DEAR DR. ROACH: Last July, I ate at a beach restaurant in Florida and shortly afterward was advised to get a hepatitis A shot, which I did. They also said to get the second shot in January 2020. Now I’m hearing that there may be complications with the second shot causing health problems and also that health insurance and/or Medicare won’t pay for it. I have scheduled an appointment to receive the second shot at the end of January through my county health department.

Are these just scare tactics, or do you believe that the second shot is necessary? The health department said that since I didn’t pay for the first shot, I will not be charged for the second one, so that’s good. — G.B.

ANSWER: Florida is experiencing a large outbreak of hepatitis A, which causes an acute illness. It is occasionally severe but always unpleasant. Fortunately, hepatitis A does not have a chronic form the way hepatitis B and C do. Hepatitis A is spread by contaminated food and water. There were numerous outbreaks reported through restaurants, not just in Florida, but also in Kentucky, Ohio, Tennessee and other states.

The hepatitis A vaccine is recommended for people who might have been exposed. The first dose should be given as soon as possible after exposure, and the second dose six to 12 months later.

I was not able to find any indication that there have been health problems related to the second dose, and I urge you to complete the two-dose series to give you long-lasting protection for the future.

DEAR DR. ROACH: Two months ago, I had an upper respiratory infection that lasted for a long time, and now I suffer from fatigue. My sister suffered for a long time with the same symptoms. She took CBD and says she feels better and stronger. I had open heart surgery to replace my mitral valve, and I take metoprolol and warfarin. Is it safe for me to take CBD? — A.T.

ANSWER: Cannabidiol, a nonpsychoactive component of cannabis (hemp), is marketed for many conditions. The scientific knowledge about its effectiveness and possible toxicities is quite limited. Similarly, the potential drug interactions are not known with certainty. Warfarin (Coumadin) is one of the most common drugs to cause concern, for both drug and food interactions. It is highly bound to proteins, and other drugs that compete with warfarin for protein binding can significantly change drug levels and small changes in drug levels can make the drug either useless or toxic. It also is metabolized by three different enzymes, one of which is commonly sped up or slowed down by other medicines, including CBD. Although I could not find any published cases of harm from people taking both CBD and warfarin, CBD can affect the platelets, which could lead to increased bleeding risk in people taking warfarin. I would recommend against CBD oil in people on warfarin. If you did want to take it, you should have frequent checks of the warfarin effect by an INR test.

I couldn’t find any good studies to show CBD is effective for frequent colds or fatigue. One study suggested cannabinoids such as CBD may worsen acute infection but may be beneficial for persistent respiratory infections. Fatigue was among the most common side effects noted with the use of CBD for a type of epilepsy, the only use approved by the Food and Drug Administration.

Finally, CBD is not regulated, and its purity is not guaranteed.

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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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