Stop Hair Loss

Toppik is the brand name for a range of hair loss concealer and remedy products. Toppik is used worldwide and is one of the biggest selling concealers on the market.

What are Toppik Hair Building Fibres?

Toppik hair building fibres works in pretty much the same way as Nanogen Nanofibres. It is a shake-on hair loss concealer product, containing tiny microfibre ‘hairs’ formulated using organic keratin protein.

How does it work?

The fibres are distributed over the hair using an applicator that looks similar to a salt or pepper shaker. The static charge of the fibres makes them cling to the hair where they swell, giving the appearance of thicker, fuller hair. Toppik claims to be able to cling to even the finest of hairs, creating an illusion of a full head of hair.

Is Toppik any good?

As far as temporary concealers are concerned, Toppik is certainly one of the most popular brands available. Note however that as with DermMatch and Nanogen Nanofibres, Toppik is a temporary solution, and therefore does not offer permanent benefits. The product requires that you have a certain amount of hair, so if you continue to lose yours, you’ll soon be unable to use Toppik products.

Does Toppik cause any side effects?

Aside from the occasional allergic reaction, Toppik does not cause any side effects that we are aware of.

What does it cost?

A months supply of Toppik Hair Building Fibres costs around £20 GBP (approx $32 USD). The manufacturer also recommends that you buy another product called Toppik Fibrehold Spray for around £8 GBP (approx $13 USD) to hold the fibres in place, although we would suggest trying regular hairspray before buying their branded product.

You are also advised to buy a Toppik Spray Maximizer to distribute Toppik more evenly over the hair. Add to this their ‘Hairline Optimiser’ comb for £5.95 (approx $10 USD) and their ‘Hair Fattener’ at £19.95 per month (approx $31 USD) and the cost can become significant.

If you buy the recommended range of products, this equals an initial cost of around £73 GBP (approx $114 USD), then an ongoing cost of £48 GBP per month (approx $75 USD). It is important to note that how long each purchase of Toppik products lasts can vary depending on the extent of hair loss of the individual.

Malaria

What is Malaria : Malaria is one of the most common infectious diseases and an enormous public health problem. Malaria is one of the leading causes of disease and death in the world. It is estimated that there are 300-500 million new cases every year, with 1.5 to 2.7 million deaths worldwide. Malaria is an infectious disease characterized by cycles of chills, fever, and pain and sweating. Historical records suggest malaria has infected humans since the beginning of mankind. There are four species of Malaria. Of the four species of malaria, the most serious type is Plasmodium falciparum malaria. It can be life-threatening. The other three species of malaria (P. vivax, P. malariae, and P. ovale) are generally less serious and are not life-threatening Although malaria has been virtually eradicated in countries with temperate climates, it's still prevalent in tropical and subtropical countries in Africa, Asia, the Middle East, South America and Central America. Evolving strains of drug-resistant parasites and insecticide-resistant mosquitoes continue to make this disease a global health issue. Malaria remains one of the world's leading infectious killers, particularly of children in sub-Saharan Africa. Most American cases of malaria develop in travelers who have recently returned from parts of the world where malaria is widespread. Generally, Africa carries the highest risk for the most serious cases. Parasitic Plasmodium species also infect birds, reptiles, monkeys, chimpanzees and rodents. There have been documented human infections with several simian species of malaria, namely P. knowlesi, P. inui, P. cynomolgi, P. simiovale, P. brazilianum, P. schwetzi and P. simium; however, with the exception of P. knowlesi, these are mostly of limited public health importance. Although avian malaria can kill chickens and turkeys, this disease does not cause serious economic losses to poultry farmers. However, since being accidentally introduced by humans it has decimated the endemic birds of Hawaii, which evolved in its absence and lack any resistance to it. When symptoms appear The time from the initial malaria infection until symptoms appear (incubation period) generally ranges from:1 9 to 14 days for Plasmodium (P.) falciparum. 12 to 18 days for P. vivax and P. ovale. 18 to 40 days for P. malariae. 11 to 12 days for P. knowlesi. Symptoms can appear in 7 days.  Sometimes, the time between exposure and  signs of illness may be as long as 8 to  10 months with P. vivax and P. ovale. The incubation period may be longer if  you are taking medicine to prevent  infection (chemoprophylaxis) or because  you have some immunity due to previous  infections. Variation in symptoms In regions where malaria is present,  people who get infected many times may  have the disease but have few or no  symptoms.Also, how bad malaria  symptoms are can vary depending on your  general health, what kind of malaria  parasite you have, and whether you still  have your spleen. Common symptoms of malaria In the early stages, malaria symptoms  are sometimes similar to those of many  other infections caused by bacteria,  viruses, or parasites. Symptoms may  include: Fever. Chills. Headache. Sweats. Fatigue. Nausea and vomiting. Symptoms may appear in cycles and may  come and go at different intensities and  for different lengths of time. But,  especially at the beginning of the  illness, the symptoms may not follow  this typical pattern. The cyclic pattern of malaria symptoms  is due to the life cycle of malaria  parasites as they develop, reproduce,  and are released from the red blood  cells and livercells in the human body.  This cycle of symptoms is also one of  the major indicators that you are  infected with malaria. Other common symptoms of malaria Other common symptoms of malaria  include: Dry (nonproductive) cough. Muscle and/or back pain. Enlarged spleen. In rare cases, malaria can lead to  impaired function of the brain or spinal  cord,seizures, or loss of consciousness. Infection with the P. falciparum  parasite is usually more serious and may  become life -threatning. There are other conditions with symptoms  similar to a malarial infection. It is  important that you see your doctor to  find out the cause of your symptoms.

Hyoid bone

The hyoid bone is shaped like a horseshoe, and is suspended from the tips of the styloid processes of the temporal bones by the stylohyoid ligaments. It consists of five segments, viz., a body, two greater cornua, and two lesser cornua.
The Body or Basihyal (corpus oss. hyoidei).—The body or central part is of a quadrilateral form. Its anterior surface is convex and directed forward and upward. It is crossed in its upper half by a well-marked transverse ridge with a slight downward convexity, and in many cases a vertical median ridge divides it into two lateral halves. The portion of the vertical ridge above the transverse line is present in a majority of specimens, but the lower portion is evident only in rare cases. The anterior surface gives insertion to the Geniohyoideus in the greater part of its extent both above and below the transverse ridge; a portion of the origin of the Hyoglossus notches the lateral margin of the Geniohyoideus attachment. Below the transverse ridge the Mylohyoideus, Sternohyoideus, and Omohyoideus are inserted. The posterior surface is smooth, concave, directed backward and downward, and separated from the epiglottis by the hyothyroid membrane and a quantity of loose areolar tissue; a bursa intervenes between it and the hyothyroid membrane. The superior border is rounded, and gives attachment to the hyothyroid membrane and some aponeurotic fibers of the Genioglossus. The inferior border affords insertion medially to the Sternohyoideus and laterally to the Omohyoideus and occasionally a portion of the Thyreohyoideus. It also gives attachment to the Levator glandulæ thyreoideæ, when this muscle is present. In early life the lateral borders are connected to the greater cornua by synchondroses; after middle life usually by bony union. The Greater Cornua or Thyrohyals (cornua majora).—The greater cornua project backward from the lateral borders of the body; they are flattened from above downward and diminish in size from before backward; each ends in a tubercle to which is fixed the lateral hyothyroid ligament. The upper surface is rough close to its lateral border, for muscular attachments: the largest of these are the origins of the Hyoglossus and Constrictor pharyngis medius which extend along the whole length of the cornu; the Digastricus and Stylohyoideus have small insertions in front of these near the junction of the body with the cornu. To the medial border the hyothyroid membrane is attached, while the anterior half of the lateral border gives insertion to the Thyreohyoideus.       The Lesser Cornua or Ceratohyals (cornua minora).—The lesser cornu are two small, conical eminences, attached by their bases to the angles of junction between the body and greater cornua. They are connected to the body of the bone by fibrous tissue, and occasionally to the greater cornua by distinct diarthrodial joints, which usually persist throughout life, but occasionally become ankylosed.       The lesser cornua are situated in the line of the transverse ridge on the body and appear to be morphological continuations of it (Parsons). The apex of each cornu gives attachment to the stylohyoid ligament;the Chondroglossus rises from the medial side of the base.       Ossification.—The hyoid is ossified from six centers: two for the body, and one for each cornu. Ossification commences in the greater cornua toward the end of fetal life, in the body shortly afterward, and in the lesser cornua during the first or second year after birth.

Hepatitis C

Hepatitis C is a contagious liver disease that results from infection with the hepatitis C virus. It can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness.

The hepatitis C virus is usually spread when blood from an infected person enters the body of a susceptible person. It is among the most common viruses that infect the liver.

Every year, 3–4 million people are infected with the hepatitis C virus. About 150 million people are chronically infected and at risk of developing liver cirrhosis and/or liver cancer. More than 350 000 people die from hepatitis C-related liver diseases every year.

Geographical distribution

Hepatitis C is found worldwide. Countries with high rates of chronic infection are Egypt (15%), Pakistan (4.8%) and China (3.2%). The main mode of transmission in these countries is attributed to unsafe injections using contaminated equipment.

Transmission

The hepatitis C virus is most commonly transmitted through exposure to infectious blood. This can occur through:

• receipt of contaminated blood transfusions, blood products and organ transplants;
• injections given with contaminated syringes and needle-stick injuries in health-care settings;
• injection drug use;
• being born to a hepatitis C-infected mother.

Hepatitis C may be transmitted through sex with an infected person or sharing of personal items contaminated with infectious blood, but these are less common.

Hepatitis C is not spread through breast milk, food or water or by casual contact such as hugging, kissing and sharing food or drinks with an infected person.

Symptoms

The incubation period for hepatitis C is 2 weeks to 6 months. Following initial infection, approximately 80% of people do not exhibit any symptoms. Those people who are acutely symptomatic may exhibit fever, fatigue, decreased appetite, nausea, vomiting, abdominal pain, dark urine, grey-coloured faeces, joint pain and jaundice (yellowing of skin and the whites of the eyes).

About 75-85 % of newly infected persons develop chronic disease and 60–70% of chronically infected people develop chronic liver disease; 5–20% develop cirrhosis and 1–5% die from cirrhosis or liver cancer. In 25 % of liver cancer patients, the underlying cause is hepatitis C.

Diagnosis

Diagnosis of acute infection is often missed because a majority of infected people have no symptoms. Common methods of antibody detection cannot differentiate between acute and chronic infection. The presence of antibodies against the hepatitis C virus indicates that a person is or has been infected. The hepatitis C virus recombinant immunoblot assay (RIBA) and hepatitis C virus RNA testing are used to confirm the diagnosis.

Diagnosis of chronic infection is made when antibodies to the hepatitis C virus are present in the blood for more than six months. Similar to acute infections, diagnosis is confirmed with an additional test. Specialized tests are often used to evaluate patients for liver disease, including cirrhosis and liver cancer.

Getting tested

Early diagnosis can prevent health problems that may result from infection and prevent transmission to family members and other close contacts. Some countries recommend screening for people who may be at risk for infection.

These include:

• people who received blood, blood products or organs before screening for hepatitis C virus was implemented, or where screening was not yet widespread;
• current or former injecting drug users (even those who injected drugs once many years ago);
• people on long-term hemodialysis;
• health-care workers;
• people living with HIV;
• people with abnormal liver tests or liver disease;
• infants born to infected mothers.

Treatment

Hepatitis C does not always require treatment. There are 6 genotypes of hepatitis C and they may respond differently to treatment. Careful screening is necessary before starting the treatment to determine the most appropriate approach for the patient.

Combination antiviral therapy with interferon and ribavirin has been the mainstay of hepatitis C treatment. Unfortunately, interferon is not widely available globally, it is not always well tolerated, some virus genotypes respond better to interferon than others, and many people who take interferon do not finish their treatment. This means that while hepatitis C is generally considered to be a curable disease, for many people this is not a reality.

Scientific advances have led to the development of new antiviral drugs for hepatitis C, which may be more effective and better tolerated than existing therapies. Two new therapeutic agents telaprevir and boceprevir have recently been licensed in some countries. Much needs to be done to ensure that these advances lead to greater access and treatment globally.

Prevention

Primary prevention

There is no vaccine for hepatitis C. The risk of infection can be reduced by avoiding:

• unnecessary and unsafe injections;
• unsafe blood products;
• unsafe sharps waste collection and disposal;
• use of illicit drugs and sharing of injection equipment;
• unprotected sex with hepatitis C-infected people;
• sharing of sharp personal items that may be contaminated with infected blood;
• tattoos, piercings and acupuncture performed with contaminated equipment.

Key facts

• Hepatitis C is a liver disease caused by the hepatitis C virus.
• The disease can range in severity from a mild illness lasting a few weeks to a serious, lifelong condition that can lead to cirrhosis of the liver or liver cancer.
• The hepatitis C virus is transmitted through contact with the blood of an infected person.
• About 150 million people are chronically infected with hepatitis C virus, and more than 350 000 people die every year from hepatitis C-related liver diseases.
• Hepatitis C is curable using antivirals.
• There is currently no vaccine for hepatitis C; however, research in this area is ongoing.

Hepatitis B

What Is Hepatitis B?

You may have heard of hepatitis, but many people are not sure what it is. Hepatitis is an infection of the liver. The group of viruses that infect the liver are called hepatitis viruses. Some types of hepatitis can cause very serious diseases and — in extreme cases — may lead to death.

Three types of hepatitis virus can be sexually transmitted. The type of hepatitis most likely to be sexually transmitted is hepatitis B (HBV). Hepatitis B is spread through semen, vaginal fluids, blood, and urine.

About 46,000 American women, men, and children become infected with HBV each year. Most of these infections occur among people who are age 20 to 49.

What Are the Symptoms of Hepatitis B?

Because hepatitis B often has no symptoms, most people are not aware that they have the infection. About 1 out of 2 adults who have it never have hepatitis B symptoms. When hepatitis B symptoms do occur, they usually appear between six weeks and six months after infection.

When hepatitis B symptoms do develop, the ones most likely to happen first include

• extreme tiredness
• tenderness and pain in the lower abdomen
• loss of appetite
• nausea, vomiting
• pain in the joints
• headache
• fever
• hives

Later hepatitis B symptoms include

• more severe abdominal pain
• dark urine
• pale-colored bowel movements
• jaundice — yellowing of the skin and eyes

Is There a Cure for Hepatitis B?

No, there is no medicine that can cure hepatitis. But in most cases, hepatitis B goes away by itself within 4 to 8 weeks. More than 9 out of 10 adults with HBV recover completely.

However, about 1 out of 20 people who get HBV as adults will be "carriers" and have chronic (long-term) infection with HBV. Nine out of 10 infants who get HBV at birth will have chronic infection unless they receive immediate treatment. Most HBV carriers remain contagious for the rest of their lives. There are about one and a quarter million HBV carriers in the U.S.

HBV carriers are more likely to pass the infection to other people. Chronic HBV infections can lead to severe liver disease — including liver damage (cirrhosis) and liver cancer. About 1 out of 5 people with chronic HBV infection die from the infection.

There are drugs that can help treat chronic hepatitis B. Keep in mind that pregnant women can't use these drugs.

How Is Hepatitis B Spread?

Hepatitis B is very contagious. It is passed through an exchange of semen, vaginal fluids, blood, and urine by

• having sexual intercourse without a latex or female condom
• having unprotected oral sex
• sharing needles and other "works" to inject drugs
• sharing personal hygiene utensils such as toothbrushes and razors
• accidental pricks with contaminated needles in the course of health care

HBV can also be passed from mother to infant during birth.

Pregnancy and Hepatitis B

Pregnant women who know they may have been exposed to hepatitis B should be tested before giving birth. Other women should consider testing. Talk with your health care provider to see if testing may be right for you either before you get pregnant, or during your pregnancy.

Unless treated at birth, 9 out of 10 infants born to women with HBV will carry the virus. Immediate treatment of the infant can be 90 to 95 percent effective. Treatment includes a shot at birth, followed by two more shots given during the next six months.

There are several ways to help prevent getting hepatitis B or spreading it to other people.

• You can abstain from sexual intercourse.
• If you choose to have sex, use female or latex condoms every time.
• Get the hepatitis B vaccine.
• Don't "shoot" drugs, especially with "unclean" needles or "works."
• Don't share items such as razors or toothbrushes — they may have infected blood on them.
• Emergency Prevention
  If you are exposed to the semen, vaginal fluids, blood, or urine of someone with HBV and you have not already received the HBV vaccine, see your health care provider right away. You can reduce your risk of infection by getting treatment within 14 days of being exposed.
  The vaccine protects against the hepatitis B virus by making your body's immune system develop antibodies. The antibodies will protect you by fighting off the virus if you ever come in contact with it in the future.
  The hepatitis B vaccine is given in a series of three shots. The first and second shot are given one month apart. The third shot is usually given six months after the first shot. If you miss your second or third shot, get it as soon as possible.
  The vaccine has been very successful. In fact, the number of people who get HBV each year has dropped from 260,000 in the 1980s to 46,000 in 2006.
  Extra Protection
  There is a vaccine for people at risk for hepatitis A, too. And there is a vaccine against both hepatitis A and B that can be used for people 18 and older. The combination vaccine reduces the total number of shots from 5 to 3. Ask your health care provider about your options.

  Should I Get the Hepatitis B Vaccine? Should My Child Get It?

  Today, the hepatitis B vaccine is routinely given to infants and children up to 18 years of age. But adults who are at risk for getting HBV should also get vaccinated.

  Hepatitis B is passed through an exchange of semen, vaginal fluids, blood, and urine by

  • having sexual intercourse without a latex or female condom
  • having oral sex without a condom or dental dam
  • sharing needles and other "works" to inject drugs
  • sharing personal hygiene utensils such as toothbrushes and razors
  • getting accidentally pricked with contaminated needles in the course of health care

  If you have done any of these things, talk to your health care provider about whether the hepatitis B vaccine is right for you.

  Can I Get Hepatitis from the Hepatitis B Vaccine?

  No. There is no live virus in the vaccine, so it cannot give you an infection.

  Key facts

  • Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease.
  • The virus is transmitted through contact with the blood or other body fluids of an infected person.
  • Two billion people worldwide have been infected with the virus and about 600 000 people die every year due to the consequences of hepatitis B.
  • The hepatitis B virus is 50 to 100 times more infectious than HIV.
  • Hepatitis B is an important occupational hazard for health workers.
  • Hepatitis B is preventable with the currently available safe and effective vaccine.

Hepatitis A

Hepatitis A is a highly contagious liver disease caused by the hepatitis A virus. Spread primarily by the fecal-oral route or by ingestion of contaminated water or food, the number of annual infections worldwide is estimated at 1.4 million. Symptoms include fever, fatigue, jaundice, and dark urine. Although those exposed usually develop lifelong immunity, the best protection against Hepatitis A is vaccination.

Key facts

• Hepatitis A is a viral liver disease that can cause mild to severe illness.
• Globally, there are an estimated 1.4 million cases of hepatitis A every year.
• The hepatitis A virus is transmitted through ingestion of contaminated food and water, or through direct contact with an infectious person.
• Hepatitis A is associated with a lack of safe water and poor sanitation.
• Epidemics can be explosive in growth and cause significant economic losses.
• Improved sanitation and the hepatitis A vaccine are the most effective ways to combat the disease.

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Hepatitis A is a liver disease caused by the hepatitis A virus. The virus is primarily spread when an uninfected (and unvaccinated) person ingests food or water that is contaminated with the faeces of an infected person. The disease is closely associated with a lack of safe water, inadequate sanitation and poor personal hygiene.

Unlike hepatitis B and C, hepatitis A infection does not cause chronic liver disease and is rarely fatal, but it can cause debilitating symptoms and fulminant hepatitis (acute liver failure), which is associated with high mortality.

Hepatitis A occurs sporadically and in epidemics worldwide, with a tendency for cyclic recurrences. Every year there are an estimated 1.4 million cases of hepatitis A worldwide.

The hepatitis A virus is one of the most frequent causes of foodborne infection. Epidemics related to contaminated food or water can erupt explosively, such as the epidemic in Shanghai in 1988 that affected about 300 000 people. Hepatitis A viruses persist in the environment and can resist food-production processes routinely used to inactivate and/or control bacterial pathogens.

The disease can wreak significant economic and social consequences in communities. It can take weeks or months for people recovering from the illness to return to work, school or daily life. The impact on food establishments identified with the virus, and local productivity in general, can be substantial.

Geographical distribution

Geographical areas can be characterized as having high, intermediate or low levels of hepatitis A infection.

Areas with high levels of infection

In developing countries with very poor sanitary conditions and hygienic practices, most children (90%) have been infected with the hepatitis A virus before the age of 10 years old. Those infected in childhood do not experience any noticeable symptoms. Epidemics are uncommon because older children and adults are generally immune. Symptomatic diseases rates in these areas are low and outbreaks are rare.

Areas with intermediate levels of infection

In developing countries, countries with transitional economies, and regions where sanitary conditions are variable, children often escape infection in early childhood. Ironically, these improved economic and sanitary conditions may lead to a higher susceptibility in older age groups and higher disease rates, as infections occur in adolescents and adults, and large outbreaks can occur.

Areas with low levels of infection

In developed countries with good sanitary and hygienic conditions, infection rates are low. Disease may occur among adolescents and adults in high-risk groups, such as injecting-drug users, homosexual men, people travelling to areas of high endemicity, and in isolated populations such as closed religious communities.

Transmission

The hepatitis A virus is transmitted primarily by the faecal-oral route. This is when an uninfected person ingests food or water that has been contaminated with the faeces of an infected person. Waterborne outbreaks, though infrequent, are usually associated with sewage-contaminated or inadequately treated water.

The virus can also be transmitted through close physical contact with an infectious person, although casual contact among people does not spread the virus.

Symptoms

The incubation period of hepatitis A is usually 14–28 days.

Symptoms of hepatitis A range from mild to severe, and can include fever, malaise, loss of appetite, diarrhoea, nausea, abdominal discomfort, dark-coloured urine and jaundice (a yellowing of the skin and whites of the eyes). Not everyone who is infected will have all of the symptoms.

Adults have signs and symptoms of illness more often than children, and the severity of disease and mortality increases in older age groups. Infected children under six years of age do not usually experience noticeable symptoms, and only 10% develop jaundice. Among older children and adults, infection usually causes more severe symptoms, with jaundice occurring in more than 70% of cases.

Who is at risk?

Anyone who has not been vaccinated or previously infected can contract hepatitis A. In areas where the virus is widespread (high endemicity), most hepatitis A infections occur during early childhood. Risk factors include:

• poor sanitation
• lack of safe water
• injecting drugs
• living in a household with an infected person
• being a sexual partner of someone with acute hepatitis A infection
• travelling to areas of high endemicity without being immunized.

Treatment

There is no specific treatment for hepatitis A. Recovery from symptoms following infection may be slow and take several weeks or months. Therapy is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost from vomiting and diarrhoea.

Prevention

Improved sanitation, food safety and immunization are the most effective ways to combat hepatitis A.

The spread of hepatitis A can be reduced by:

• adequate supplies of safe drinking water
• proper disposal of sewage within communities
• personal hygiene practices such as regular hand washing with safe water.

Several hepatitis A vaccines are available internationally. All are similar in terms of how well they protect people from the virus and their side-effects. No vaccine is licensed for children younger than one year of age.

Nearly 100% of people develop protective levels of antibodies to the virus within one month after a single dose of the vaccine. Even after exposure to the virus, a single dose of the vaccine within two weeks of contact with the virus has protective effects. Still, manufacturers recommend two vaccine doses to ensure a longer-term protection of about five to eight years after vaccination.

Millions of people have been immunized worldwide with no serious adverse events. The vaccine can be given as part of regular childhood immunizations programmes and can also be given with other vaccines for travellers.

Immunization efforts

Vaccination against hepatitis A should be part of a comprehensive plan for the prevention and control of viral hepatitis. Planning for large-scale immunization programmes should involve careful economic evaluations and consider alternative or additional prevention methods, such as improved sanitation, and health education for improved hygiene practices.

Whether or not to include the vaccine in routine childhood immunizations depends on the local context, including the proportion of susceptible people in the population and the level of exposure to the virus. Several countries, including Argentina, China, Israel and the United States of America have introduced the vaccine in routine childhood immunizations.

While the two-dose regimen of inactivated hepatitis A vaccine is used in many countries, other countries may consider inclusion of a single-dose inactivated hepatitis A vaccine in their immunization schedules. Some countries also recommend the vaccine for people at increased risk of hepatitis A, including:

• travellers to countries where the virus is endemic
• men who have sex with men
• people with chronic liver disease (because of their increased risk of serious complications if they acquire hepatitis A infection).

Regarding immunization for outbreak response, recommendations for hepatitis A vaccination should also be site-specific, including the feasibility of rapidly implementing a widespread immunization campaign.

Vaccination to control community-wide outbreaks is most successful in small communities, when the campaign is started early and when high coverage of multiple age groups is achieved. Vaccination efforts should be supplemented by health education to improve sanitation, hygiene practices and food safety.