Deciding about HIB vaccine - have I missed anything?

[Mama Metis]

Background: I'm researching each disease/vax one by one in the order they appear on the CDC schedule. I'm on HIB, so obviously its slow going,  but LO won't be here until summer, so we have some time. I'd like to bounce my research/ideas off of the awesome inquiring minds on this board, both non-vaxers and delayed/selective vaxers. Okay, so here goes...

In addition to the basics of the disease and the contents of the vaxes, I looked at three issues particular to HIB: 1) Effectiveness: evidence points to a high degree of effectiveness against the type B strand 2) A possible link to type I diabetes: the literature definitely does NOT support any link between the vax and diabetes as was once feared; and 3) Serotype replacement: The literature  confirms this is a serious issue on the population level. However, serotype replacement effects all children, not just vaxed ones. And there still is a very small risk of HIB, even though it has been significantly reduced since the 80s. 

Those are my basic findings... now here are my questions:

1. Have I missed anything major?

2. The vaccine has made HIB quite rare. Do you consider this a reason to not get this vax? In other words, would you knowingly rely on herd immunity? Does this feel wrong to anyone (i.e. allowing other children to take on risk so that yours can reap the benefit of less risk of disease? no judgement, just trying to think this one out)

3. If we do ultimately decide to get this vax, I would want ActHIB reactivated with saline. Does anyone disagree with this choice? How has your experience been with requesting this (or any) particular brand from your Ped?

Thanks so much for any help you can provide! This board has already been an incredibly helpful source for me. I am indebted to many of you!

[mamakay]

2. The vaccine has made HIB quite rare. Do you consider this a reason to not get this vax? In other words, would you knowingly rely on herd immunity? Does this feel wrong to anyone (i.e. allowing other children to take on risk so that yours can reap the benefit of less risk of disease? no judgement, just trying to think this one out)

Yes, I consider the rareness of Hib a good reason not to vax against it in this one case. It's almost eradicated in the US, and even when it was endemic, it was rare that colonization led to invasive disease.I don't really think of this as mooching off of herd immunity. Even if Hib was still endemic, I'd only get the vax if my baby was at special risk. I think vaxes that come with "serotype replacement" and similar problems should only be used selectively.

I *do* vax against measles because of herd immunity, but measles doesn't have serotype replacement issues like Hib, so the morality is different there.

And no, I don't think you've missed anything. The entire (valid) argument against the Hib vax is about replacement and herd immunity.If you're breastfeeding, read up on breastfeeding and Hib, too.

http://insidevaccines.com/wordpress/invasive-bacterial-infections-and-breastfeeding/

[Otto]

Originally Posted by mamakay 

I *do* vax against measles because of herd immunity, but measles doesn't have serotype replacement issues like Hib, so the morality is different there.

I think I've seen one South American report of Hia moving in on Hib's territory, but that's it. Has it really been doing a pneumococcal routine?

[Mama Metis]

Mama Kay, thanks for your thoughts and the link on breastfeeding and HIB. 

Quote:

Originally Posted by Otto 

 think I've seen one South American report of Hia moving in on Hib's territory, but that's it. Has it really been doing a pneumococcal routine?

Great question. I'd love to have the serotype replacement issue better "quantified" for me. 

[mamakay]

Originally Posted by Otto 

Originally Posted by mamakay 

I *do* vax against measles because of herd immunity, but measles doesn't have serotype replacement issues like Hib, so the morality is different there.

I think I've seen one South American report of Hia moving in on Hib's territory, but that's it. Has it really been doing a pneumococcal routine?

The type that primarily replaces Hib is NTHi (aka, non-typeable h influenzae). NTHI isn't an actual serotype, so it's not technically "serotype replacement", but it's essentially the same thing.

ETA:

http://insidevaccines.com/wordpress/2008/02/11/sisyphus-and-the-conjugate-vaccines-ii/

[Mama Metis]

Ah, interesting. So yes it looks like Haemophilus cases are back up, maybe not quite to pre-vaccine levels (hard to say since the data doesn't go back that far) but there is definitely a significant replacement effect: http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/G/cases&deaths.PDF

I really thought I'd want to get the HIB vaccine, but I'm just not seeing a reason to. Anybody want to talk me into it???