[bertolo1988]

The current version of hepatitis A grants immunity for life after the second dose. Those 2 doses are exactly the same and it was thought that they should be taken 6 months to 2 years after each other. A recent study says that the second dose could still grant immunity for life even if it is taken 5 years after the first dose. It is a super effective vaccine!

They also last for a very long time in a normal fridge.

Why isn't it included in normal vaccination plans? It looks like there is something controlling the supply and we are paying with human lives all over the world.

[maxlybbert]

It's a relatively new vaccine (from the late '90s) and, in the US, the main reason people get vaccinated is to attend school, so anyone who was able to attend school before the late '90s wouldn't have been vaccinated without going out of their way (perhaps for international travel, which is why I was vaccinated -- in the late '90s).

Additionally, hepatitis outbreaks are associated with sanitation problems. Chicken pox, measles, mumps, etc. are associated with putting many people close together, like in a school, so it took a while to add hepatitis to vaccination schedules.

It's also true that many people believe the vaccination wouldn't be necessary if we could just get people to pay attention to sanitation, so there is some opposition along the lines of "if we require this vaccine, we're admitting defeat as far as a clean society is concerned."

[thinkcontext]

Hep A vaccine is required in less than half of states to attend school, CA not being one.

http://www.immunize.org/laws/hepa.asp

[maxlybbert]

Thank you. I haven't paid much attention to what vaccines my kids have, so I really have no idea if they are vaccinated against hepatitis. I remember being surprised that chicken pox was on the list of required vaccinations, but I eventually got over that (incidentally, after I made comments on Hacker News about that vaccine being silly).

[brianwawok]

Hey I finally found something Indiana was progressive with

[tome]

> The current version of hepatitis A grants immunity for life

"The current version of hepatitis A vaccine", presumably.

[userbinator]

The disease itself too, once you recover from it. That's how vaccinations and the immune system work.

https://en.wikipedia.org/wiki/Hepatitis_A

"After a single infection, a person is immune for the rest of his or her life.[8]"

[maxerickson]

You realize this pedantry is incompatible with the "second dose" in the initial comment?

[bertolo1988]

I wanted to say vaccine! Sorry.

[Filligree]

I don't know if this is still the case, but back when I grew up the answer was that it was made from live virus, so there was a (tiny) chance of getting the actual disease if you got it.

Therefore it was only given to populations already at risk of infection, e.g. nurses.

[protomyth]

I remember the same. Our Early Childhood staff got the vaccine unless they had a liver (could be kidney, it has been 20 years) problem. Office staff were not given the vaccine because there was a risk. Things, obviously, could have changed.

[Xylakant]

I’m not a nurse and I have both Hep A and B vaccinations. At least in Germany you can get if you ask for it.

[Filligree]

That was also the case in Norway. It just wasn't automatic.

The risk was really tiny anyway. Even if you did get infected, it was unlikely to cause any damage.

But going from other comments in the thread it's not the same vaccine that is used today, so I expect they fixed the problem.

[Xylakant]

I’d be surprised if it was a live vaccine, due to a medical condition I usually don’t get them. And Wikipedia to the rescue https://en.m.wikipedia.org/wiki/Hepatitis_A_vaccine, it’s inactivated virus cultures.

[Filligree]

Same page says one of the ones still in use is in fact attenuated live virus. I'm not remotely surprised it's not commonly in use in the west, though.

[rabboRubble]

40+ F here... a couple of years ago I got "serious" about my health. I had been generally healthy and slacking for the last decades. I made sure all my vaccinations were up to date. Out of all medical related tasks, getting the HEPA/B vaccines were the biggest fight.

I had to argue with my primary care doctor for them. I also had to fight the insurance company for them. The primary care doctor relented after I stated "these vaccines are on the CDC recommended list of vaccines for all healthy adults over the age of X. I do not understand why you are rejecting the idea. It seems contrary to good public health policy." She put in the request uncertain if the insurance company would authorize but I got the first shot so I assumed the troubles were over. Wrong...

Come time to get the 2nd shot of 3 (I think the combined A/B vaccine is a 3 part shot IDK), the care team tells me "we are not sure if we can give you the 2nd shot because the insurance provider rejected the first shot request". Why they didn't tell me right away, no idea. So we danced around for a while, and I finally asked how much the entire series of shots were. They didn't know. Is is $100 or $1000? I tell them if it's $100 I'll just pay for it myself, far cheaper than hospitalization. I guess after some embarrassment on their part, I get the 2nd shot without paying and don't hear about the problems between the doctor office and the insurance company again. I ask before the 3rd shot if the issues got cleared and I heard nothing. Haven't been billed either so I am assuming all is well.

Sooooooo.... while homeless population increases, publicly accessible toilets and sinks disappear, plastic shopping bags are outlawed, my by experience doctors and insurance companies have been dissuading people from getting vaccine protections. We are surprised a dirty unsanitary society with a shitty healthcare system has disease outbreaks? I am not, not at all. It's why I fought so hard for the vaccinations. I would get the a HEPc vaccine if there was one available.

[toomuchtodo]

Thank you for doing your part!

[tryingagainbro]

>>the second dose could still grant immunity for life even if it is taken 5 years after the first dose. It is a super effective vaccine!

Why shouldn't USA--as in the FedGov--make such vaccines 100% free for everyone, a child or a 55 year old? An ounce of prevention and all....maybe subsidize them, pay cost only.

Personally I went to a private clinic and paid for them, but it was hundreds and hundreds. Not everyone can afford them and when you 80 million (or whatever) vaccines, the price can come down.

[zghst]

Usually children are heavily vaccinated, not adults. However, the costs of vaccines are usually covered by insurance. Additionally the federal gov't provides a program called CHIP that ensures millions of children (8.9 million kids covered 2016) in lower income households receive proper immunization.

[tryingagainbro]

That leaves or left a nice chunk out of it, the middle class (pre- Obama care at least). Also let's not forget that a lot of immigrants come in USA with patchy vaccination history.

[zghst]

Also if you look at the people who make up the uninsured, most uninsured are quite eligible for coverage either through an ACA tax cut, employer-sponsored insurance, or Medicaid eligibility.

The largest chunk of uninsured, based on a study by the Kaiser Family Foundation, are "undocumented immigrants" with an estimated 5.4 million uninsured. The remainder of those who aren't able to obtain health insurance (not to be confused with health care, which any individual can obtain by going into an emergency room or free health clinic) have either a coverage gap (2.6 million) or their income is too high to obtain a subsidy (3.0 million).

[tryingagainbro]

"Most," "largest chunk" etc don't really work in real life. My idea was for the government to give free (essential) vaccines to everyone, no ID /questions asked. It makes $$ sense.

[zghst]

Legally, the government cannot give out vaccines with no questions asked, no ID. Every asset the government distributes must be accountable. We must keep a immunization record (usually in the patient's possession) of who and when, along with records on the health care provider's end for compliance.

Say someone experiences an adverse reaction to a vaccine (which does happen) and wants to sue the hospital; no questions asked means that the medical provider did not do a proper assessment of the patient, leaving that professional legally liable to damages.

[sp332]

That's interesting, and it's a good argument for the money to come from the government and not insurance companies. When it's a public health issue, you want make sure everyone is covered.

[zghst]

I definitely agree with you. I'm very much in favor of an optional single payer solution, consolidating the various programs down into one.

The issue is that doing so will put millions in the insurance industry out of work. It becomes more than a public health issue, and very much so that looks to eliminate a industry that has wide power to retaliate through various strategies.

Not to mention, single payer is a quite resource intensive strategy that will require extensive capital to start versus spending now for more coverage through a program.

Because of this, single payer may never come to America through federal means.

[zghst]

The middle class make up the majority of 155 million Americans covered by employer-based coverage. Immigrants that come into the country (legally) are required by law to have received or receive vaccinations listed by the gov't.

Health and preventing health issues is not the responsibility of the government, but individual.

[tryingagainbro]

Health and preventing health issues is not the responsibility of the government, but individual.

Sure, says who? USA takes "26 percent of gross domestic product" in taxes http://www.taxpolicycenter.org/briefing-book/how-do-us-taxes... , so the govt can't just take. And USA pays for liver transplants, disability and loss in productivity.

Not to mention that US made healthcare its business with Obamacare.

>>Immigrants that come into the country (legally) are required by law to have received or receive vaccinations listed by the gov't.

For $10 the Sudan (++++) authorities will give you any vaccination record the US Embassy requires

[zghst]

For my first point, I infer that you know your body and lifestyle best. Education exists to help people avoid preventable conditions (which are leading of health problems) and there isn't any reason why an individual should be compelled to seek the advice of a medical professional other than their own volition.

Sudan has recently experienced 15 deaths due to a botched vaccination. In countries like Sudan, workers may not be properly trained, there are less legal protections, and doctors are much more time-resource bound, leading to rushed care.

[pkaye]

When you immigrate to the US, there are vaccination requirements already.

[thinkcontext]

Hep A is on the ACA list of vaccines required to be covered w/o a co-pay, why did you have to pay?

https://www.cdc.gov/vaccines/adults/find-pay-vaccines.html

[maxerickson]

A significant portion of the country is ideologically opposed to the price fixing implied there. And not just people that identify as Republicans.

[zghst]

Price fixing is a criminal federal offense of the Sherman Act. Not only does it affect competing businesses, but it also limits the price of items much further down the line that have nothing to do with the original vaccine. A fixed cost on one item like a vaccine doesn't account for the needles, sanitary faculties, physicians, components of the vaccine, etc., all of which vary in cost.

Price fixing a vaccine, versus subsidizing it, would affect thousands of private businesses and spur a flurry of changes across the health care industry, first and foremost would strike anxiety into the market, driving up prices. Resources become inefficiently allocated for the vaccine because of legal requirements, instead of pressing patient needs.

I see many people who want healthcare fixed via government monopolization, but it is my best belief that healthcare stays private, with various government subsidies, especially post-investigation of the VA scandal by the Obama administration.

Private (non-profit) healthcare has more incentive to fight fraud, specialize in pathologies, appropriately allocate resources, and most importantly, provide excellent, aboveboard care.

[maxerickson]

In my comment it would be the government fixing the price, so I imagine they would write the law (the one providing 100% coverage of vaccines) to either comply with the Sherman Act or to be excepted from it.

The idea that the government would provide 100% coverage of vaccines without fixing prices is one that people are free to argue, meanwhile I will gesticulate wildly in the direction of Medicaid.

[thinkcontext]

What's significant? I'd be very surprised if it was a majority. Know of any polling?

[maxerickson]

Page 13 is vaguely informative:

https://www.kff.org/slideshow/public-opinion-on-prescription...

[Xeoncross]

> The current version of hepatitis A [vaccine] grants immunity for life after the second dose.

Wait, this makes it sound fool-proof. I know it's supposed to do this, but how successful is this vaccine at actually doing this for __% of the population?

[Xylakant]

95% for at least 15 years, jo numbers given on lifelong immunity

https://en.m.wikipedia.org/wiki/Hepatitis_A_vaccine