Washington state health officials credit new regulations that made it more difficult for parents to obtain an exemption from the requirement that children to be fully immunized before entering school.

Under the old rules, to obtain an exemption parents only had to sign a certificate indicating that they object on medical, religious or philosophical grounds.

Proponents of the new law said the ease with which exemptions could be obtained in Washington is one reason why the state has the highest vaccine exemption rates in the country.

Under the new law, parents seeking an exemption must get information from a health care provider about the benefits and risks of vaccine before the provider signs a Certificate of Exemption form.

Kids with exemptions tend to cluster geographically, often living in the same areas, going to the same schools — creating “pockets of under-vaccinated children at risk of outbreaks,” Washington state health officials say.

Click on map for more information about exemption rates

Schools with higher exemption rates have higher rates of diseases like measles and whooping cough (pertussis).

Currently, Washington state is in the midst of a whooping cough epidemic with more that 1,000 cases reported so far just this year.

At this rate, the state is projected to see more than 3,000 cases in 2012, the highest rate seen in decades.

Important points:

• All recommended vaccines for Washington children under age 19 are provided at no-cost through the state’s Childhood Vaccine Program.

• Health care providers may charge an office visit fee and a fee to give the vaccine, called an administration fee — but people who cannot afford the administration fee can ask their regular health care provider to waive the cost.

• For help finding a health care provider or an immunization clinic, call your local health agency (doh.wa.gov/LHJMap/LHJMap.htm), visit the ParentHelp123 resource finder (https://resources.parenthelp123.org/) or call the Family Health Hotline (www.parenthelp123.org/resources/family-health-hotline) at 1-800-322-2588.

• Information about the exemption law (www.doh.wa.gov/cfh/Immunize/) is available online.

In some cases, people come down with a serous illness that can last for months but often people experience only a mild illness and some have no symptoms at all.

Some forms of viral hepatitis go away on their own, but others, like Hepatitis B and Hepatitis C, can go one to become chronic, lifelong infections, which can lead to serious health problems including liver damage, cirrhosis, liver cancer, and even death, the CDC warns.

Most people with chronic hepatitis do not know they are infected and can go 20 or 30 years without showing symptoms.

A simple blood test can determine whether you have hepatitis.

The month of May has been designated Hepatitis Awareness Month in the United States, and tomorrow, May 19th, is being recognized as the first ever Hepatitis Testing Day in the United States.

The National Digestive Diseases Information Clearinghouse has prepared the following material to explain about the different kinds of hepatitis, how to avoid infection and what you can do if you are infected.

Viral Hepatitis: A through E and Beyond

What is viral hepatitis?

Viral hepatitis is inflammation of the liver caused by a virus. Several different viruses, named the hepatitis A, B, C, D, and E viruses, cause viral hepatitis.

All of these viruses cause acute, or short-term, viral hepatitis. The hepatitis B, C, and D viruses can also cause chronic hepatitis, in which the infection is prolonged, sometimes lifelong. Chronic hepatitis can lead to cirrhosis, liver failure, and liver cancer.

Researchers are looking for other viruses that may cause hepatitis, but none have been identified with certainty. Other viruses that less often affect the liver include cytomegalovirus; Epstein-Barr virus, also called infectious mononucleosis; herpesvirus; parvovirus; and adenovirus.

Key Points

• Viral hepatitis is inflammation of the liver caused by the hepatitis A, B, C, D, or E viruses.

• Depending on the type of virus, viral hepatitis is spread through contaminated food or water, contact with infected blood, sexual contact with an infected person, or from mother to child during childbirth.

• Vaccines offer protection from hepatitis A and hepatitis B.

• No vaccines are available for hepatitis C, D, and E. Reducing exposure to the viruses offers the best protection.

• Hepatitis A and E usually resolve on their own. Hepatitis B, C, and D can be chronic and serious. Drugs are available to treat chronic hepatitis.

What are the symptoms of viral hepatitis?

Symptoms include

• jaundice, which causes a yellowing of the skin and eyes

• fatigue

• abdominal pain

• loss of appetite

• nausea

• vomiting

• diarrhea

• low grade fever

• headache

However, some people do not have symptoms.

Hepatitis A

How is hepatitis A spread?

Hepatitis A is spread primarily through food or water contaminated by feces from an infected person. Rarely, it spreads through contact with infected blood.

Who is at risk for hepatitis A?

People most likely to get hepatitis A are

• international travelers, particularly those traveling to developing countries

• people who live with or have sex with an infected person

• people living in areas where children are not routinely vaccinated against hepatitis A, where outbreaks are more likely

• day care children and employees, during outbreaks

• men who have sex with men

• users of illicit drugs

How can hepatitis A be prevented?

The hepatitis A vaccine offers immunity to adults and children older than age 1. The Centers for Disease Control and Prevention recommends routine hepatitis A vaccination for children aged 12 to 23 months and for adults who are at high risk for infection. Treatment with immune globulin can provide short-term immunity to hepatitis A when given before exposure or within 2 weeks of exposure to the virus. Avoiding tap water when traveling internationally and practicing good hygiene and sanitation also help prevent hepatitis A.

What is the treatment for hepatitis A?

Hepatitis A usually resolves on its own over several weeks.

Hepatitis B

How is hepatitis B spread?

Hepatitis B is spread through contact with infected blood, through sex with an infected person, and from mother to child during childbirth, whether the delivery is vaginal or via cesarean section.

Who is at risk for hepatitis B?

People most likely to get hepatitis B are

• people who live with or have sexual contact with an infected person

• men who have sex with men

• people who have multiple sex partners

• injection drug users

• immigrants and children of immigrants from areas with high rates of hepatitis B

• infants born to infected mothers

• health care workers

• hemodialysis patients

• people who received a transfusion of blood or blood products before 1987, when better tests to screen blood donors were developed

• international travelers

How can hepatitis B be prevented?

The hepatitis B vaccine offers the best protection. All infants and unvaccinated children, adolescents, and at-risk adults should be vaccinated. For people who have not been vaccinated, reducing exposure to the virus can help prevent hepatitis B. Reducing exposure means using latex condoms, which may lower the risk of transmission; not sharing drug needles; and not sharing personal items such as toothbrushes, razors, and nail clippers with an infected person.

What is the treatment for hepatitis B?

Drugs approved for the treatment of chronic hepatitis B include alpha interferon and peginterferon, which slow the replication of the virus in the body and also boost the immune system, and the antiviral drugs lamivudine, adefovir dipivoxil, entecavir, and telbivudine. Other drugs are also being evaluated. Infants born to infected mothers should receive hepatitis B immune globulin and the hepatitis B vaccine within 12 hours of birth to help prevent infection.

People who develop acute hepatitis B are generally not treated with antiviral drugs because, depending on their age at infection, the disease often resolves on its own. Infected newborns are most likely to progress to chronic hepatitis B, but by young adulthood, most people with acute infection recover spontaneously. Severe acute hepatitis B can be treated with an antiviral drug such as lamivudine.

Cirrhotic liver showing scarring (Photo by Nephron under a Creative Common license).

Hepatitis C

How is hepatitis C spread?

Hepatitis C is spread primarily through contact with infected blood. Less commonly, it can spread through sexual contact and childbirth.

Who is at risk for hepatitis C?

• People most likely to be exposed to the hepatitis C virus are

• injection drug users

• people who have sex with an infected person

• people who have multiple sex partners

• health care workers

• infants born to infected women

• hemodialysis patients

• people who received a transfusion of blood or blood products before July 1992, when sensitive tests to screen blood donors for hepatitis C were introduced

• people who received clotting factors made before 1987, when methods to manufacture these products were improved

How can hepatitis C be prevented?

There is no vaccine for hepatitis C. The only way to prevent the disease is to reduce the risk of exposure to the virus. Reducing exposure means avoiding behaviors like sharing drug needles or personal items such as toothbrushes, razors, and nail clippers with an infected person.

What is the treatment for hepatitis C?

Chronic hepatitis C is treated with peginterferon together with the antiviral drug ribavirin.

If acute hepatitis C does not resolve on its own within 2 to 3 months, drug treatment is recommended.

Hepatitis D

How is hepatitis D spread?

Hepatitis D is spread through contact with infected blood. This disease only occurs at the same time as infection with hepatitis B or in people who are already infected with hepatitis B.

Who is at risk for hepatitis D?

Anyone infected with hepatitis B is at risk for hepatitis D. Injection drug users have the highest risk.

Others at risk include

• people who live with or have sex with a person infected with hepatitis D

• people who received a transfusion of blood or blood products before 1987

How can hepatitis D be prevented?

People not already infected with hepatitis B should receive the hepatitis B vaccine. Other preventive measures include avoiding exposure to infected blood, contaminated needles, and an infected person’s personal items such as toothbrushes, razors, and nail clippers.

What is the treatment for hepatitis D?

Chronic hepatitis D is usually treated with pegylated interferon, although other potential treatments are under study.

Hepatitis E

How is hepatitis E spread?

Hepatitis E is spread through food or water contaminated by feces from an infected person. This disease is uncommon in the United States.

Who is at risk for hepatitis E?

People most likely to be exposed to the hepatitis E virus are

• international travelers, particularly those traveling to developing countries

• people living in areas where hepatitis E outbreaks are common

• people who live with or have sex with an infected person

How can hepatitis E be prevented?

There is no U.S. Food and Drug Administration (FDA)-approved vaccine for hepatitis E. The only way to prevent the disease is to reduce the risk of exposure to the virus. Reducing risk of exposure means avoiding tap water when traveling internationally and practicing good hygiene and sanitation.

What is the treatment for hepatitis E?

Hepatitis E usually resolves on its own over several weeks to months.

What else causes viral hepatitis?

Some cases of viral hepatitis cannot be attributed to the hepatitis A, B, C, D, or E viruses, or even the less common viruses that can infect the liver, such as cytomegalovirus, Epstein-Barr virus, herpesvirus, parvovirus, and adenovirus.

These cases are called non-A–E hepatitis. Scientists continue to study the causes of non-A–E hepatitis.

Hope through Research

The National Institute of Diabetes and Digestive and Kidney Diseases, through its Division of Digestive Diseases and Nutrition, supports basic and clinical research into the nature and transmission of the hepatitis viruses, and the activation and mechanisms of the immune system. Results from these basic and clinical studies are used in developing new treatments and methods of prevention.

The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.

For More Information

American Liver Foundation

75 Maiden Lane, Suite 603

New York, NY 10038–4810

Phone: 1–800–GO–LIVER (465–4837), 1–888–4HEP–USA (443–7872), or 212–668–1000

Fax: 212–483–8179

Email: info@liverfoundation.org

Internet: www.liverfoundation.org

Centers for Disease Control and Prevention

Division of Viral Hepatitis

1600 Clifton Road

Mail Stop C–14

Atlanta, GA 30333

Phone: 1–800–CDC–INFO (232–4636)

Fax: 404–371–5488

Email: cdcinfo@cdc.gov

Internet: www.cdc.gov/hepatitis

Hepatitis Foundation International

504 Blick Drive

Silver Spring, MD 20904–2901

Phone: 1–800–891–0707 or 301–622–4200

Fax: 301–622–4702

Email: hfi@comcast.net

Internet: www.hepatitisfoundation.org

You may also find additional information about this topic by visiting MedlinePlus at www.medlineplus.gov.

This publication may contain information about medications. When prepared, this publication included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1–888–INFO–FDA (1–888–463–6332) or visit www.fda.gov. Consult your doctor for more information.

The total of 1,008 reported as of April 21 is more than reported in all of 2011 and is the highest number of cases since 1,026 were reported in all of 2005.

At this rate, the state is on track to reach more than 3,000 cases for the year; levels that haven’t been seen in more than six decades, officials said.

“We’re very concerned about the risk to infants, especially because of how quickly whooping cough is spreading,” said Secretary of Health, Mary Selecky. “Whooping cough can be life threatening for infants, and they’re too young to get enough doses of vaccine to be protected. That’s why we want everyone else to make sure they’re vaccinated against whooping cough.”

Already this year 71 infants under a year old have been reported to have whooping cough. Eighteen of them have been hospitalized. No babies have died in 2012, but two babies died in 2010 and two in 2011.

Whooping Cough (Pertussis)

Pertussis, the whooping cough bacteria -- CDC photo

Whooping cough, also known as pertussis, is a highly contagious respiratory illness spread by coughing and sneezing.

It is caused by a bacteria called Bordetella pertussis. The name, pertussis, comes from Latin, from per-‘away, extremely’ + Latin tussis ‘a cough.’

According to the U.S. Centers for Disease Control and Preventing, in the 20th century,  pertussis was one of the most common childhood diseases and a major cause of child death in the United States.

Initially, an infection may seem like just a cold. However, during this phase of the infection, which can last several weeks, a person can spread the disease to others.

Patients typically then go on to develop a severe, persistent–often wracking–cough that can last for several more weeks.

The coughing fits can be prolonged and are often followed by a long inhalation that causes the “whooping” sound that gives the disease its name.

The bouts of coughing can leave victims breathless and unable to eat, drink or sleep. Complications of the infection include pneumonia, seizures and death.

Whooping cough can affect people of all ages — but is most serious in infants, especially those too young to get vaccinated or who aren’t fully protected.

There is a vaccine that can prevent infection, but it is not effective in newborns or infants and it wears off with time.

Many cases in the current epidemic are being reported in school age children. The vaccine that young children get wears off over time, so all children age 11-12 should get a whooping cough booster shot, called Tdap, health officials said.

The Tdap vaccine is also recommended for pregnant women and women who recently gave birth.

Getting vaccinated before giving birth helps prevent the mother from spreading the illness to her newborn.

The Department of Health has release a public service announcement featuring Chelsey Charles, a mother whose 27-week-old infant  Kaliah died of whooping cough last year.

“It devastated our family,” Chelsey Charles says. “Don’t wait; go get your Tdap shot before it’s too late for somebody else.”

“This is what we’re trying to prevent,” says Dr. Maxine Hayes, State Health Officer. “When adults get sick with whooping cough it can be miserable, but when babies get the disease, they often must be hospitalized because it’s difficult for them to feed, sleep, and breathe.”

Selecky and Hayes urge all teens and adults to check their immunization status. Many health care providers use the state’s immunization registry and can check which vaccines have been given.

Most health insurance carriers cover the whooping cough vaccine; adults should double check with their health plan.

Whooping cough vaccines are available to all Washington children under 19 years old through health care provider offices participating in the state’s Childhood Vaccine Program.

More information on whooping cough disease and who should be vaccinated is available on Department of Health’s website (www.doh.wa.gov).

The number of reported cases is updated every Tuesday afternoon.

Free vaccine available

Hookworm (Photo: CDC)

By Katherine Kahn, Contributing Writer
Health Behavior News Service

Purposely infecting patients with hookworms or whipworms to treat hay fever and other immune-related diseases has been experimented with since the 1970s.

A new review by The Cochrane Library concludes that current evidence doesn’t yet support the use of this therapy.

However, worm therapy does appear to be safe, the review’s lead author says.

“Allergic diseases affect hundreds of millions of people worldwide, especially in industrialized countries,” says review author Ashley Croft, M.D., a public health physician at the headquarters of the Surgeon General, Whittington Barracks, in Lichfield, UK. “Existing treatments for allergies, which mostly involve pharmacotherapy, are often expensive, dangerous, or ineffective. If worm therapy can be shown to be effective and safe, it will represent an important new clinical option for treatment.”

Croft theorizes that worm therapy might work if having intestinal worms “‘tones up’ the immune system of their human hosts, so that the host stops being over-responsive to common allergens. This helps the worms avoid detection and destruction by the host’s immune system.”

“It’s generally appreciated that in the 20th century a whole series of immunological diseases have emerged out of nowhere,” Weinstock explains, including hay fever, asthma, inflammatory bowel diseases, and multiple sclerosis. “Why did these diseases emerge? If you look around the world, these diseases are fairly common in industrialized countries, but in less developed countries, they are relatively rare.”

 Key Points

• Since the 1970s, worm therapy has been used as an alternative treatment for hay fever under the assumption that it might calm overactive immune systems.

• No long-term studies have been conducted to demonstrate that worm therapy relieves hay fever symptoms.

• An evidence review of available studies of worm therapy shows no benefit for hay fever sufferers, and that while safe it may cause minor digestive problems.

The cause, Weinstock believes, is the tremendous improvement in hygiene—and that includes lack of exposure to intestinal worms, such as hookworms and whipworms. “Up until the 20th century, everybody had worms,” Weinstock says.

The lack of worm infections in modern societies, Weinstock conjectures, has led to over-reactive immune systems and an increase in immune-related diseases.

Croft’s review examined evidence from two placebo-controlled, double blinded studies that enrolled a total of 130 adults who had either intermittent or persistent allergic rhinitis.

One study used hookworm larvae, which enter through the skin and travel to the intestines and the other study used pig whipworm eggs that participants swallowed.

Participants who used worm therapy had no reduction in hay fever symptoms or percentage of days when symptoms were minimal. They also had no changes in lung function or quality of life scores.

Croft cautions that these studies are too small to truly evaluate effectiveness. “It did come as a surprise, therefore, that we found that people with allergic rhinitis who took worms were less likely to have to take tablets as rescue medication during the grass pollen season.”

Weinstock also says that the studies to date haven’t been designed very well and says it was surprising researchers found any response at all since the study follow-up times were too short.

“To treat an allergy, you probably have to have a treatment strategy that’s at least six months long,” before evaluating effectiveness, he says. The studies ran for only three months and six months, respectively, after initiating worm therapy.

“Our main finding was that worm therapy is safe,” says Croft. “In participants who took worms there were some gastrointestinal side effects, such as abdominal pain and diarrhea, but these were transient and were not so severe as to cause people to drop out of the trials.”

Croft says that there is enough evidence to support continued research in worm therapy. “Clinical trials in worm therapy are not expensive to run and the potential benefits from this new form of therapy are very great,” he says.

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.

Dr. Larry Corey

Dr. Larry Corey, M.D., president and director of Fred Hutchinson Cancer Research Center, has been elected to membership in the American Academy of Arts and Sciences.

The Academy is one of the nation’s oldest and most prestigious honorary societies and independent policy-research centers.

The current membership includes more than 250 Nobel laureates and more than 60 Pulitzer Prize winners.

Dr. Corey has led the Hutchinson Center since January 2011 and has held other leadership positions there since 1996, first as head of infectious disease sciences in the Clinical Research Division and later as senior vice president and co-director of the Center’s Vaccine and Infectious Disease Division.

Dr. Corey is an expert in virology, immunology and vaccine development. His research has focused on herpes viruses, HIV and other viral infections, particularly those associated with cancer.

He also is principal investigator of the Hutchinson Center-based HIV Vaccine Trials Network, an international collaboration of scientists and institutions that combines clinical trials and laboratory-based studies to accelerate the development of HIV vaccines.

Dr. Corey is a professor of laboratory medicine and medicine, adjunct professor of pediatrics and microbiology, and holder of the Lawrence Corey Endowed Chair in Medical Virology at the University of Washington. He is also an infectious disease physician at Seattle Cancer Care Alliance.

Dr. Corey is the Hutchinson Center’s second president to be elected to the Academy. Yeast geneticist Lee Hartwell, Ph.D., a 2001 Nobel laureate, was elected in 1998. He led the Center from 1997 until 2010.

Corey is among 220 leaders in the sciences, social sciences, humanities, arts, business and public affairs who have been elected to the American Academy of Arts and Sciences 2012 class of fellows.

Since its founding in 1780, the Academy fellows have included: George Washington and Benjamin Franklin in the eighteenth century, Daniel Webster and Ralph Waldo Emerson in the nineteenth, and Albert Einstein and Winston Churchill in the twentieth.

The new class will be inducted at a ceremony Oct. 6 at the Academy’s headquarters in Cambridge, Mass.