Lots of questions regarding Hib

[MommatoGray]

Hi,

This is my third post, each of my posts are about vaccines and all three have a component pertaining to Hib. I hope that this will be my last post regarding Hib, I have tried to think of every question I have and get them all out there. I thank all of you so much, I don’t really have anyone to talk to about this. I have a wonderful DH, but he doesn’t weigh in on the issue of vaccinations. He just tells me that he trusts me and knows I will make the best decision. He is fully supportive of whatever I choose, but sometimes I wish he had an opinion. Anyways that is a bit of my background and now to the place I am now. I have a DS, he my first child. He is almost five months old, I am EBF, we stay at home, and I have him on probiotics, vitamin D, and rosa canina (immune booster). At this point I have just been delaying vaccination until I reached a well thought out decision. I am leaning towards continuing to wait, I am comfortable waiting on Dtap, Pneumococcal, and Meningococcal. I am in Canada, so we don’t get rotavirus vaccine here.

I am still hung up on Hib, I cannot stop thinking about it and for some reason cannot move past the idea of him getting deathly ill because I skipped this. For those people who want to tell me to just get it if I am going to worry so much, please don’t, I will not give a vaccine to only calm my fears. And please don’t tell me that there are other diseases that we don’t have vaccines for. I know these things and neither comment helps make my decision. Thank you.

And yes, I have searched the forums. I have probably read a 100+ posts on Hib, but I cannot get these things straight, so please have patience with me. I will be referring to Aviva Romm’s book “Vaccinations: A Thoughtful Parents Guide” and to Stephanie Cave’s book “What Your Doctor May Not Tell You About Children’s Vaccinations.”

1. I am not quite sure if I quite understand how Hib works. I understand that 85% of healthy individuals carry it around with no problems. What I am not quite sure about is if there are a bunch of healthy people carrying it around when and how does it turn invasive? Could my DS be exposed to it and he just can’t handle it yet? Is that how it works, and do only sick people transfer it around? Because most people that have it are children under 5, does that mean a child who can give it to my DS would be sick. Or can they be asymptomatic and just be carriers?
2. These are the list of risk factors I found in Aviva’s book:

• “Attending a daycare center
• Crowded households
• Large households
• Low socioeconomic status
• Young age
• Ethnicity, with Native Americans, Inuits, blacks, and Hispanics being at greatest risk
• Lack of breast-feeding
• Household, hospital, or institutional exposure
• Immunocompromise, sickle-cell anemia, cancer”

The only risk factor we have is young age. And in Stephanie Cave’s book she also lists being male as a risk factor, so I guess we have that one as well. Do you know any other risks that are not listed?

1. In Aviva’s book she talks about antibiotic resistant organisms. Is Hib antibiotic resistant? So If DS did contract Hib would antibiotics do anything to fight it? Also I have read on this forum that some of you decide against Hib because you are worried that another Influenzae will come in and take B’s place. And that strain has a good chance of being antibiotic resistant. Is that right?
2. Hib does seem to have one of the more safer profiles as far as vaccines go. Some of what I read says that the increased rate of contraction up to a week after being vaccinated is no longer a worry?
3. In Stephanie Cave’s book she states “the disease is most commonly seen in children between the ages of two months and three years, with the peak time being at six to seven months of age.” Does anyone know why this peak happens? Is it because people stop breastfeeding?
4. She goes on to say that, “since introduction of the Hib conjugate vaccine, incidence of the disease among children aged four years and younger has declined 98 percent. About three hundred cases of the disease occur each year in the United States, most of them in unimmunized children and most caused by non-type-B H. Influenza.” What is non-type-B influenza?
5. I was thinking about waiting until he was 15 months, cause then he just needs one shot instead of four, or not giving it at all. The other side of me panics and thinks I need to go and get it right away, because he will be six months soon. But then I think I don’t want to give it to him at the peak times, because if the risk of contracting it goes up after vaccination and we are in the peak months then it seems like a really bad idea.
6. I have also read that if you are going to give Hib you should also do Pneumococcal, that giving one without the other is useless. Is this true?

Please any advice and help would be great, I hope I remembered all of the things I needed sorted out. I am tired of worrying, and just want to choose and move past this. I have been seeing a wonderful pediatric naturopath, but she doesn’t talk specifically about vaccinations. Basically all she said was that she doesn’t vaccinate her kids and she gave me the name of a naturopath in Toronto that specializes in vaccinations. Thank you again. 

Wife to my highschool sweetheart. Mommy to one DS and one fur baby. We , , have a  and I am currently taking a journey down the road of non-vaxing.

Edited by MommatoGray - 5/28/11 at 10:06pm

[mamakay]

- we're all regularly colonized with stuff that could turn invasive under the right conditions. With Hib and pneumococcus, a big factor is being newly colonized and then catching something like RSV, a cold virus, flu or flu-like virus, etc. There are also host factors like immunodeficiencies that are genetic, and some viruses cause a transient "mini-AIDS" condition for a little while after you recover. Why colonizing bacteria turn invasive is one of those topics where there are still more questions than answers for, tho, really.

- hib is somewhat antibiotic resistant. Probably not so much any more.

- the risk factors have totally changed since Romm's book was written. Look at this:

http://www.cdc.gov/abcs/reports-findings/survreports/hib09.html

You can see the changes over time, here:

http://www.cdc.gov/abcs/reports-findings/surv-reports.html

- the whole "increased risk of invasive hib disease" for a week or so post vaccination (aka: vaccine mediated disease enhancement) is NOT a threat with the current vaccine and hasn't been for a long time. That was a totally different type of vaccine technology that had that issue. Yes, it's a really safe vaccine now. I'm personally just not a big fan of universal use because of the replacement issues with NTHi.

-the whole "peak cases at 6 months" isn't true any more in the US. A reason it USED to be true was that that was the age where people first encountered the bacteria for the first time. We were all colonized with hib over and over again, gaining more immunity each time. (universal hib vaccination has changed that scenario.) Also, there's something really technical about infant immune systems that make them unusually unable to clear Hib when it starts becoming a pathogen (as opposed to a colonizer.) I'll give you more info if you want (or point you in the right direction) but it's super-technical stuff.

- non type b h influenzae is all the other species of Haemophilus influenzae besides hib. There's an hia, hib, hic, etc. The type called "non-typeable h influenzae" aka "NTHi" is the one that's really exploded since universal Hib vaccination almost eradicated Hib in N America. It looks like "replacement" to me, but others disagree.

-on the "give it now?" question, see the new risk factors.

- the whole "have to give it with pneumococcal vax" idea is totally incorrect. There's nothing like that going on between the two vaccines.

Here's some stuff that might be useful to you, too:

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

-

[MommatoGray]

Thank you so much mamakay for responding. I do have some questions regarding your reply. I am not sure if I can not understand those studies, but I can not quite figure out what you would like me to see from them. I do see that race is a factor that differs from romms book. The "whites" seem to be at an increased number of cases. I don't really see any other risk factors listed in those studies. I do see age there, but every year seem to be just a bit different. Could you help me understand them?

As for the NTHi , could you point me in the direction to find more information on this?

Also, for the give it now question, it seems (if I am reading the studies properly) that it just varies a little each year. The number of cases <1 were 1 or 2 or sometimes 0. Same with the cases at 1. So when do I give it or do I give it at all? I don't know if this is too personal, but what did you do? Is this one that you would consider important to give? I read the ActHib insert yesterday, I think it was the correct one. And it said that if it is given between 7-11 months that they only need two shots, and if given later then they need only one. I feel like that is where I was trying to get to, so that there would not be so many shots. But essentially you are saying it is quite safe as far as vaccines go and there is no aluminum in it. But it is conjugated with tetnus toxoid, so the risks of the tetnus shot are also valid for the Hib shot then?

And thank you for clearing up the pneumococcal vax idea, because I may be able to give him Hib, but I am not ready to give him a lineup of vaccinations. And I know that they are not linked but I think the idea that I have heard is that they both can lead to meningitis so why would you give one if you are not going to give the other?

Back to the risk factors, then are the ones I listed still valid, according to your link BF should help minimize risk. Also not being in daycare has to help as well, right?

I was also reading about Hib in the pink book and it stated this:

``In 1998–2000, approximately 44% of children younger than 5 years of age with confirmed invasive Hib disease were younger than 6 months of age and too young to have completed a three-dose primary vaccination series. Fifty-six percent were age 6 months or older and were eligible to have completed the primary vaccination series. Of these age-eligible children, 68% were either incompletely vaccinated (fewer than 3 doses) or their vaccination status was unknown. Thirty-two percent of children aged 6–59 months with confirmed type b disease had received three or more doses of Hib vaccine, including 22 who had received a booster dose 14 or more days before onset of their illness. The cause of Hib vaccine failure in these children is not known.``

Could this be  `the old vaccine that caused this.

Thanks again!

Edited by MommatoGray - 5/29/11 at 1:10pm

[witchygrrl]

Take a look at this link:

http://www.thetruthergirls.com/Natural_Protection.html

Basically, they found studies that said that if you breastfeed, babies are protected from HiB, and that even if you partially breastfeed/partially give babies formula, that was enough to prevent the illness.

I don't vax at all, but this was one of the easiest for me to give up because we breastfed exclusively for 7 months, and still nurse a little even now (she's 34 months), and DD didn't go into daycare until she was 18 months old. I feel very confident on my decision. But definitely keep doing your homework.

[mamakay]

The old vaccine with major issues was called the "hib polysaccaride vaccine", and it very quickly quit being used after the new vaccine (the "hib conjugate vaccine") was approved, around 1991, so I don't think those cases of vaccine failure could be because of that. It's more likely that in 1998-2000, there was just still a lot of Hib floating around out there and no vaccine is 100% effective.

Regarding risk factors, I was mostly noticing that young age is no longer the biggest risk factor. Now you're more likely to catch it after age one.

Regarding NTHi:

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

Especially this study/finding:

http://cid.oxfordjournals.org/content/44/12/1611.full

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.

Almost all of that increase comes from NTHi.

Regarding what I think about the Hib vaccine...I think those conjugate vaccines that cause replacement should be used selectively and not universally. JMO.