Hib and "strain replacement"

[mamakay]

In a different thread, you mentioned that you don't think replacement is a problem with the Hib vax. Have you looked over the evidence indicating that replacement with Hib might really be happening?

Like:

http://www.sciencedirect.com/science/article/pii/S0264410X10004755

Changing epidemiology of invasive Haemophilus influenzae in Ontario, Canada: Evidence for herd effects and strain replacement due to Hib vaccination

However, strain replacement of Hib with serotype f and non-typeable strains in children under 5 years was documented.

And...

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

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.

There's a lot more evidence, too. I'm just trying to keep it shortish here.

The idea that replacement with h-flu is a real phenomenon seems to be an emerging scientific consensus. For several years, I've been regularly checking into google scholar to get updates on this and a few other issues.

Do you do anything similar?

Why do you think strain replacement with h-flu isn't real?

[DrBobSears]

HIB strain replacement is a little different than most other types (like the flu or Pneumococcal disease). HIB stands for Hemophilus Influenza type B.  There is also a type A and a non-typable (neither A nor B). BUT these aren't really different strains of the same germ (like there can be with flu or Pneumococcus). They are basically different germs. HIB is a much more dangerous bacterium than HIA (hemophilus influenza type A). And HIB is much more dangerous than non-typable. So, as we've gotten rid of HIB (type B), the type A and non-typable may have increased, but not really as a replacement for type B.  OR, they may be more common now that HIB isn't around.  But the bottom line is that we can really look at HIB and HIA and non-type as 3 different germs, NOT as different strains of the same germ.

That's my understanding of this particular germ.  So that's why I say strain replacement hasn't occured (if you are looking at strain replacement in the same way as you would with Pneumococcus). BUT, you are also correct. Getting rid of HIB may have contributed to an increase in HIA and non-typable.  But those germs aren't nearly as dangerous, so overall that's a fine replacement as far as I'm concerned.  I haven't had time to read the links you put here, but hope to soon.

[mamakay]

Please stop talking down to me. I apparently know a lot more about this one particular subject than you do. I'm not meaning to come across as arrogant, and I know PCPs know a lot more about other health issues than I do. But at least pretend for a moment that I didn't post this without knowing what h influenzae type b is. (Also Hif, Hie, etc.)

I know where on earth all the potential replacement serotypes have popped up threatening to "replace" Hib, Prevnar 19A-style, and also, I know how the old models completely failed to consider or detect for NTHi, and why.

NTHi appears to be the biggest replacer of Hib, and consider this, too:

http://www.cdc.gov/eid/content/16/3/455.htm

In most age groups, CFRs were higher for ncHi than for Hib;

How does that mesh with:

And HIB is much more dangerous than non-typable.

Invasive NTHi is now about as common as invasive Hib was before the conjugate vaccine (and before any vaccine for Hib in canada.) The CFR is actually HIGHER for NTHi that it is for Hib. How is this much milder?

ETA: I'm a selective vaxer, by the way. I just want accurate info out there.

Also, please read my links. I'm intentionally keeping them sparse as to not overwhelm you or take up too much of your time. I just want you to learn something new.

Edited by mamakay - 6/2/11 at 2:07am

[mamakay]

Dude. Please read the studies.

It's a whopping 2 articles I'm asking you to read and consider.

Please?

[DrBobSears]

Sorry you felt "talked down too." I think that you know very little about me and have greatly misjudged me if you think that I was trying to belittle you in any way.

[mamakay]

I don't think you were trying to be malicious, but your response to my OP was wildly inappropriate considering 1) the evidence I linked to, and 2) the words I typed. Maybe you can look back and admit to that and maybe you can't, but whatever.

Will you please just read the links and consider the evidence?

[fitmommy]

Wow we got some harsh moms on here!! Whats with the hostility?? I think your being inappropriate. You can display your info in a better manner,maybe than he would be more opt to read your research.Ive seen the research & i find it very interesting! But dont like the attitude.I do not vax but this info is new to me, so thanks for posting it.

[mamakay]

Originally Posted by fitmommy 

Wow we got some harsh moms on here!! Whats with the hostility?? I think your being inappropriate. You can display your info in a better manner,maybe than he would be more opt to read your research.Ive seen the research & i find it very interesting! But dont like the attitude.I do not vax but this info is new to me, so thanks for posting it.

What was actually wrong with my first post in this thread?

His response to my OP was essentially him saying "Pshaw." based on an apparently n00b/ignorant view of the issue at hand.

So, whatever.

I only became quasi-hostile after I was blown off.

If Dr Sears wants to parade his ignorance for all of the selective vax world to see, that's his choice.

I really wish he would just look at evidence, tho.

[fitmommy]

Nothing was wrong in your first post.Than i read his response, didnt find any thing inappropriate AT ALL. so when i read your reply i was shocked cuz i dint think he was being inappropriate & u seemed to have thought he blew you off which im not seeing.He gave u his answer without reading your evidence so maybe thats why u think he blew you off?? Idk... But any way i hope he does look over the evidence as well:)

Ive seen many of your posts & very much enjoy them, u put out some great info! May i ask what vaxes do u give? Im curious cuz you seem to be very much against them, so im quit interested...U dont half to tell me its all good if u dont.

[mamakay]

Originally Posted by fitmommy 

Nothing was wrong in your first post.Than i read his response, didnt find any thing inappropriate AT ALL. so when i read your reply i was shocked cuz i dint think he was being inappropriate & u seemed to have thought he blew you off which im not seeing.He gave u his answer without reading your evidence so maybe thats why u think he blew you off?? Idk... But any way i hope he does look over the evidence as well:)

Ive seen many of your posts & very much enjoy them, u put out some great info! May i ask what vaxes do u give? Im curious cuz you seem to be very much against them, so im quit interested...U dont half to tell me its all good if u dont.

Yes, replying without even looking at the evidence is "blowing me off" IMO. Especially combined with the fact that I mentioned that I check google scholar regularly to see what totally new evidence is coming in.  How can he think someone who regularly checks google scholar for the most up to date research needs to be told what h flu is?

I do MMR (mostly for the measles part) and DTaP (mostly for the tetanus part, because of potential injury ER/TIG concerns) somewhat delayed.

Chickenpox before puberty if not caught naturally.

Delaying HepB, HepA, and HIB, and might eventually give depending on future disease epidemiology.

Really not a fan of flu-shots and prevnar at all.

[fitmommy]

Ok gotcha:)

Thanks for answering my question.I did some shots for my now 5 year old when she was an infant. I did it when i wasnt educated on vaxes... My son is currently not vaxed.The only one i have considered for him is the dtap only for the p part. Also chickenpox if she doesnt get them by age 12.

[mamakay]

I would really like Dr Sears to at least look at the evidence concerning Hib and NTHi replacement.

Why do you not want to do that, Dr. Sears?

[DrBobSears]

I plan to.  I just don't have time right now. But I do spend an ungodly number of hours studying every aspect of vaccination that I can when I have time that I set aside for this.  It's definately on my list.

[mamakay]

Originally Posted by DrBobSears 

I plan to.  I just don't have time right now. But I do spend an ungodly number of hours studying every aspect of vaccination that I can when I have time that I set aside for this.  It's definately on my list.

Thank you, Dr Sears. And I'm genuinely sorry for being hostile in response to your response. I hope you can understand why I was upset, but I also know I was pretty rude. And I'm sorry for that.

H-flu replacement really is one of the biggest valid vax debates happening in the scientific community right now. I personally think the phenomenon is real and deserves more attention, too.

[DrBobSears]

Thanks.  This reminds me of how I used to talk about aluminum in vaccines.  I used to say, "Don't worry about it - it's harmless. We swallow aluminum all the time - it's everywhere, so the amount in vaccines MUST be harmless."  Yes, I actually uttered those words in several early vaccine talks.  Then I decided to actually see if there was any research to back up my statements, and there was none. And there was a lot of research to show how dangerous aluminum can be.  So, I learned my lesson there.  I'll take a look at this issue this year and include it in my future writings.  Thanks for sharing this research - I look forward to reading it in more detail. Thanks for your apology, and I also apologize for coming across as if I was dismissing your research. It was unintended.