on the fence with HIB-need opinions

[nycmom18]

Hello,

we have not yet vaxed our 8 month old ds-which i am mostly confident in. the only thing that is really haunting me still for this period in his life is HIB.

My ds is basically exclusively breastfed still, he has started about a teaspoon a day of solids, and he stays home with me all day everyday.

This is what i know, (so i believe):

-HIB is a very horrible damaging and fatal bacteria-however not around a lot anymore

-by doing the vaccine for HIB i am putting my ds body in a vulnerable state for other serotypes. but is this the sacrifice we make for such a horrible bacteria? and we just continue to make vaccines for the other serotypes eventually?

-meningitis is a state of health-not a disease*please help me understand why people say this. because it seems like an excuse sometimes to not get the vaccine, but i know if my child contracted HIB bacteria, and got meningitis and maybe even worse from it, i would NEVER forgive myself for not preventing it from happening.

i am forgetting a lot of other questions i think about daily right now, but i am open to all opinions or pm me as well. thanks for taking the time!

[just_lily]

Originally Posted by nycmom18

This is what i know, (so i believe):

-HIB is a very horrible damaging and fatal bacteria-however not around a lot anymore
Actually, most cases of Hib are benine. There may be no symptoms present, or they are just passed off as the common cold. There are very few cases of Hib diagnosed because in most instances there won't be any laboratory testing if someone just seems to have a cold.

-by doing the vaccine for HIB i am putting my ds body in a vulnerable state for other serotypes. but is this the sacrifice we make for such a horrible bacteria? and we just continue to make vaccines for the other serotypes eventually? I have never heard that by getting the vax you actually become more vulnerable to other strains. Someone else will have to speak to this. Of course the pharma plan is to just make more and more vax... but where does it end, and what damage are we doing to our children to get there? I am most concerned about the potential link between the Hib vax and Type 1 Diabetes. A quick google search will bring up all kinds of information on this.

-meningitis is a state of health-not a disease*please help me understand why people say this. because it seems like an excuse sometimes to not get the vaccine, but i know if my child contracted HIB bacteria, and got meningitis and maybe even worse from it, i would NEVER forgive myself for not preventing it from happening. The reason why people point out that meningitis is a condition is because you can't vaccinate against all kinds of meningitis. It is like trying to vaccinate against fever. There are hundreds of bacterial and viral strains that can cause meningitis and we only vaccinate against 9 of them (Hib, Meningicoccal, and 7 in Pc). I don't think it is an excuse, just a statement of fact. With serotype replacement you have to understand that you aren't reducing your child's chance of contracting meningitis, just the chance of getting meningitis caused by Hib.

Hib was the vax that my doctor really went after me about, and I have to admit that I did some second guessing. But when I thought about it logically I realized that I had never even heard of Hib until I had a baby. Everyone I know over the age of about five has never been vaccinated for this, and they all managed to survive childhood.

Serotype replacement is definitely a factor. The link to diabetes is concerning. And for me, it is also just too new. I have a problem injecting my child with something that hasn't even been around long enough that we know how long it takes to wear off.

And if you are nursing, that provides a great deal of protection.

[kiara7]

You can do a search on pubmed for studies on hib in breastfed babies. There was a swedish study I think, that found 0 incidence of hib bacteria in breastfed babies.

[gcgirl]

Originally Posted by kiara7

You can do a search on pubmed for studies on hib in breastfed babies. There was a swedish study I think, that found 0 incidence of hib bacteria in breastfed babies.

It wasn't zero, but it was much lower in babies the longer they were breastfed.

And we don't do Hib or Pc because of the serotype conversion. It's totally pointless now.

[Sileree]

Hib Disease and Vaccine Info

I hope this info is helpful.

Reported Cases Per Year Ages <5
2001 – 27
2002 – 34
2003 – 32
2004 – 19
2005 – 9
2006 – 29
2007 – 17

[CDC. Surveillance Summaries, 2001-2007. MMWR.]

“Ninety percent of individuals carry Hib bacteria in their nose and throat without showing signs of the disease. The organism enters the body through the nasopharynx. Organisms colonize the nasopharynx and may remain only transiently or for several months in the absence of symptoms (asymptomatic carrier). Nontypeable (unencapsulated) strains are also frequent inhabitants of the human respiratory tract.”

[The Pink Book, Chapter 9]

"There is little risk of getting the disease after age 5."

(Also from The Pink Book)

Major Clinical Manifestations
*Meningitis (50-65% of total cases, mortality rate 2-5%, neurological sequeale in 15-30% of survivors)
*Epiglottis (17% of cases)
*Arthritis (8%)
*Skin infection (6%)
*Pneumonia (15%)
*Bone infection (2%)

Breastfeeding Decreases Risk

“The association of decreased risk for invasive Hi infection and long duration of breastfeeding was persisting beyond the period of breastfeeding itself. This finding supports the hypothesis of a long-lasting protective effect of breastfeeding on the risk for invasive Hi infection.”

[“Protective Effect of Breastfeeding on Invasive Haemophilus influenzae Infection: A Case-Control Study in Swedish Preschool Children.” International Journal of Epidemiology.]

“Breastmilk has a high concentration of secretory immunoglobulin and potentially could serve as a source of passive antibody protection of infants against systemic invasion by Haemophilus influenzae type b.”

[“Breastmilk Antibody to the Capsular Polysaccharide of Hib.” Journal of Infectious Diseases.]

Short-term Side Effects, Clinical Trials on Package Insert
ACTHIB
-All trials include children vaccinated conmittantly with DTP, which is no longer used
PEDVAXHIB
-All trials include children vaccinated conmittantly with DTP and OPV, which are no longer used today
HIBTITER (only vaccine with trials in which children were given just the Hib and side effects were monitored)
-401 infants 1-6 months old given three doses alone, DTP two weeks later
-Adverse events recorded for two days
*33% irritability
*22% sleepiness
*9.5% prolonged crying >4 hours (!)
*6% appetite loss
*2.2% vomitting
*0.4% diarrhea
*0.2% rash
-354 children 15-23 months given one dose
-Adverse events recorded for one day
*2.5% diarrhea
*1.4% vomitting
*1.1% prolonged crying >4 hours
*0.5% rash

Side Effects in Medical Literature
*Antibody levels decrease immediately following vaccination (Daum, 1989; Marchant, 1989)
*2-6 times increased risk of Hib disease in seven days following vaccination (Black, 1988; Harrison, 1988; Osterholm, 1988; Shapiro, 1988; Hiner, 1988)
*Increased risk of seizures?
Vadheim et al:
-Group #1: vaccinated with DTP, OPV and Hib, had 5 seizures within 48 hours and 3 more within 3-14 days
-Group #2: vaccinated with DTP, OPV and Hep B, had 0 seizures within 48 hours and 2 within 3-14 days.
*GBS?
*Transverse myelitis?
*Thrombocytopenia?
*Causal relationship to diabetes (Classen, 1999; Karvoven, 1999)

Vaccine Effectiveness

“Vaccine effectiveness was estimated to be 56.7%.”

[“Estimating Haemophilus Influenzae Type B Vaccine Effectiveness in England and Wales by Use of the Screening Method.” Journal of Infectious Diseases.]

“By using conditional logistic regression the vaccine effectiveness [against pneumonia] was estimated as 31.0%.”

[“Effectiveness of Haemophilus Influenzae B Conjugate Vaccine on Childhood Pneumonia: A Case-control Study in Brazil.” International Journal of Epidemiology.]

“In 1998–2000… thirty-two percent of children aged 6-59 months with confirmed type b disease had received 3 or more doses of the vaccine…”

[CDC. “Progress Toward Elimination of Haemophilus influenzae Type B Disease Among Infants and Children – United States, 1998–2000.” MMWR.]

Serotype Replacement

“We show… an increase in virulence of non-b serotypes; and a concomitant increase in NC strains… Reduction of Hib carriage may open ecological niches for H. influenzae nontype-b strains and therefore potentially increase the risk of colonization and invasive disease by these strains.”

[“Emergence of Nonencapsulated and Encapsulated Non-B-Type Invasive Haemophilus Influenzae Isolates in Portugal 1989-2001.” Journal of Clinical Microbiology.]

“In addition to the proportional increase in cases of nontype b H. influenzae disease in the post H. influenzae type b vaccine era, the incidence of invasive H. influenzae disease was found to be approaching the rates of H. influenzae type b disease that were documented in the prevaccine period. Fifty-six percent of invasive disease now occurs in individuals aged >10 years.”

[“Characterization of Invasive Haemophilus Influenzae Disease in Manitoba, Canada, 2000-2006: Invasive Disease Due to Non-type B Strains.” Clinical Infectious Diseases.]

“The incidence of Hib meningitis decreased 69% during the 1-year period after initiation of Hib immunization (from 2.62 to 0.81 cases/100,000 person-years; P<.001). In contrast, the incidence for H. influenzae type a meningitis increased 8-fold. Therefore, Hib immunization contributed to an increased risk for H. influenzae type a meningitis through selection of circulating H. influenzae type a clones.”

[“Prevention of Haemophilus Influenzae Type b (Hib) Meningitis and Emergence of Serotype Replacement with Type A Strains After Introduction of Hib Immunization in Brazil.” Journal of Infectious Diseases.]

[carriebft]

http://children.webmd.com/vaccines/n...ccinated-child

5 hib cases in outbreak. 3 unvaccinated- 1 died. 1 partially vaccinated but not done with series and 1 vaccinated but with immune deficiency.

so this can go either way I guess. most were unvaccinated or not totally vaccinated, but one vaccinated child also got it.

[dessismama]

The vaccinated child was immunocompromised so this explains why she/he was so suseptible.

[mamakah]

When you have some time (about an hour) you should listen to this...
http://www.hpakids.org/RadioShow.htm
listen to #5 aired on OCT 19th.
I just listened to it today and they talked quite a bit about Hib and other VPDs. One point they had was of course, the breastfeeding thing, but also that we all have the hib bacteria in and around us. They said that when someone has a bad diet of junk food, sugar, bread etc. Our immune cells are not coated with a certain sugar that recognizes the hib bacteria as friendly. Thus, attacking it like an enemy, resulting in the battle of the hib bacteria and the immune system.
This brought me so much comfort, and made it an easy explanation to my hubby. We both laughed at the analogy I used.
The immune cells are having a party drinking too much (in this case to much junk and sugar), this intoxicates them and makes them pick a fight with one of their roommates that they have lived harmonyously (sp?) with for some time. This result in a viscious brawl that only one of them wins in the end! Had the Immune cells not been so chemically altered (sugar and junk again) they would have never picked a fight with their roomies Hib and the fight wouldn't have happened.

[Lazy Gardens]

Originally Posted by nycmom18

-by doing the vaccine for HIB i am putting my ds body in a vulnerable state for other serotypes.

No, you are not. The other serotypes can infect an unvaccinated child just as readily as they can a vaccinated one.

Also, the other serotypes, for some complex biochemical reasons, are far less likely to cause the fast-moving meningitis that type b does.

[mamakay]

Originally Posted by Lazy Gardens

No, you are not. The other serotypes can infect an unvaccinated child just as readily as they can a vaccinated one.

Doesn't that depend on whether or not the unvaccinated child is presently colonized with Hib?

Also, the other serotypes, for some complex biochemical reasons, are far less likely to cause the fast-moving meningitis that type b does.

Hia can be very similar.


http://pediatrics.aappublications.or...rint/108/1/e18

We describe 5 cases of invasive disease, including
4 cases of meningitis in young children attributable
to H influenzae serotype a in Utah during a 10-month
period. Three cases were attributable to a unique
strain that possesses a deletion mutation associated
with invasive strains of Hib but not normally found
in noninvasive strains. Two of these cases, described
below, were strikingly reminiscent of severe disease
caused by Hib.

Their follow-up study was interesting, too.
http://jcm.asm.org/cgi/reprint/40/4/1264

Then there's this:

In addition to the proportional increase in cases of non-type b Haemophilus influenzae disease in the post-H. influenzae type b vaccine era, the incidence of invasive H. influenzae disease was found to be approaching the rates of H. influenzae type b disease that were documented in the prevaccine period. Fifty-six percent of invasive disease now occurs in individuals aged >10 years.

Of course, that's all "invasive disease" and not just "fast moving meningitis".


ETA:
...just found this, too...

http://www.ncbi.nlm.nih.gov/pubmed/17984810

Invasive infections caused by haemophilus influenzae serotypes in twelve Canadian IMPACT centers, 1996-2001.

Mean duration of hospitalization, need for admission to a pediatric intensive care unit, and case fatality rates were similar for the cases because of Hib, Hia, Hif, and nontypable serotypes.

[LilacMama]

Originally Posted by Sileree

[CDC. Surveillance Summaries, 2001-2007. MMWR.]

“Ninety percent of individuals carry Hib bacteria in their nose and throat without showing signs of the disease. The organism enters the body through the nasopharynx. Organisms colonize the nasopharynx and may remain only transiently or for several months in the absence of symptoms (asymptomatic carrier). Nontypeable (unencapsulated) strains are also frequent inhabitants of the human respiratory tract.”

[The Pink Book, Chapter 9]

Wow, now I'm totally confused. On page 2 of the downloadable PDF on HIB from The Pink Book, it says that HIB could be isolated in the noses/throats of 0.5-3% of young children and was extremely rare in adults, in the pre-vaccine era.

The prevalence of the bacteria has HUGE impact on my decision to give this vax or not. Is the CDC contradicting themselves or am I missing something in my understanding?

[mamakay]

The prevalence of hib carriage in all age groups is way down now compared to the prevaccine era. This is the most recent/current evidence I've been able to locate:

http://pediatrics.aappublications.or...l/108/4/e60#T1

In Amish community A, pharyngeal swabs were obtained from 144 (93%) of 155 residents in participating households. Five residents (3%) were carriers of Hib, and 3 households (9%) had 1 or more Hib carriers (Table 1). In Amish community B, pharyngeal swabs were obtained from 154 (86%) of 180 residents. Thirteen (8%) were Hib carriers, and 8 (28%) of 29 households had 1 or more Hib carriers. In the non-Amish comparison group, pharyngeal swabs were obtained from 136 (56%) of 242 total household members . None of the participants were carriers.

But it's not completely eliminated nationally, as we can see from the small number of invasive hib cases we still get a year now.

If it's still floating around at a low level, that means kids are still possibly going to encounter it eventually, just at an older age than it was prevaccine.

[Spectrolite]

Quote:
Mean duration of hospitalization, need for admission to a pediatric intensive care unit, and case fatality rates were similar for the cases because of Hib, Hia, Hif, and nontypable serotypes.

from
http://www.ncbi.nlm.nih.gov/pubmed/17984810
Invasive infections caused by haemophilus influenzae serotypes in twelve Canadian IMPACT centers, 1996-2001.

Quote:
"...the incidence of invasive H. influenzae disease was found to be approaching the rates of H. influenzae type b disease that were documented in the prevaccine period. Fifty six percent of invasive disease now occurs in individuals aged over 10 years. "
from
"Characterization of Invasive Haemophilus Influenzae Disease in Manitoba, Canada, 2000-2006: Invasive Disease Due to Non-type B Strains"





Have any of you found other studies that give evidence of this??

What is the major cause of fatal bacterial meningitis today, now that Hib is nearly out of the question?

[mamakay]

Have any of you found other studies that give evidence of this??

Not that actually compared it to the incidence of invasive disease before the introduction of the Hib vaccine like that study you posted does. But we do have extremely strong evidence that replacement happens:


adults in England after Hib immunization in kids:

http://www.ncbi.nlm.nih.gov/sites/en...t=AbstractPlus

Though numbers of Hib infections in adults fell after the introduction of Hib vaccines for children (P = 0.035), and there was no increase in infections caused by other capsulated Hi serotypes, total numbers of invasive Hi infections increased due to a large rise in infections caused by non-capsulated Hi (ncHi) strains.

(noncapsulated is the same thing as "nontypeable")

Same thing in adults in the US:

http://www.ncbi.nlm.nih.gov/sites/en...indexed=google

Nontypeable H. influenzae disease accounted for the greatest proportion of cases (35.8%-61.5%) in all but 1 age group. The number of cases of invasive nontypeable H. influenzae disease increased by 657%, from a low of 7 cases in 1996 to a high of 53 cases in 2004; as a proportion of annual cases, nontypeable H. influenzae disease increased from 17.5% in 1996 to 70.7% in 2004. Overall, the case-fatality rate was 12.7%, with the highest rate observed in persons aged > or = 65 years (20.6%). The case-fatality rate was similar for the hospital discharge database and for Indiana, Maryland, Oregon, and Wisconsin (range, 12.9%-18.2%).

Scroll about 2/3rds of the way down here and watch the total cases of h-flu from 1991 onward:

http://www.cdc.gov/vaccines/pubs/pin...ses&deaths.pdf

And here you can see that Hib conjugate vaccine uptake in 1992 was still only 28%:

http://www.cdc.gov/vaccines/pubs/pin...G/coverage.pdf

Here's some raw European data you can look at:
http://www.euibis.org/documents/2006_hib.pdf

Look at table 4 on page 21. Check out the "overall incidence" line. There's an overall slight increase since 1999.

Now go down further to figure 4 on page 24. B goes down, and the nontypeable/noncapsulated goes up. Of course that's just the "proportional to one another" cases...but remember the "overall incidence" from table 4...the total cases have gone UP. The increase in Nthi is "absolute"...not just "proportional".

Now go down to page 29 and look at figure 6. That's what you'd expect, since the vax is effective against serotype B.

And now go down to figure 10, page 34. Is it what you were expecting? See the pattern yet? lol

If that's a coincidence, it is one heck of one, huh?
Especially interesting in tables 6 and 10 are the weird spikes in 2002. Not sure what to make of that.

[Spectrolite]

Ok, so what the numbers are saying is that the morbitidy and mortality of non-typable H infections is not yet at the same number as they were with HiB in the pre vaccine days, but they sure seem to be getting there.

So we are in sort of a lull right now with bacterial meningitis? In between high rates of HiB cases and possible upcoming high rates of non-HiB cases?

[mamakay]

Originally Posted by Spectrolite

Ok, so what the numbers are saying is that the morbitidy and mortality of non-typable H infections is not yet at the same number as they were with HiB in the pre vaccine days, but they sure seem to be getting there.

So we are in sort of a lull right now with bacterial meningitis? In between high rates of HiB cases and possible upcoming high rates of non-HiB cases?

Maybe. Looking at the CDC's appendix g data, it looks like "invasive h-flu" (this will include bacteremia, pneumonia, etc in addition to meningitis) is very nearly back to where it was when the hib vaccine was introduced. But it might be less meningitis and more bacteremia or something.
I haven't found any good data going back to 1990 or 1991 that tracked, for the whole population, what percentage of h-flu cases were meningitis vs. "other" types of invasive disease.

A point that can be made in favor of elimination of Hib, is that it is good for pediatric health (so far), even if that's at the expense of adults getting more invasive h-flu infections. I'm just not sure about the ethics of that sort of immunization program.

[Spectrolite]

But so far those invasive diseases seen in adults have not been so fatal, no? More easily treatable than that fast-moving Hib meningitis?

[mamakay]

Originally Posted by Spectrolite

But so far those invasive diseases seen in adults have not been so fatal, no? More easily treatable than that fast-moving Hib meningitis?

Probably. Either that, or medicine has improved significantly in the past 20 years. Maybe a bit of both.

Don't forget this, too:

Mean duration of hospitalization, need for admission to a pediatric intensive care unit, and case fatality rates were similar for the cases because of Hib, Hia, Hif, and nontypable serotypes.

But that's just kids. Maybe adults are less likely to die from invasive NTHi infection.

[anewmama]

Mamakay, you made a point in this thread or somewhere else about HiB being colonized later in children due to it being less in circulation. So for children not vaccinated, their risk factor could at a later age, I think you said 4?, would almost be that of a 6 month old. I know I am saying this badly. But do you think that one dose of HiB for an over 2 year old child would not be a bad thing given the risks of an older child being more like a younger child?

Can you re-state what you said? I think I asked you this in another thread but I lost the thread. Sorry if this hijacks this discussion....

[mamakay]

Originally Posted by anewmama

Mamakay, you made a point in this thread or somewhere else about HiB being colonized later in children due to it being less in circulation. So for children not vaccinated, their risk factor could at a later age, I think you said 4?, would almost be that of a 6 month old. I know I am saying this badly. But do you think that one dose of HiB for an over 2 year old child would not be a bad thing given the risks of an older child being more like a younger child?

Can you re-state what you said? I think I asked you this in another thread but I lost the thread. Sorry if this hijacks this discussion....

I understand what you're asking. In a nutshell, I think it is possible that a 4 yo exposed to hib for the first time might be about as at risk of serious disease as 6 month olds were prevaccine. There's also a chance that the theory (it's really the "scientific concensus", but I'm skeptical...long story...lol) that kids under two are unable form antibodies against the bacteria's polysaccharide, and that's why prevaccine most cases happened in kids under 2.

Looking at the evidence behind "the scientific concensus" might make for an interesting spinoff thread, relevant to the decisions selective/delayers are faced with.