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Sweeping Call For Vaccinations Questioned Health Experts, Insurers Baffled By Hepatitis A Announcement

Fri., March 13, 1998

It was supposed to be gentle en couragement to be vaccinated, but it was like yelling “hepatitis A” in a crowded restaurant.

News of the Spokane Regional Health District’s announcement Wednesday urging all 410,000 Spokane County residents to get hepatitis A vaccinations spread across the country like a contagious disease.

Local insurance providers grumbled about not being consulted.

Health officials from all over called the recommendation to vaccinate everyone “unprecedented,” “unusual” and “experimental.” And the national media focused on Spokane.

“We don’t support this,” said Dr. Paul Stehr-Green, chief epidemiologist for the state Department of Health. “I don’t think this is ever warranted. This approach has not ever been demonstrated to be effective. I don’t think it will work.”

Spokane County currently does have a higher rate of hepatitis A than anywhere else in the state. Last year, 190 people tested positive. Already this year, 122 have tested positive.

On Wednesday, the health district sent out a “call to action,” urging every resident to be vaccinated.

The move sparked hundreds of phone calls to the district, health insurers, and the state. National Public Radio and TV stations in Canada, New York and Seattle did stories on the vaccine recommendation.

“I actually got a call last night at 20 ‘til midnight from a ‘CBS Evening News’ guy,” said a weary Paul Stepak, district epidemiologist.

On Thursday, Spokane Health Officer Kim Thorburn said she merely wanted to encourage people to take personal responsibility and take advantage of an effective vaccine.

“We feel obligated to keep the community informed,” Thorburn said. “We thought we were putting out another one of our reminders to the community. We’re quite surprised at the response it’s engendered.”

This was the district’s first notice advising everyone to get vaccinated. Before, the district focused on vaccinating groups such as food handlers, day-care workers, sewage workers, drug users and people with liver disease.

At the health district, vaccinations cost $84 for a series of two shots.

About 300 people went to the health district office on Thursday for vaccinations. The district vaccinated another 170 people out in the community.

So far this year, the district has vaccinated about 10,000 people against hepatitis A. Hepatitis A is a vexing problem with no real solution, said Dr. William Schaffner, chairman of the Department of Preventive Medicine at the Vanderbilt University School of Medicine in Tennessee.

Community outbreaks are usually fought with a combination of handwashing education campaigns, inoculations for exposed people and vaccinations in targeted communities, such as low-income children.

“Your health officer, Dr. Thorburn, has suggested the vaccine equivalent of nuking - let’s immunize everybody,” said Schaffner, also a liaison with an immunization advisory committee of the Centers for Disease Control and Prevention.

“As with all programs, the devil is in the details. The philosophy is wonderful. The question is, can it be done?”

But there are no details here, just a recommendation, which leaves health officials and insurance companies holding up their hands.

Whitman County residents called the local health department, wondering if they needed a vaccination to come to Spokane.

“There’s some hysteria associated with this pronouncement,” Whitman County Health Officer Tim Moody said. “This is causing problems well beyond the borders of Spokane County. It’d be nice to turn back the clock and say, ‘We wish this didn’t happen.’ But now we have to deal with it.”

Health insurers in Spokane don’t cover vaccinations for hepatitis A, unless people belong to certain government-subsidized plans or they’re in a high-risk group.

On Thursday, representatives from three insurance companies said they weren’t changing their policy.

Premiums at Group Health Northwest would have to increase 6 percent next year to cover vaccinations for all members, said Dr. Henry Berman, president of Group Health Northwest.

“I have a lot of concerns that the public is frightened, that people think that they’ll get this randomly,” Berman said.

People get hepatitis A from personal contact and from contaminated food or water. The virus incubates from two to seven weeks, and public health officials must trace a difficult map of dinners and diarrhea to try to figure out the source.

“This makes it very hard for public health to do anything,” Schaffner said. “It’s like working with a ghost.”

The virus is spread by fecal-oral contact. This means that handwashing is crucial to prevent the spread of the disease.

Symptoms of hepatitis A include fatigue, nausea, vomiting, diarrhea and jaundice. But children often don’t show any symptoms at all, meaning infected kids can spread the disease without knowing they have it.

In Spokane, the virus has mainly hit men from 19 to 39 years old. Many use drugs, particularly methamphetamines. It’s a tough community to target.

That’s why Thorburn said she wanted to vaccinate jail inmates, a proposal met coolly by state officials.

State epidemiologist Stehr-Green said he admired Thorburn’s aggressiveness and commitment to public health. He added that many of her innovative ideas should be tested before being put in place.

“I’m convinced Kim is sincerely trying to control this outbreak and do the best thing she could do,” he said. “I would’ve done it differently.”

, DataTimes ILLUSTRATION: Color Photo


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