National health experts warned yesterday that hepatitis B, a serious viral disease that can lead to death from liver cancer or cirrhosis, is on the rise in the United States, jumping 68 percent since 1978 to 200,000 infections each year.
"In anyone's book, it is one of the top killers and cripplers in the United States," said Dr. James Mason, head of the Centers for Disease Control.
Mason joined major health groups in urging a major national push to vaccinate high-risk groups -- from health workers to homosexual men -- against the disease. Based on new scientific evidence released yesterday, Mason gave assurances that a vaccine to prevent the disease, available since 1982 but not yet widely used, is safe and effective.
"It is clear, absolutely clear, that this vaccine is safe," he said, dismissing what he called unfounded fears that the vaccine might tranmit the deadly disease AIDS.
The hepatitis B warning coincided with two other major health developments yesterday: The CDC said there would be a severe shortage in the coming year of a combination vaccine to protect children against diphtheria, tetanus and pertussis (whooping cough). The CDC called for an immediate postponement of follow-up shots for children 18 months and older "until greater supplies are available."
Mason said in an interview that he did not expect disease outbreaks to result, since infants at greatest risk still would get shots, while older children would carry immunity from their initial shots. Details on Page A11. A British journal reported the first documented case of a health care worker becoming infected with the AIDS virus after accidental exposure to blood from a patient with the incurable disease. U.S. officials, concerned about reaction among health workers here, cautioned that, with adequate precautions, the risk to health care workers still appears to be quite small. Details on Page A18.
AIDS, or acquired immune deficiency syndrome, has affected more than 7,000 Americans since its discovery in 198l, killing nearly half of them. The disease is found predominantly among sexually active homosexual men and intravenous drug abusers. It is spread by a virus through sexual contact and through blood and body fluids, and its route of transmission is similiar to that of hepatitis B.
Hepatitis B is also spread through sexual contact, contaminated needles, from carrier mothers to infants and through contact with body fluids. Although far less deadly, it is a far greater public health problem. But because it has been around longer, people have been less concerned, Mason said. If it were discovered today, he said, "people would be just as concerned about hepatitis B as they are about AIDS today."
Because the hepatitis B virus is difficult to grow in the laboratory, the vaccine is produced from blood products taken from hepatitis carriers, such as homosexual men, who are the same groups at greatest risk of carrying AIDS in their blood. But the study results released yesterday by the CDC and New York researchers -- in conjunction with the vaccine manufacturer, Merck, Sharp & Dohme -- documented that the AIDS virus is not present in the vaccine and that any viruses originally in the blood would have been killed by chemicals used in the production process.
About 200 million people worldwide -- including a million Americans -- are chronic carriers of hepatitis B, Mason said. Each year, CDC experts noted, 200,000 more Americans are infected, with about 50,000 developing such serious signs of the disease as jaundice and 10,000 needing hospitalization. Many people exposed to the virus do not become ill and in fact become immune to the disease, but about 10 percent of them become long-term carriers who are at risk of later developing serious illness and can also affect others, often unknowingly, said Dr. James Maynard of the CDC.
Maynard said there are about 20,000 new carriers in the United States each year, of whom about 3,500 develop cirrhosis of the liver and 850 liver cancer, both deadly conditions.
Hepatitis B is generally a disease of young adults from 15 to 40, he said. It has risen from about 40 cases per 100,000 Americans in 1979 to an expected level of almost 70 cases per 100,000 in 1984. CDC statistics show that about 6 percent of cases occur among health care workers, 21 percent in homosexual men, 15 percent in people who have had heterosexual contact with carriers and 15 percent among intravenous drug users.
But he noted that 4 of 10 cases occur among people of "unknown risk," suggesting that the disease is perhaps moving more widely into the general population.
Because there is no effective treatment or cure for hepatitis B, the government and health groups yesterday urged that the best strategy for reducing the problem is vaccination of high-risk groups.
But Mason noted that in addition to the unfounded fears of AIDS, the cost of the vaccine -- about $100 for three shots -- and the problems of persuading adult populations to get vaccinated had proven more difficult than expected.
Although the cost of the vaccine may come down in the future, health experts yesterday criticized insurance companies and the government for failing to cover the hepatitis B vaccinations, saying the disease costs the country more than $350 million annually.