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Stickman Readers' Submissions April 17th, 2013

Hepatitis B

I recently had an experience with a couple of clinics here in Bangkok that may be of interest to some readers regarding hepatitis B. One of the clinics is on a sub soi off Sukhumvit and the other on Sukhumvit soi 77.

Prior to entering a more "serious" relationship with a Thai lady who works at a massage shop I suggested that we both get completely tested for STDs which included a pelvic / visual exam for her. Everything was OK. Not romantic but we both felt (or at least I did) more comfortable to pursue an intimate relationship.

Free Party at Cloud nine

A few of days later after some sexual activity including one unprotected encounter, I noticed that the hepatitis B test was not on the results and we went back to the clinic for the test and to start vaccination for her.

Unfortunately she tested positive for the virus which was obviously quite a shock to both of us. To make matters worse, the doctor / nurse informed us of the results in the waiting room in front of several other people which I thought was a little insensitive.

The test at this clinic was basic and looked for two serologic markers.

1. HBsAG which indicates an acute or chronic infection. Obviously a bad indication.

2. antiHBs which indicates natural recovery and immunity and is present in successful vaccinations. A good indication.

She tested positive for HBsAG and negative for antiHBs and basically nothing could be done for her. My test indicated that I was not infected but still susceptible to the virus. The individual that informed us of the results although not rude was distant and reluctant to provide any additional information or guidance other than to say she had low levels of infection and to check back in 6 months.

I was skeptical so we went to one of the major hospitals and went through a complete and expensive series of tests. The results were that she was highly infectious and had to make major changes in her lifestyle (no alcohol, etc.) and hope her immune system would help her to recover. Not the same information the clinic provided! I again tested negative for the virus and negative for the antibodies even though I was 4 months and two injections into a 3-shot course of vaccine for hepatitis B. I should have shown some antibodies and had some but not complete protection unless I was one of the small percentage of non-responders (5-10%) for whom the vaccine doesn't work. The doctor also informed me that I had about a 15% chance of infection from the one unprotected sex encounter.

Here is the key point I am trying to make in this post. In December I had been to a clinic off a popular and busy soi on Sukhumvit Road to start the series of three injections which normally takes about 6 months to provide full immunity. The initial injection, one a month later and the last 5 months after that. I paid 1,500 baht each for the first two injections. After I got the results from the major hospital I returned to the clinic and informed them of the recent tests and asked the "doctor" what type of vaccine he used. He looked very uncomfortable with the question (I was polite) wrote down Engerix-B and quickly replied that it didn't work for some people. His speech and body language indicated to me that something was wrong and that perhaps I did not get a true vaccine but maybe a placebo. Incidentally, when I got the first injection a syringe with a clear liquid was already sitting on the table ready for use. I did not see the nurse take it from the sterile package and fill it from the vaccine vial which at the time made me a little uncomfortable. Also, I found out later that the vaccine should have a slightly milky appearance. For the second injection I remember that the nurse removed the syringe from the packaging and filled it from a typical vaccine bottle.

I went back to the major hospital and got a series of hBIG vaccine injections and another one of the original that I was supposed to get in the first place. This is the course of treatment used for health care providers that have been exposed to known infected individuals (accidental needle stick, etc.). The doctor spent almost a full hour counseling us and indicated that there was a 50% chance it would work. Ten days later I went to another hospital and got tested for the antibodies and found that I now had high antibody levels and should protected at this point for 20 years. This cost me about 100,000 baht and a few nervous days but was worth it and incidentally I required the entire hBIG supply of the hospital and I had to wait 8 hours for them to find the rest because the dose is based on body weight. It also confirmed or at the least made me suspect that I did not get the real vaccine.

The point of this story is go to the major hospitals for your immunizations and you will get what you pay for. Maybe I did get the correct vaccine at the clinic but I had my doubts and as this disease is serious why take a chance to save a little money.

Also, the doctor at the major hospital indicated that hepatitis B and C were endemic in the Thai population and that most people did not know about it and that it was highly infectious compared to HIV. None of the massage or bar girls I talked to even knew about this let alone get tested for it. Many didn't want to know and only got the standard HIV test because the shop required it.

You can even get it from a manicure or pedicure if they don't sterilize the instruments. So I would recommend that anyone that

lives here in South-East Asia get immunized. It's cheap insurance in the long run. There is some conflicting information on the internet but I generally used the Center for Disease Control CDC in the US for research. Check out the hepatitis B FAQ for health professionals.


Stickman's thoughts:

Scary…and it does nothing for your confidence in small clinics!