DEAR DR. ROACH: I am approaching 70 years old and am in good health. I exercise by swimming and walking every day. I have decided to go to Egypt, as I have always wanted to see the amazing pyramids.

I contracted hepatitis C through a transfusion many years ago. While I was being treated, my doctor advised me not to receive either hep A or hep B inoculations. I followed his advice to the letter. In the 1970s, the treatment was prednisone. In the 1990s, the treatment was interferon for two years. It was quite taxing, but there is not a trace of the virus after many blood tests. Am I risking my health by going to Egypt? The tour company suggests inoculating against hep A, hep B, typhoid and yellow fever. I am up to date on tetanus, flu and pneumonia. I don’t want to risk my health. Your suggestions? — Anon.

ANSWER: Hepatitis A, B and C all are viral infections of the liver. Hepatitis A is usually a self-limited illness that has no chronic infection phase, but it can be very serious in people with any other type of liver disease. Hepatitis B and C both can cause a chronic infection lasting for decades, but both can now be treated — and hepatitis C cured — in most people. Current treatments for hepatitis C are much more effective and have fewer side effects than the treatments you underwent. Hepatitis A and B have very effective vaccines to prevent infection; there is no vaccine yet for hepatitis C.

I’m afraid your doctor must not have conveyed the information correctly, since hepatitis A and B vaccines are particularly important for a person with hepatitis C to receive. You should have gotten those vaccines years ago. The only reason I can think for not giving them to you would be that your blood tests previously might have shown you already had immunity to both hepatitis A and B. These are simple blood tests to run: If you are immune, you don’t need to worry about it, but if not, you should consider vaccination. Hepatitis A vaccine is particularly important to get, as the disease can be transmitted by contaminated food and water, and is common in Egypt. The Centers for Disease Control and Prevention recommends hepatitis B vaccination for travelers who might consider a new sexual partner, tattoo or medical procedure while in Egypt.

People who are infected with both hepatitis B and hepatitis C can have a flare of hepatitis B while being treated for hepatitis C. It’s not clear why this happens, but it’s an issue during treatment for hepatitis C, not for vaccination for hepatitis B.

DEAR DR. ROACH: I often wonder how many colds and other contagious illnesses could be prevented if only we stopped the practice of shaking hands. Of course, there’s no answer to this question, but if our culture would stop this practice, I bet we would all be healthier! — M.W.

ANSWER: Most colds are spread by hand-to-hand contact; however, they also can be transmitted through aerosol droplets. Not shaking hands is very likely to reduce cold and flu transmission (and as you suggest, many other diseases as well).
Frequent hand-washing has almost as much benefit as avoiding handshakes. If you do shake hands, it’s a very good idea to be careful not to touch your face until you wash your hands.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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