified.
Prevaccination testing is recom- mended for patients
who have already received multiple infusions of these
products. 

Household contacts and sex partners of HBV carriers.
All household and sexual contacts of persons
identified as HBsAg positive should be vaccinated. The
decision to do prevaccination testing to determine
susceptibility to HBV infection should be made
according to the guidelines described earlier in the
section "Prevaccination testing for susceptibility."
Hepatitis B vaccine should be admin- istered at the
age-appropriate dose  to those deter- mined to be
susceptible or judged likely to be susceptible to
infection. 

Adoptees from countries where HBV infection is
endemic. Adopted or fostered orphans or unaccompanied
minors from countries where HBV infection is endemic
should be screened for HBsAg . If the children are
HBsAg positive, other family members should be
vaccinated. 

International travelers. Vaccination should be
considered for persons who plan to spend more than 6
months in areas with high rates of HBV infection and
who will have close contact with the local population.
Short-term travelers who are likely to have contact
with blood (e.g., in a medical setting) or sexual
contact with residents of areas with high or
intermediate levels of endemic disease should be
vaccinated. Vaccination should begin at least 6 months
before travel to allow for completion of the full
vaccine series, although a partial series will offer
some protection. The alternate four-dose schedule (see
Table_1) should provide protection if the first three
doses can be delivered before departure. 

Injecting drug users. All injecting drug users who are
susceptible to HBV should be vaccinated as soon as
their drug use begins. Because of the high rate of HBV
infection in this population, prevaccination screening
should be considered as outlined in the section
"Prevaccination testing for susceptibility." Injecting
drug users known to have HIV infection should be
tested for anti-HBs response after completion of the
vaccine series. Those who do not respond to
vaccination should be counseled accordingly. 

Sexually active homosexual and bisexual men.
Susceptible sexually active homosexual and bisexual
men should be vaccinated. Because of the high rate of
HBV infection in this population, prevaccination
screening should be considered as described in the
section "Prevac- cination testing for susceptibility."
Men known to have HIV infection should be tested for
anti-HBs response after completion of the vaccine
series. Those who do not respond to vaccination should
be counseled accordingly. 

Sexually active heterosexual men and women.
Vaccination is recom- mended for men and women who are
diagnosed as having recently acquired other sexually
transmitted diseases, for prostitutes, and for persons
who have a history of sexual activity with more than
one partner in the previous 6 months. Most patients
seen in clinics for sexually transmitted diseases
should be considered candidates for vaccination. 

Inmates of long-term correctional facilities. Prison
officials should consider undertaking screening and
vaccination programs directed at inmates with
histories of high-risk behaviors. 
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