Weighing the pros and cons of a hepatitis B vaccination

Dear Dr. ROACH: I would like to know your opinion on the hepatitis B vaccine and its advantages and disadvantages. I am a 39 year old male who is thinking about possibly getting one. –Anon.
ANSWER: Hepatitis B is a viral disease that can cause both acute and chronic liver disease. It is much better to prevent it than to treat it.
In adults in North America, the most common ways to acquire a new hepatitis B infection are through sexual transmission and injection drug use. Transmission can also occur through household contact when living with a person with hepatitis B and sharing items that could potentially be contaminated with blood, such as toothbrushes, razors or nail clippers.
Hepatitis B vaccination is particularly recommended for anyone who may have a new sexual partner or is taking injection medication. However, vaccination is recommended for all adults under 60 and adults over 60 at higher risk.
Hepatitis B vaccination is mandatory for healthcare workers who are regularly exposed to blood. The biggest downside to the vaccine is a sore arm. Serious side effects are rare.
Many people have been exposed to hepatitis B, so I often give the first dose of the vaccine at the same time as testing the person to see if they are already immune. It does not harm a person who is immune and prevents a person from having to visit multiple times. I prefer the Heplisav-B vaccine for adults, which includes two doses (other vaccination schedules are three) and provides rapid immunity.
Dear Dr. ROACH: I am a very active 72-year-old man. At 45, I had quadruple bypass surgery. I suffer from atrial fibrillation and heart failure, but I never have shortness of breath and only feel lightheaded when I stand up too quickly.
I take a lot of medication and now my blood pressure is normal. My total cholesterol is 122 mg/dL and my kidney function and blood sugar levels are normal. I train with a trainer for 60 minutes three days a week and hike in the mountains at a moderate pace for 60 to 90 minutes, usually twice a week.
After training with the trainer I take essential amino acids which seem to help my muscle recovery. A few years ago I started taking a creatine supplement and felt a positive difference during and after training. I stopped taking it for a few months after reading mixed reviews about the benefits of creatine for me. I’d like to come back to it, but only if it makes sense. What do you think? —JB
ANSWER: Congratulations on doing so well after a big, life-changing event! I am sure your exercise program will help your heart and your overall health.
Creatine has been found to particularly help with short-term, high-intensity activities such as heavy weight lifting and sprinting. The benefit was improved power output, but most studies found no benefit in improving endurance activity. Young men are likely to benefit the most, although there is evidence of benefit in female lifters, studies in older men have found no benefit.
Since the goal of these studies was to improve high-intensity performance, I’m not sure the benefits found in the studies are fully applicable. On the other hand, creatine is well tolerated and is unlikely to interact with your medications. So there’s no big downside if it seems to help.
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Dr. Roach regrets that he cannot respond to individual letters, but will include them in the column if possible. Readers may email questions to [email protected] or mail them to 628 Virginia Dr., Orlando, FL 32803.
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