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LANDSCAPING, INC.
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Israel's War
On Hepatitis
WENDY ELLIMAN SPECIAL TO THE JEWISH NEWS
I
srael is protecting an en-
tire generation against
hepatitis B, and believes
itself on the road toward
total suppression of the
disease within its borders. It
is among a dozen countries
(others include Singapore,
Taiwan, Japan, Italy, Greece
and risk-populations within
the United States) to run a
national prevention program
against this viral disease of
the liver, which not only
debilitates, but is also direct-
ly linked to the development
of liver cancer.
"We showed the association
between hepatitis B and liver
cancer some years ago," says
Professor Daniel Shouval,
who heads the Liver Unit at
the Hebrew University-
Hadassah Medical Center in
Jerusalem. "The next step
was to access the problem of
heptatitis B in the country
asd a whole."
Professor Shouval and his
team chose as their study
population women admitted
to the delivery rooms in the
two Hadassah Hospitals in
Jerusalem. Over the course of
eight years, they screened
more than 20,000 healthy
Jewish and Arab women for
the virus to determine the
prevalent rates of carrier
states.
"We found that the frequen-
cy of the carrier state varies
according to the ethnic
background," says Professor
Shouval. "Carrier rates
among immigrants from
Mediterranean and Middle
Eastern countries and from
southern Russia are much
higher than among west
Europeans. Hepatitis B car-
riers number 1.5 to 3 percent
among first-generation North
African women, for example,
as compared with 0.5 to 0.6
percent in those of western
European origin."
More alarming, however,
were the Israeli team's fin-
ding about how the virus is
transmitted. They discovered
that infants of carrier-
mothers have a 12 to 20 per-
cent chance of contracting
hepatitis B between the ages
of 2 and 16. and, in contrast
to the existing belief that an
infected mother passes on the
virus to her baby during the
dirst week of life only, they
found a horizontal spread
within the family during the
early years of life.
These findings convinced
Israel's Advisory Council on
Immunization Practices that
a national immunization pro-
gram was essential. "Inevit-
ably, there were difficulties in
planning and financing such
a program," says Professor
Shouval. "Not the least of
them was that the vaccine,
developed abroad, initially
cost $150 per adult dose,
although it's come way down
since then. Ultimately, we got
financing from the SK Foun-
dation of the Netherlands, in-
vested part of it in epidemio-
logical surveys and assess-
ment of vaccination practices
— and came up with a pro-
gram that is both comprehen-
sive and effective.
The program, launched two
years ago, immumizes all
hospital-born infants (which
is virtually every birth) in the
first 48 hours of life. "Vac-
cines are usually given
several months into life," says
Professor Shouval, "but im-
munization against hepatitis
B is effective aas early as the
The Israeli team
found a horizontal
spread of the
virus within the
family.
day of birth. Second and third
shots are given 30 days and
six months later, protecting
95 percent for at least seven
years and maybe forever."
If hepatitis B infection was
a serious pboblem among
Israelis in general, it was of
critical proportions among
the 50,000 Ethiopian Jews
who have moved to the coun-
try in the past decade.
"We found that almost 90
percent of the over-40s and up
to 15 percent of the younger
Ethiopian Jewish population
in Isreal carried the virus,"
says Professor Shouval. "We
decided to intervene with
them ahead of the national
program. We started by vac-
cinating all those under 2
years of age, and followed this
by immunizing all family
members of carriers. The new
generation of Ethiopian Jews
growing up in Israel is im-
mune to hepatitis B, and the
disease should be
-"-ated
among them within ,,._'nera-
tion."