Concerned that California's hepatitis A rate is twice as high as the national average, state lawmakers are deciding whether to add hepatitis A to the list of immunizations for school children.

Assembly Bill 1594, sponsored by Dean Florez, D-Shafter, would make hepatitis A shots a requirement for children entering kindergarten. If approved, the law would go into effect July 1, 2001.

The national hepatitis rate is 10 cases per 100,000 people. In California, it is 21 cases per 100,000.

Requiring the vaccination would help prevent huge outbreaks such as the one that hit Stanislaus County in 1993. That year, 470 hepatitis A cases were reported.

"It was horrendous," recalled Roselyn Cunningham, a communicable disease nurse for the Stanislaus County Health Services Agency.

AB 1594 was introduced after the Centers for Disease Control in Atlanta recommended that California, along with 10 other Western states where hepatitis rates were at least double the national average, implement mandatory vaccinations.

Requiring the shots would be an important first step in controlling the spread of hepatitis A, said Dr. Philip Rosenthal, a pediatrics and surgery professor at the University of California at San Francisco. "This bill would help protect California families."

The Health Services Agency implemented several measures to help curtail the disease during the outbreak's peak in 1993. School districts banned students and teachers from bringing home-cooked foods to be shared. Also, school nurses and the county's environmental health department conducted extensive training on hand washing.

Compared to the outbreaks seen in the early and mid-1990s, several Northern San Joaquin Valley counties have seen their hepatitis rates decrease. In 1998, the rate in Stanislaus County was eight cases per 100,000 residents, below the national average. San Joaquin County's rate was 11 cases per 100,000. Last year, Merced County's rate was more than five times the national average at 58 cases per 100,000.

Hepatitis A is a viral infection that affects the liver. It can be spread if an infected person does not practice good hygiene, such as thoroughly washing their hands after defecating, then directly handling food or water. The disease can also be transmitted through close person-to-person contact.

Approximately 150,000 cases are reported in the United States annually and nearly one-third of those affected are children younger than 15. Health experts say that hepatitis A is underreported because young children often show no symptoms of the disease.

And while children may be asymptomatic, they can still pass the disease along to others, including adults, who are more likely to experience severe symptoms such as fever, fatigue, nausea, darkening of the urine, jaundice and loss of appetite.

Adults can be infected with hepatitis A for two weeks before they even start to show symptoms.

Hepatitis A is an acute disease, meaning that the majority of people eventually recover from the condition, most within two months. However, 10 percent to 15 percent of people infected take as long as six months to recover.

Hepatitis A kills about 100 people a year nationwide.

Until recently, hepatitis A shots were only recommended to people traveling to countries where the incidence is high: Mexico, Central and South America, Africa, parts of the Middle East and Southeast Asia. The vaccine was approved by the Food and Drug Administration in 1995.

Stanislaus County's Health Services Agency offers hepatitis A shots through its public health clinic. The immunization consists of two shots given within two months. Each shot costs $25.

If AB 1594 becomes law, hepatitis A shots would be covered by Medi-Cal and private insurance. It would also add one more immunization to the list of shots kindergartners must receive before they can be enrolled in school.

Currently, children must be immunized for diphtheria, Haemophilus influenzae type B (Hib), measles, mumps and rubella, whooping cough, polio and tetanus. Hepatitis B was added to the list for kindergartners in 1997 and seventh-graders just last month.

Health experts remind parents that the vaccination for hepatitis B does not protect against hepatitis A. Hepatitis B is mainly spread through sexual contact or needle sharing but was added to the list of required childhood immunizations as a precaution because of its severity.

Reprinted by permission of Modesto Bee.