Stephanie Mikulsky January 24, 1999

Disease & Discrimination Periodical Review

The hepatitis B Virus (HBV) is widespread and although it often remains asymptomatic, can cause liver damage resulting in death. A hepatitis B vaccine has been developed and is currently given to all newborns and health professionals, after being mandated by the government in 1991. There have been numerous articles published on the subject, each presenting a different aspect of the immunization effort. In the September 1996 issue of The Journal of the American Medical Association (JAMA), the results of a mass HBV immunization in Taiwan were published. The article focuses on the biological findings of the program and the benefits of mass immunizations. A second article, found in the July 1998 issue of Science, deals with the possible adverse side effects of the vaccine and how they may hinder hepatitis B vaccination efforts. The articles present the effort to vaccinate against hepatitis B in two different ways.

In 1984, the mass immunization program commenced in Taiwan, where 15-20% of its population are HBV carriers. The results of 10 years of research were published in JAMA, entitled, "Seroepidemiology of Hepatitis B Virus Infection in Children". The report announces that in the study population, there was a decline in HBV carriers, as well as a decrease in the hepatitis B surface antigen. The results support mass immunization as an effective tool in reducing the number of children who are carriers for the virus. In reducing the number of carriers of the virus, the rate of transmission is also reduced; therefore, those heading the program believe "the ultimate goal of preventing HBV-related chronic liver disease and hepatocellular carcinoma in Taiwan is foreseeable in the near future."(Chen, 908)

The article explores the study from a medical standpoint where the intended audience is health care professionals. The general public would not benefit from the article, because it concentrates on the findings of the study using complex medical terms. The article does not include guidelines nor information about the vaccine that would be useful to the public. Utilizing specific information from the report may be difficult without a background in biology, therefore those versed in biology will most benefit from it.

The author presents a clear account of the study by describing the program, population study, the results, as well as commenting on the results and conclusion. The article addresses the positive biological impact the vaccine has and the importance of implementing the vaccine into the present program for vaccinating children. It does not however, explore the logistics of vaccinating other populations or the rest of Taiwan. Although most of the evidence from the study shows immunization to be successful, there are two cases in which the vaccine failed. The author responsibly addresses the exceptions by noting possible explanations and that more research would be needed to explain it. Overall, the article asserts that immunizing children for hepatitis B is successful in controlling the virus.

The article provides evidence that the hepatitis B vaccine is extremely useful in preventing the transmission of the virus. Recently, concerns have been raised that the hepatitis B vaccine may have adverse side effects. The article serves as a reminder that the vaccine was successful in decreasing the number of carriers in Taiwan where 15%-20% of its population are carriers. Society tends to focus on the negative aspects of a situation, and to forget the positive ones. Therefore, the article is essential in reminding the public that the hepatitis B vaccine is successful in decreasing the transmission of the disease.

The recent article "A Shadow Falls on Hepatitis B Vaccination Effort" in Science, however, addresses the concern that the vaccine for hepatitis B may have adverse side effects. There have been several cases where patients, after receiving the vaccine, have been diagnosed with diseases resembling multiple sclerosis (MS). Although, many of these incidents have been recorded, there is no evidence that the vaccine was the cause. Actually, there have been studies done which show that people who received the vaccine were less likely to get MS. Several studies are currently being conducted to ease public concern and to make sure the vaccine is safe. Many public health officials believe that the increasing public concern could hamper their vaccination efforts.

The intent of the article is to inform the public of the new debate surrounding the HBV vaccine. Therefore, it concentrates on introducing the concerns, rather than examining the detailed medical reasoning behind them. Due to the intended audience, few complex medical terms are included, and only a brief medical explanation of the concerns are provided. The article clearly provides a synopsis of the current situation; however, it does not thoroughly delve into the biological aspects.

Another reason why the article lacks medical explanations may be due to the fact that there is a limited amount of data on the subject. The accusations that the HBV vaccine is unsafe are relatively recent, therefore studies have not yet been performed to asses the validity of them. The article presents the limited available data, as well as the opinions of several health care providers. Essentially, the author presents each side's case explaining their reasoning and introduces the debate to the public. The author notes several times that the critics of the vaccine lack concrete evidence to support their views. He clearly communicates each side's position by giving the opinions of several prominent doctors and disease specialists.

The author also advances our understanding of society's role in disease and discrimination. The article raises the issue that even though future studies may prove that the vaccine is safe, society will still be weary of the vaccine. The connection with a debilitating illness, even though inaccurate, is difficult for people to forget. The article raises the point that the controversy may cause fewer people to get vaccinated, even though it has many positive effects, like preventing cancer. The last paragraph also sheds light on human nature for the author quotes Robert Chen, the vaccine safety chief for the CDC (Center of Disease Control), "many will blame [the hepatitis B vaccine] for any misfortunes that follow. 'It's human nature,' to attribute cause to almost anything that precedes a tragedy."(Marshall, 631) In many cases where tragedy strikes, humans deal with their grief by blaming others for what happened. The author not only addresses the public's concern, but how misplaced concern can hamper quality medical care.

The two articles present the hepatitis B vaccine through different points of view. The study in Taiwan views the vaccine as a successful way to deal with the virus, while the article in Science, addresses the possible side effects of the vaccine. Their contrasting views reveal the need to asses the situation thoroughly, before judging it.

Bibliography

Marshall, Elliot. "A Shadow Falls on Hepatitis B Vaccination Effort." Science, 31 July

1998, pp. 630-631.

Chen, Huey-Ling M.D. "Seroepidemiology of Hepatitis B Virus Infection in Children:

Ten Years of Mass Vaccination in Taiwan." Journal of the American Medical Association, 18 Sept. 1996, pp 906-908.