on the fence with HIB-need opinions - Page 2

[anewmama]

care to start that thread?! this is one that I am debating giving my daughter. She will be 2 in a month and a half.

[nycmom18]

i would love for this discussion to continue on this thread if you ladies are up to it. i haven't been commenting, just reading all of mamakay's posts

i must admit, all of the evidence and studies get confusing to me at times. can't research just simply state whether or not i should give my child this vaccine

of course not, i know, however, like anewmama, i'm seriously considering this vax. this is the only disease that i am truly worried about at this point. it gives me nightmares sometimes! yikes!

so to sum up the last couple of posts: if a child is given the hib vaccine or exposed to the bacteria prior to age 2, their immune system is not able to create adequate antibodies?

and i'm still confused how giving the vax or not to children affect their chance of getting hib later in life??

and does the vax then promote serotype replacement within the vaxed childs body, or is this serotype replacement happening on the population as a whole due to the vax?

*sigh* confusion....

[Spectrolite]

on natural Hib immunity in kids...

HiB study in Turkey (where HiB isnt in the vax schedule), says 65.3% of kids 6mo- 5 yrs have natural immunity.

--------
"Natural immunity to Haemophilus influenzae type B in children of Ankara, Turkey

Abstract Background : Haemophilus influenzae type b (Hib) infection has a high morbidity and mortality rate especially in children under 5 years of age. The incidence of Hib disease in Turkey is not known, and Hib vaccine is not included in the National Immunization Program. The aim of this study was to determine the natural immunity to Hib of children 6−60 months of age living in the Park Health Center region of Ankara, Turkey.

Methods : A total of 270 children were selected by layered random sampling method, and 242 of them (89.6%) participated in the study. A questionnaire was given to the parents of the children who were included in the study and blood samples were taken from those children. Anti-Hib IgG antibody (anti-PRP) level was determined in the serum by using anti-Haemophilus influenzae IgG EIA kit and anti-PRP antibody levels of 0.15 µg/mL and over were accepted as the natural immunity.

Results : Natural immunity was determined in 65.3% of the children. A relationship was determined statistically between the history of disease with possible Hib agent and with natural immunity.

Conclusions : The exposure rate of children with Hib was higher than expected, even in children who were just a few months old. Our data revealed that multicentric, national studies should be done to define the burden of Hib disease before making a decision for Hib vaccine to be included in the National Immunization Program."

[Spectrolite]

but now i found this. am i reading this correctly? These are in 2 pre vaccine communities. are they saying that the younger children had low % (of naturally acquired) antibodies present, and the % decreased further still with age? ie barely any natural immunity at 4 years old?
this relates to anewmama's question on pg 1 of this thread.

"Natural Haemophilus influenzae type b capsular polysaccharide antibodies in 412 infants and children from West Africa (Burkina-Faso) and France: A cross-sectional serosurvey"

http://www.springerlink.com/content/q7747705540r2052/

None of the children from Burkina-Faso or France had antibody levels > 1.0 mgrg/ml before one year of age. Thereafter, only 9.51% of French children in the 12- to 17-month age stratum and 19.2% over 4 years of age had antibody levels > 1.0 mgrg/ml. There were no non-detectable results for children over 4 years of age, and the means for natural detectable Hib CP antibodies were > 0.15 mgrg/ml for both populations.

[Spectrolite]

Dynamics of natural immunity caused by subclinical infections, case study on Haemophilus influenzae type b (Hib) (year 2000)


http://journals.cambridge.org/action...line&aid=66667

"Natural immunity to Haemophilus influenzae type b (Hib) is based primarily on antibodies that are thought to develop in response to subclinical infections. Wide use of conjugated Hib vaccines could lead to decreases in circulating Hib bacteria, thereby diminishing antibody levels in the unvaccinated. We applied a statistical model to estimate the duration of natural immunity to Hib under different forces of infection. Prior to the introduction of conjugated Hib vaccines, new Hib infections were estimated to occur once in 4 years and the antibody concentration to stabilize at a level around 1 μg/ml. In the absence of new stimuli, i.e. infection, 57% of the unvaccinated population would become susceptible to invasive disease (antibody levels < 0·15 μg/ml) in 10 years. Due to an interaction between the force of infection and the duration of immunity, in some situations numbers of invasive infections could increase in unvaccinated cohorts. This theoretical scenario has yet to be observed in practice."


So this doesn't sound good. :/

But I dont' quite understannd how breastfeeding comes into the picture then. Would the mother have had to acquired natural immunity at some point to be able to pass along the antibodies to her baby? So would this only happen most likely in non-vaccinated communities? I wasn't vaxed for this, I lived in the pre-vaccine era, possibly have natural immunity? Do i need to get my titers checked to see if I am passing along the right antibodies to dd?

Sorry I'm all over this thread these days. I am now sooo neck deep in this vax issue, it's been taking over every spare moment I have for the past 3 weeks. I feel like I NEED to decide very very soon on what to do. I talked with a organic food store owner today about vaxing (she doenst vax) and ended up getting rather teary. !! I just havne't really talked face to face about this issue with another "crunchy" mama who understands how emotions/mama instinct are part of this decision...

[anewmama]

All good questions. That last article you posted is what is giving me pause. And enough to make anyone a bit angry. If we are both reading it right, vaxing is doing to HiB like to what vaccination is doing to chickenpox. It is taking away the chances of later exposure and reinforcing immunity.

For breastfeeding.... I have seen the studies but never asked myself if they were done in areas where Hib vaccination uptake was high. If not, it would sort of make sense that breastfeeding confers immunity through antibodies until the child is older and then natural exposure comes into play and most kids are able to handle the exposure. Or, maybe breastfeeding provides protection and still Hi colonized early on so the colonization part happened and the antibodies are present already to help deal with it. So when breastfeeding is stopped, the body has some exposure. But what if you take away the natural circulation of Hi and the colonization doesn't happen, even where babies are breastfeed (and unvaccinated)? This is the point I am at.

So, breastfeeding would be great if HI were still circulating at higher rates. Without the circulation, how short term or long term is the breastfeeding protection? And without colonization, couldn't future exposure cause more problems?

And then at to this... serotype replacement?!

Enough to make you go a bit bonkers.

[Spectrolite]

Yeah, anewmama, I guess I'm at the same point as your right now.

When I first delved into the complicated world of Hib, I found out about breastfeeding and thought, "ok, no problem, my babe will be fine." because I am exclusively breastfeeding and plan to for at least 6 months, and will continue to BF until she is 2.

I thought it was as simple as that.

But being that we live in a highly vaccinated community (and so far are only traveling in highly vaxed areas), we are not exposed to Hib. (Crazy thinking that now I would actually WANT to be exposed to this insane bacteria?! ???)



Also, I had only seen a handful of articles about BFing Hib protection. i don't know if they are enough for me

......Do we have to take a vacation to Turkey to get natural immunity for our kids? A MDC meet-up in sunny Ankara? I'm in!!

ps--with all this info, this "90% of us have the bacteria in our nose right now!" piece of info doesn't make sense ?? help?

[Spectrolite]

oh man, just read the turkish airlines crash story

[nycmom18]

sitting confused here as well:

i wonder if any study will realy ever get to the bottom of this. i mean, so many studies are done without all of the right components, therefore not being 100%truthful.

who knows anymore??....

[Spectrolite]

this is the kind of situation that makes me lean over to the vaxing side of the fence. I HATE the idea of vaxing, terrible terrible, pretty nasty, not so green thing. But if we opt out from it now, since it's gone so far already, are we still creating more risks for ourselves?

[mamakay]

For breastfeeding.... I have seen the studies but never asked myself if they were done in areas where Hib vaccination uptake was high. If not, it would sort of make sense that breastfeeding confers immunity through antibodies until the child is older and then natural exposure comes into play and most kids are able to handle the exposure. Or, maybe breastfeeding provides protection and still Hi colonized early on so the colonization part happened and the antibodies are present already to help deal with it. So when breastfeeding is stopped, the body has some exposure. But what if you take away the natural circulation of Hi and the colonization doesn't happen, even where babies are breastfeed (and unvaccinated)? This is the point I am at.

So, breastfeeding would be great if HI were still circulating at higher rates. Without the circulation, how short term or long term is the breastfeeding protection?

Yeah. Maybe.
We're kind of on our own here speculating about what might happen.

On the down side from a "wanting to avoid the vax" POV:
The breastfeeding protection studies might not apply to a post-vaccine society. It probably still applies as long as you're still breastfeeding (there's been no hib epidemic in adults yet, and if the baby/child is colonized, mom will be, too, so there probably is a lot of protection in that scenario) but even the most radical extended nursers among us aren't going to nurse for forever.

On the bright side from a vax-avoidant POV:
There is evidence that immunity to one type of h-flu creates a "cross protection" against other types. So if in our post-vax society, we've traded hib colonization for more nthi colonization, maybe that nthi immunity will help prevent invasive hib after breastfeeding has stopped. Maybe. That's extremely speculative, though. Maybe I'll go dig into the original research and see what the actual evidence is behind cross-reactive immunity.

[macypickle]

im in the exact same predicament..
he had his 2 month appt today and i told his ped i was not comfortable with doing any vaccines at this time and she said thats fine but she would reallylike me to consider the Hib for 4 months..

[mamakay]

But I dont' quite understannd how breastfeeding comes into the picture then. Would the mother have had to acquired natural immunity at some point to be able to pass along the antibodies to her baby? So would this only happen most likely in non-vaccinated communities? I wasn't vaxed for this, I lived in the pre-vaccine era, possibly have natural immunity? Do i need to get my titers checked to see if I am passing along the right antibodies to dd?

As long as you're breastfeeding a lot, you're probably fine. If your baby becomes colonized with Hib, he'll be protected somewhat, and you'll be colonized transiently, too, probably upping the sIGa against hib in your milk.

Prevaccine, that was good enough for life, more or less. Babies and kids were colonized over and over again and developed their own immunity over time (partially mooching off mom's immunity when breastfed early in life, which prevented invasive disease at that time), so once they were weaned, it wasn't an issue, because colonization had created active immunity over time.

So wow. Huh. The argument in favor of doing the hib vax in the post vaccine era certainly does look strong. And I don't think (and I know it was a joke, but still) a single vacation to Turkey would remedy this predicament. Prevax, babies were colonized over and over and over again. It takes multiple exposures to create serious immunity, probably.

[mamakay]

Wow. I wonder if this same scenario will hold true for Prevnar and PCV13? And all the other bacterial vaxes in the works?
What a depressing situation, where unvaxed individuals are more at risk than they ever were prevaccine.
Wow.

[Spectrolite]

aw, mamakay, don't depress me!!! i'm in a rollercoaster with this vax ride already...i keep leaning to and fro... and just when i started to lean more no-vax, i get this info. grrr.

it's amazing how many times in a day i can jump over the fence.

so there goes my faith in relying on those "protective effects of breastfeeding" studies ???????????????

[anewmama]

mamakay, I have alot of respect for your level headed knowledge of vaccines. I see you post here and on baby center (at least on one community). You seemed to disappear for a while and I almost PM'd you to see how you are. I am glad you are posting again.

But to see you go "wow"... twice in one post certainly alarms me. This thread has been very illuminating for me. Like Spectrolite, I was riding on the information about breastfeeding protection. This discussion raises some very scary questions.

[mamakay]

Part of my shock at thinking about all this, is thinking about what this will mean for developing countries being persuaded to initiate Hib immunization by the "first five-10 years free!" offers from GAVI and the WHO.

This is an interesting article:
http://www.ncbi.nlm.nih.gov/pubmed/18316845
http://www.icmr.nic.in/ijmr/2008/january/editorial1.pdf


India has amazingly little invasive Hib disease, and also one of the highest breastfeeding rates in the world. (I've never seen anyone claim cause and effect there, but I doubt it's a coincidence)

http://icmr.nic.in/ijmr/2007/may/0516.pdf

(read the whole thing...it's interesting)

H influenza b (Hib): Paediatricians and pathologists
have long known that Hib disease in Asia is very
low... .

Yet the thrust of
international research on Hib in India has been to
convince health planners that the problem was
unrecognized due to poor microbiological facilities..

Not convinced, the
WHO undertook a large population based study.
This reported the incidence of Hib disease at nine
per 100,0009.

The WHO wants hib vaccine introduced globally, even where hib is not a problem. The "public-private partnership", GAVI "helps" by giving developing countries the vaccines for free...temporarily.

http://jacob.puliyel.com/download.php?id=129

(again, I suggest reading the full text)

With this funding, vaccine costs can
come close to zero, and countries are
persuaded to start the programme.
Funding is withdrawn after a couple of
years and nations are effectively lured
into a debt trap.

What is going to happen to the poorest kids in countries like India once the free shots are withdrawn, the country can't afford to immunize every baby, and Hib circulation re-emerges? Are they going to have a hib epidemic where there was none before?

This is also interesting reading:



http://www.bmj.com/cgi/content/extract/319/7203/188/a
(read the rapid responses, too)



http://www.bmj.com/cgi/content/extract/333/7569/621-c


I wonder if anyone in India is thinking about what they might be getting themselves into if they accept GAVI's limited time offer of 5 or 10 years of free Hib vaccines?

[Spectrolite]

Originally Posted by anewmama

mamakay, I have alot of respect for your level headed knowledge of vaccines.

But to see you go "wow"... twice in one post certainly alarms me. This thread has been very illuminating for me.

:

This particular issue starts to bring me to thinking again how we are sort of in a "lose-lose" situation with whatever decision we make re vaxing...(esp when we vax againsta bacteria.)

[Spectrolite]

mamakay, I'm itching (again ) to know what you think personally about this Hib vax at this point.

Are we at a point of no return in regards to vaxing against bacteria?

For healthy, BFing, nutritionally-aware people, do you still think the risks of vaccinating are still worse than the risks of getting a type of Hi disease?

You seem to be great with numbers and have been at this for years. I don't want to seem like I'm not doing my hw. As a newbie, I greatly appreciate personal comments from "old-timers"

[Spectrolite]

And what about this thought: (I know it's what most non-vaxers think but I'm writing my thoughts down anyway)

Say preschool-aged children are now more susceptible to the HiB bacteria nowadays (post vaccine era).

Ok, so we as parents provide our babies with breastmilk to protect them against harmful bacteria.
When they get older and no longer bf, we can provide our growing children power foods and a healthy family life to boost their immune system.

So we can hope that a healthy lifestyle will continue to protect them against HiB should they encounter it later in life...... oui?