Q&A: Myths, Misinformation Surrounding Hepatitis Vaccines

Amid a noticeable mistrust in health care information, especially regarding the effectiveness of vaccines, pharmacists must stay equipped with useful ways of counseling patients hesitant to receive vaccines. For hepatitis vaccines specifically, pharmacists must navigate myths of hep A and B vaccines causing injury and promote the safety and effectiveness of these FDA-approved immunization schedules.

“The old myth that natural immunity is better than vaccination. Of course, if you're to get the actual infection, it could lead to liver failure, and in hepatitis B, liver cancer,” Jeff Goad, PharmD, MPH, President of the National Foundation for Infectious Diseases (NFID), told Drug Topics. “So again, remember, hepatitis B was our first cancer vaccine. It actually prevents cancer. So, when you're thinking about positive messages to counter some of the myths around it, most everyone can get around prevention of cancer.”

Goad joined Drug Topics to discuss hepatitis A and B vaccines, the myths surrounding them, and the ways in which pharmacists can help patients better understand these viral diseases.

Jeff Goad, PharmD, MPH, President of the NFID, caught up with Drug Topics during the month of May, which is Viral Hepatitis Awareness Month. | image credit: kittisak / stock.adobe.com

Stay tuned for more from our interview with Goad, who sat down with us to discuss hepatitis vaccines during Viral Hepatitis Awareness Month. In the next part of our series with Goad, he discusses pharmacists’ role in counseling patients seeking hepatitis vaccines and the importance of boosting immunization rates across the world.

READ MORE: Q&A: Vaccines Available to Protect Patients Against Hepatitis Viruses

Drug Topics: Vaccine hesitancy seems to be a growing concern in the US with the dissemination of misinformation on social media and beyond. Are there certain trends in vaccine hesitancy regarding the hepatitis A or B vaccine that are particularly alarming?

Jeff Goad: Maybe now more than ever, we're paying a lot more attention to what people think about vaccines; both from what we call misinformation, meaning that they just got the wrong information, probably from the wrong source; or disinformation—which is a little bit more scary—that's intentionally spreading wrong information. We're very sensitive to that, and a lot of the myths around vaccination apply to hep A and B, but there are some maybe specific trends around what people think about hep A and B. For example, perceived risk. Most people think that you only get hepatitis A if you travel, for example. But we know that hepatitis A, we've had large outbreaks, for example, in California and a few other states related to the homeless population. We also get outbreaks from restaurants within the United States and grocery stores with certain types of foods that are pre-prepared and then distributed through grocery outlets. The CDC monitors these very closely through their food safety program.

We also know that there are low vaccination rates. Low vaccination rates tend to tell us a little bit about what people think about these hep A and B vaccines. For example: hep A in the adult population. Remember, there is no universal recommendation for hep A in the adult population; that's for pediatrics. So, it's probably not surprising that we only have about a 9% vaccination rate for hep A in adults. But for kids, we're running at about 83% after 2 doses. We'd like to see the 83% over 90%, which is what we see for most pediatric vaccines. We have a little bit of ways to go for the pediatric side; probably a long ways to go for the adult. And in the Hepatitis B area, we see about 30% to 50% vaccination. And again, for adults, that's really probably focused more on high-risk populations, those who have renal disease or liver disease. In those populations, we're still not capturing all of them, but in the general population, we're probably a lot lower. For kids, we're over 90% for a full-dose series. We're where we should be, we could be a little higher, but 90% is pretty good for hepatitis B in kids.

There's just a general mistrust in vaccines. Again, that misinformation versus disinformation is important. Some of the more specific ones around hep A, again as I mentioned, vaccines aren’t necessary unless you’re traveling, but there is domestic use for the vaccine. Hepatitis A doesn't cause serious illness. Most people, when they hear about it, they hear about it as maybe causing some flu-like symptoms, but we do know it can lead to acute liver injury and liver failure in some people. And of course, “Hep A has harmful additives.” We've heard this for many vaccines. For example, there's no mercury, there's no thimerosal. Thimerosal was a source of mercury. There is none in any of the hep A or B vaccines. For hep B, for example, vaccines are only needed for health care workers or drug users. And it turns out people who have sex are at risk for hepatitis B. In developing countries, we really see that maternal transmission, which we may not think about here in the United States because we screen our mothers, but realize people immigrate to the United States and may bring Hepatitis B with them in a chronic phase that maybe they acquired from their mother.

The old myth that natural immunity is better than vaccination. Of course, if you're to get the actual infection, it could lead to liver failure, and in hepatitis B, liver cancer. So again, remember, hepatitis B was our first cancer vaccine. It actually prevents cancer. So, when you're thinking about positive messages to counter some of the myths around it, most everyone can get around prevention of cancer. That might be something to make sure you talk about. As pharmacists plan their strategies, making sure that they're making evidence-based recommendations and really talking about hepatitis B from the facts, referencing credible sources. The CDC hopefully remains a credible source as we go forward over the next few years. But we also have non-governmental organizations, like the National Foundation for Infectious Diseases at nfid.org, that also has a lot of information for consumers and health care providers. Thinking about, how do we normalize some of this? Well, you have to talk to your patients. So, that's offering vaccines for example, at every pharmacy visit, reducing some of those access barriers, since we know that most of the population walks through the doors of a pharmacy every week. We could actually increase adult coverage just by putting that little reminder into every time that you interact with a patient. So, there are a lot of strategies that we can employ to help combat some of the myths and misinformation around vaccines, particularly hep A and hep B.

Drug Topics: What is your advice for a patient who may not have concerns in seeking the hepatitis A or B vaccine, or patients that may prioritize other immunization regimens before the hepatitis vaccine. What would you say to those patients?

Jeff Goad: Well, I think people always do that risk-based calculation, that economic calculation. All we can do is really help them through understanding the risks and benefits of vaccine. On the benefits side, for example, we know the hepatitis vaccines [are] safe, they've been used for decades, they're effective over 95%, and they’re long-lasting. For decades, we've known that these vaccines continue to work even after vaccination in childhood. So, we have really reliable vaccines that prevent things like cancer, which we have to keep reminding patients. We know that there are continual hepatitis A outbreaks in the United States. You probably hear about them on the local level. We don't see as many national outbreaks, but there have been some very notable ones. But within your states, you're going to hear about the restaurant down the street, the grocery store, and you’re going to hear about hepatitis A in those. As we source foods from other countries, which very likely we’ll need to continue to do, that's when we bring in the risk of hepatitis A outbreaks.

And of course, hepatitis B silent progression. It has a very, very long incubation period, up to 6 months. [This] means you can be asymptomatic and transmitting the disease, making it very important as a strategy to think about how do we help people understand that this disease causes cancer and it's highly effective, but you may not know you're even being exposed to it. This is a really good reason to get a vaccine when you could be exposed through sexual contact or blood and you don't know about it.

Hepatitis A vaccines, like all vaccines, can be co-administered. If they're worried about getting too many vaccines, maybe they can get the hep A and B at the same time. Of course, they can. But if they want to reduce the number of shots, they can consider the combination vaccine of hep A and B. And then, of course, [they’re] thinking about moving to universal recommendations. That's new for hep B, and it's a strategy we use for influenza. Influenza used to have a lot of different high-risk populations that you had to think about, and eventually, we got to everyone 6 months and older. For hepatitis B, we're on the pathway to that. We now have it all the way from birth through 59 years of age for universal recommendations. What universal means is you don't need a condition, you don't need a certain occupation, you just should get the hepatitis B vaccine.

READ MORE: Immunization Resource Center

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