on the fence with HIB-need opinions - Page 3

[anewmama]

My 4 am thought on this also is this: so there was a drop in meningitis related HiB until other serotypes moved in and the rates of meningitis came back up more or less. So, if breastfeeding protects against serotype B, are there any studies around protection provided from breastfeeding for other serotypes that are now causing some of the meningitis cases?

You have to also think that breastfeeding is protective, but not necessarily for all breastfed babies. A few studies showed the protective qualities but I am not sure there is enough of a sample or sufficient studies done, particularly for Hi disease and how the bacteria has transformed to today.

So there is the risk that even in a breastfed baby, that breastfeeding is not enough. Particularly, if the theory is that HI increased fourfold in incidences after the 1940's due to antibiotic use (and I suspect, due to formula pushing): if the bacteria is evolving this way to survive, then it could be evolving right now to "evade" the protective qualities of breastmilk.



For what it's worth, I elected to give my daughter the vaccine yesterday for many of the reasons posted here (and she has been breastfed). She has so far had no reactions whatsoever. The serotype thing bothered me at 4 am, but my thoughts above are somewhat consoling me even if they might not be accurate.

[Marnica]

Originally Posted by anewmama

My 4 am thought on this also is this: so there was a drop in meningitis related HiB until other serotypes moved in and the rates of meningitis came back up more or less. So, if breastfeeding protects against serotype B, are there any studies around protection provided from breastfeeding for other serotypes that are now causing some of the meningitis cases?

You have to also think that breastfeeding is protective, but not necessarily for all breastfed babies. A few studies showed the protective qualities but I am not sure there is enough of a sample or sufficient studies done, particularly for Hi disease and how the bacteria has transformed to today.

So there is the risk that even in a breastfed baby, that breastfeeding is not enough. Particularly, if the theory is that HI increased fourfold in incidences after the 1940's due to antibiotic use (and I suspect, due to formula pushing): if the bacteria is evolving this way to survive, then it could be evolving right now to "evade" the protective qualities of breastmilk.



For what it's worth, I elected to give my daughter the vaccine yesterday for many of the reasons posted here (and she has been breastfed). She has so far had no reactions whatsoever. The serotype thing bothered me at 4 am, but my thoughts above are somewhat consoling me even if they might not be accurate.

I hear you.....and I'm right there with you but what stops me from getting this for my son is not my fear of any immediate reaction. It is my faer of what may happen later....years from now. Mostly with diabetes. I get it in my head that he will get just this 1 vaccine and that's it. I pick up the phone to make the appointment and my mommy instincts are screaming at me "what are you doing?? Put down the phone!!" So I do and then I do it all again the next day. I cannot ignore those instincts. What I really feel is like my head is about to explode and I really just want to cry

[anewmama]

Well, some say the diabetes studies was not well done. I am not knowledgeable enough to agree or disagree.

As for mommy instinct: When my daughter was 3, I gave her one DTaP. It was against all of my instincts. As the needle went in, I felt this COLD sharp shiver of fear run down my gut. The kind of fear that you experience when you almost just DIED. I felt weak in the knees. I felt helpless and lost. So I did not do any more vaccines. She did get a cough that night (from the vaccine or from the doctor's office, who knows). And other than being a little fussy, from the cough?, she had no other reactions.

She is now 23 months more or less and I am cautiously approaching this again. I was nervous giving the HiB vax but did not experience anything like I did above. Even with that feeling above and that my daughter was in daycare part-time at 4 months, I still did not give any more vaccines.

But now I am cautiously looking at options. I have found 2 doses of singles measles and have an appointment for them. I have 2 more weeks to decide before canceling them. Mumps and Rubella do not worry me for my daughter though there are the "social" concerns around rubella. But as for MMR, even if evidence is pointing away from autism, I would never forgive myself if I did MMR and something DID happen with all the concern out there. It's just a fact and no scientific proof will remove the impact of all those anecdotal stories have had on me.

So then there is DTaP.... My husband is worried about tetanus. So those are the three I am cautiously looking at. One is under my belt and thank god I waited this long so I only have to do one Hib. Since this vaccines seems to be one that causes the least reactions, the diabetes issue aside for a moment, it seemed a good one to just "get over with" in terms of making a leap. IN some ways, the vaccine seems so much more approachable than the risk of ever putting my daughter through a spinal tap.

So last night, the serotype replacement thing bothered me at 4 am but my thoughts above are all I could come up with as to why I would "risk" B getting out of the way via vaccination and knowing that any other HI serotype might move in with meningitis still then a risk.


I SO hear you on the mama instinct. I know that feeling you are describing. Sometimes, I get really frustrated at EVERYONE (pro and against) for all their fear-mongering. It seems sometimes, that no one is being reasonable. But maybe that will never be a part of the vaccine issue. So you have to listen to yourself, heed that instinct. And then you have to sort of get in your head away from the instinctual Mom feeling and look at it in a detached way, almost not even associated with your child. And then somehow reconcile the two... to either never giving it or giving it.

I think because my daughter is so much older and stronger that it is not as terrifying to me. Maybe I did know something back then, in an unconscious level with my daughter. When she breaths in her sleep, she seems to often just stop. I have to sometimes knock her to get her going again. It's like she just holds her breath in her sleep. Is that normal sleeping for a child?! Maybe there was something there though ... who knows.

[mamakay]

Originally Posted by 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"

I'm really unsure. While your breastfeeding, breastmilk will still be as effective as it always was. After weaning, I'm unsure of the degree of risk. I really need to find out where the idea comes from that kids under 2 are unable to form immunity against polysaccharides. If they are right about that, then I lean against vaxing. If they are wrong about that, then yeah...we're probably at a point of no return.

I'm not particularly frightened for my weaned big kid right now. The CDCs estimated risk prevax of one in 250 is a total exaggeration, from what I can tell from digging into the original research. It was probably more like one in 1,000. Whether or not one in 1,000 is "really risky" is a personal call and I'm not really sure what to think there. I probably would vax if I had a kid in daycare, though, because there are so many viruses floating around in daycares, and those little viruses predispose kids to invasive bacterial disease.
Other than that, I'm just thinking.

[mamakay]

Originally Posted by 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?

Yeah, nutrition is important and certainly helps...but it's not like the breastmilk protection. Preschoolers are still basically in the same boat formula fed 6 month olds were prevaccine.

[Marnica]

Originally Posted by anewmama

IN some ways, the vaccine seems so much more approachable than the risk of ever putting my daughter through a spinal tap.

But getting the HIB vax doesn't mean that the risk of everhaving a spinal tap goes down. There are hundreds of other strains of bacteria and viruses that can lead to mennegitis that are not covered by a vaccine. Frankly I find it scary that IF my child was vaxed for HIB but was sick and I brought him to the ER and said I suspected mennegtis, they would NOT do a spinal tap because they would assume it could not possibly be mennengitis because he was vaxed for HIB.

Tests that are run should be done so based on the symptom profile NOT on the child's vax status.

[anewmama]

Originally Posted by mamakay

I really need to find out where the idea comes from that kids under 2 are unable to form immunity against polysaccharides. If they are right about that, then I lean against vaxing. If they are wrong about that, then yeah...we're probably at a point of no return.

I need to follow this in the other thread where this came up. Are you referring to this posted link? http://adc.bmj.com/cgi/content/extract/93/8/646

How are you interpreting this and leaning against vaxing? Since the vaccine use the capsule?


For me, it's not that I think breastmilk has changed, but something made incidences of HIb go up... though I guess you could bring up the lack of surveillance pre-vaccine? So how much has the bacteria been evolving so that BM might not be enough? If there were ongoing studies with Hib and breastfeeding (which I think there should be!) then we'd know more.

[mamakay]

Originally Posted by anewmama

My 4 am thought on this also is this: so there was a drop in meningitis related HiB until other serotypes moved in and the rates of meningitis came back up more or less. So, if breastfeeding protects against serotype B, are there any studies around protection provided from breastfeeding for other serotypes that are now causing some of the meningitis cases?

You have to also think that breastfeeding is protective, but not necessarily for all breastfed babies. A few studies showed the protective qualities but I am not sure there is enough of a sample or sufficient studies done, particularly for Hi disease and how the bacteria has transformed to today.

So there is the risk that even in a breastfed baby, that breastfeeding is not enough. Particularly, if the theory is that HI increased fourfold in incidences after the 1940's due to antibiotic use (and I suspect, due to formula pushing): if the bacteria is evolving this way to survive, then it could be evolving right now to "evade" the protective qualities of breastmilk.



For what it's worth, I elected to give my daughter the vaccine yesterday for many of the reasons posted here (and she has been breastfed). She has so far had no reactions whatsoever. The serotype thing bothered me at 4 am, but my thoughts above are somewhat consoling me even if they might not be accurate.

1)the breastfeeding protection is for all types of H-flu. So replacement doesn't matter there.

2)the breastmilk protection is really quite strong. But no, nothing is 100%.

if the bacteria is evolving this way to survive, then it could be evolving right now to "evade" the protective qualities of breastmilk.

No, because breastmilk doesn't create that kind of selective pressure. It's not in the best interest of a bacteria to cause invasive disease. It's an "accident" when that happens. And breastmilk doesn't prevent colonization, so there's no selective pressure on the bacteria to "evade" it.

[nycmom18]

[For me, it's not that I think breastmilk has changed, but something made incidences of HIb go up... though I guess you could bring up the lack of surveillance pre-vaccine? So how much has the bacteria been evolving so that BM might not be enough? If there were ongoing studies with Hib and breastfeeding (which I think there should be!) then we'd know more.]


hasn't the hib bacteria just gotten more violent since the vaccine has been introduced? isn't that the story with all bacteria? like when we use antibiotics to kill the bacteria? or am i completely wrong?

because it used to live in most of us without any disease prior to the vaccine, and now it is not around as much so we lack the colonization???

[anewmama]

Originally Posted by Marnica

But getting the HIB vax doesn't mean that the risk of everhaving a spinal tap goes down. There are hundreds of other strains of bacteria and viruses that can lead to mennegitis that are not covered by a vaccine. Frankly I find it scary that IF my child was vaxed for HIB but was sick and I brought him to the ER and said I suspected mennegtis, they would NOT do a spinal tap because they would assume it could not possibly be mennengitis because he was vaxed for HIB.

Tests that are run should be done so based on the symptom profile NOT on the child's vax status.

Oh, yeah of course it doesn't mean that... there is no guarantee. So much of vaccination I find is mental security. The what if I had done something differently....

I also don't think that it's a given than an ER would NOT do a spinal tap because the child is vaxed with Hib. I know that gets repeated enough here but I honestly do not think that this is a given. I also wonder how a parent might suspect meningitis when a doctor couldn't when it is something that really isn't confirmable without the tap (as I understand it, could be wrong).

So, yeah... just like with all medical care, if you feel your child has something and you are not getting the response you need, the onus is on the parent to make a stink. A big STINK. I am also not saying it probably has never happened that too much faith has been put in vaccines, either.

And as thought, without centralized medical records, the ER really has no way of knowing what vaccines your child has had unless your regular doctor is called in. If you are at all concerned that a HiB vax status might result in less than care, then lie about having given it. The ER example is not high on my worries for me. But we are all different....

[anewmama]

Originally Posted by nycmom18

[For me, it's not that I think breastmilk has changed, but something made incidences of HIb go up... though I guess you could bring up the lack of surveillance pre-vaccine? So how much has the bacteria been evolving so that BM might not be enough? If there were ongoing studies with Hib and breastfeeding (which I think there should be!) then we'd know more.]


hasn't the hib bacteria just gotten more violent since the vaccine has been introduced? isn't that the story with all bacteria? like when we use antibiotics to kill the bacteria? or am i completely wrong?

because it used to live in most of us without any disease prior to the vaccine, and now it is not around as much so we lack the colonization???

That is sort of what I am leaning towards with my "BM might not be enough anymore" comment. Info I read is that they don't know why HIb increase so much but antibiotics are suspect. Of course, if surveillance really didn't exist, maybe it never increased? Upon what are they basing that?

[mamakay]

It was probably the move to formula that removed breastfeeding immunity and caused the incidence in invasive disease to go up.

hasn't the hib bacteria just gotten more violent since the vaccine has been introduced

No, but the epidemiology has changed, putting different people at risk of invasive disease.

[anewmama]

mamakay, I am pulling this over here if you don't mind...

anewmama Quote:

But do you mean natural/ full Hib or the vaccine? If they are unable to become immune under two to natural Hib, then what makes them capable of mounting an immune response to the vaccine under 2?

mamakay Quote:

They are saying babies can't become immune to the bacteria before age 2 and that's why most cases happened before age 2.

The vax works by stimulating an immune response to the toxin the polysaccharide is conjugated to. I think it's basically that the presense of the toxin more closely mimics an actual infection, and harnesses the power of the infant immune system to go "Woah!" and start producing antibodies.

anewmama Quote:
Doesn't this make more of a case for the vaccine for the under 2 age group?

mamakay Quote:
It could. I'm just thinking that breastmilk appears to work well, too.

anewmama Quote:
If they can't, then wouldn't you want under 2 to get the vaccine (all other issues aside) if they can mount a response to the vaccine instead? This is the piece I am not getting.

And if they can't mount it under 2, what's not to say they can't mount it over 2?

mamakay Quote:
I'm thinking along a different train of thought. I'm thinking maybe they're wrong, and it's not that under 2's are "immunocompromised" in this way..maybe it's just that it takes colonization to build immunity, and all the risk is simply a matter of how many times one has been colonized with Hib before, and the main risk is with the first colonization, and that risk will be the same regardless of age
.
If I'm right, then an unvaxed 6 yo is just as at risk of invasive disease as a a formula fed 6 month old was prevax. If THEY (the scientific concensus) is right...then unvaxed kids probably aren't particularly at risk after age 2.

Make sense?



********************

Ok, I wasn't factoring in the breastmilk aspect. I was thinking beyond mom's who extend breastfeeding to the majority who stop after what 6 weeks to 6 months. So in the broader world, unvaxed formula fed babies are at "extreme" risk.

So for the bolded part above... the key words here/thoughts here, since i haven't yet read the link paigeC posted (for others http://adc.bmj.com/cgi/content/extract/93/8/646 ), are "first colonization" at whatever age versus just a physiological phenomenon that young babies/toddlers under 2 cannot built an immune response. If they can build one after 2 more easily, then a child exposed to HiB after 2 could respond and not necessarily develop invasive HiB. However, if the issue is just the FIRST colonization PERIOD, then any child as you say, is at risk for when they first counter the bacteria if they are not vaccinated even past 2.


This sort of follows what I just posted in that other thread about what happened before they introduced the booster in the UK (and I am guessing here as well). The loss of Hi floating around prevented adults from experiencing reinforced Hi immunity due to exposure from children with Hi. As children's cases went down, and then rose again per evidence, the adult case rate of Hi went up.


http://www.medicalnewstoday.com/articles/13566.php

The apparent fall in the effectiveness of the initial vaccination programme for children may be due to several factors, say the researchers, including issues with the vaccine used, which has now been changed. For adults the situation was more complex. They had initially benefited from 'herd immunity' say the authors, where the drop in infection rates among children resulted in reduced exposure to the disease for adults, and consequently fewer infections. But adults' reduced exposure to the disease also meant their antibody levels-or 'natural' immunity - was no longer being boosted. When the disease began to rise once again amongst children, some adults found themselves less equipped than before to fight the infection.

So any rise in Hi due to shortages of the vaccine or a low uptake in vaccination that increases cases is now putting BOTH adults and children without immunity or vaccination at risk.


So if an unvaccinated child of any age does encounter a "rogue" Hi disease, the child could be quite susceptible if this is all combined with the risks of FIRST colonization if they missed being exposed due to low incidences of the disease floating around and/or not being vaccinated to help them respond to the bacteria/disease despite their age.

[Spectrolite]

So mamakay and anewmama, just out of curiosity, if you were to vax your previously unvaxed older kids against Hib, that would possibly open a niche for something like pnemococco (sp?). Would that mean you would start vaxing against that? And surely, in the future, there will be other invasive bacteria causing chaos in the modern world, for which there will surely be vaxes. Would you then start vaxing against that?

Right now what I'm getting is that once you start vaxing against bacteria, you can't really stop.

?

[mamakay]

Originally Posted by anewmama

mamakay, I am pulling this over here if you don't mind...




mamakay Quote:

They are saying babies can't become immune to the bacteria before age 2 and that's why most cases happened before age 2.

The vax works by stimulating an immune response to the toxin the polysaccharide is conjugated to. I think it's basically that the presense of the toxin more closely mimics an actual infection, and harnesses the power of the infant immune system to go "Woah!" and start producing antibodies.



mamakay Quote:
It could. I'm just thinking that breastmilk appears to work well, too.





mamakay Quote:
I'm thinking along a different train of thought. I'm thinking maybe they're wrong, and it's not that under 2's are "immunocompromised" in this way..maybe it's just that it takes colonization to build immunity, and all the risk is simply a matter of how many times one has been colonized with Hib before, and the main risk is with the first colonization, and that risk will be the same regardless of age
.
If I'm right, then an unvaxed 6 yo is just as at risk of invasive disease as a a formula fed 6 month old was prevax. If THEY (the scientific concensus) is right...then unvaxed kids probably aren't particularly at risk after age 2.

Make sense?



********************

Ok, I wasn't factoring in the breastmilk aspect. I was thinking beyond mom's who extend breastfeeding to the majority who stop after what 6 weeks to 6 months. So in the broader world, unvaxed formula fed babies are at "extreme" risk.

So for the bolded part above... the key words here/thoughts here, since i haven't yet read the link paigeC posted (for others http://adc.bmj.com/cgi/content/extract/93/8/646 ), are "first colonization" at whatever age versus just a physiological phenomenon that young babies/toddlers under 2 cannot built an immune response. If they can build one after 2 more easily, then a child exposed to HiB after 2 could respond and not necessarily develop invasive HiB. However, if the issue is just the FIRST colonization PERIOD, then any child as you say, is at risk for when they first counter the bacteria if they are not vaccinated even past 2.


This sort of follows what I just posted in that other thread about what happened before they introduced the booster in the UK (and I am guessing here as well). The loss of Hi floating around prevented adults from experiencing reinforced Hi immunity due to exposure from children with Hi. As children's cases went down, their case rate of Hi went up.


http://www.medicalnewstoday.com/articles/13566.php





So any rise in Hi due to shortages of the vaccine or a low uptake in vaccination that increases cases is now putting BOTH adults and children without immunity or vaccination at risk.


So if an unvaccinated child of any age does encounter a "rogue" Hi disease, the child could be quite susceptible if this is all combined with the risks of FIRST colonization if they missed being exposed due to low incidences of the disease floating around and/or not being vaccinated to help them respond to the bacteria/disease despite their age.

Right. You're understanding me now.
And I've been thinking for a while that it might just be a matter of time before Hib is thrown into the tdap for adults to get every 5 or 10 years.

[mamakay]

Originally Posted by Spectrolite

So mamakay and anewmama, just out of curiosity, if you were to vax your previously unvaxed older kids against Hib, that would possibly open a niche for something like pnemococco (sp?). Would that mean you would start vaxing against that? And surely, in the future, there will be other invasive bacteria causing chaos in the modern world, for which there will surely be vaxes. Would you then start vaxing against that?

Right now what I'm getting is that once you start vaxing against bacteria, you can't really stop.

?

Yeah, I think once you start, you can't really stop. Well, I mean you can stop, but you're just not going to get a lot of net benefit overall for all your efforts.

On an individual level for an individual child in the postvaccine era, vaxing against hib probably won't have any significant effect on opening up a niche for another organism, because there's so little hib out there now. I think.

[anewmama]

mamakay, I could look but maybe you know it off the top of your head... but what is the suspected duration of immunity from the Hi vax? I was thinking that if it's only like 10 years or so, then both vaxed and unvaxed will all be in the same boat as adults are looking to be in as the childhood HiB vax population continues to age.





As for opening niches... here is sort of how I think of it but need to put more effort into it. But just like no one individual is at risk of all the diseases for which they vaccinate for AT ONE TIME, so too an individual who might be vaxed for Hi might not be vulnerable to other bacteria AT THE SAME TIME or even at all. It's very individualized and probably only some controllable factors playing into how well a person does if they do get infected or puts then in the risk of getting inected... ie, good nutrition, overall health, socio economic, living standard, etc.

So maybe theoretically, it opens the way for all sort of stuff, the odds of one individual getting all of the theoretically possible diseases that might move in could be low.

[mamakay]

mamakay, I could look but maybe you know it off the top of your head... but what is the suspected duration of immunity from the Hi vax?

There's no way they can know yet.

So maybe theoretically, it opens the way for all sort of stuff, the odds of one individual getting all of the theoretically possible diseases that might move in could be low.

well, you'll probably be colonized with all of them several times. It's just unlikely for any of them to ever become invasive.

[anewmama]

Thought this was an interesting, Hib among Indigenous people.

http://www.healthinfonet.ecu.edu.au/...our_review.htm

Of added concern is the nasopharyngeal carriage of non-encapsulated H. influenzae isolates which are genetically similar to Hib, and the theoretical possibility of genetic exchange between Hib and non-encapsulated H. influenzae strains in Indigenous populations where the organism is highly endemic [23]. Such concerns demonstrate the relationship between Hib and other H. influenzae organisms and highlight the need for continued surveillance of Hib immunisation and H. influenzae carriage.

I am not sure of the biology behind this.... ? anyone?

[Spectrolite]

Originally Posted by mamakay

well, you'll probably be colonized with all of them several times. It's just unlikely for any of them to ever become invasive.

NAK

Help... I'm still not getting this. I'm sure it's simple. but i dont understand.
Why is this? Is it because Hib was the most invasive type of bacteria back then, and right now there isn't anything as fast-moving as Hib?