CDC link on rationale for Hep B vax for infants - Page 2

[Bokonon]

Originally Posted by Adaline'sMama 

Are babies really vaxed in the nicu? My doc wont even vax with a cold, it seems silly to vax with a child who is in the nicu.

I completely agree, but it happens.  It wasn't an issue in my NICU, but I've known moms with NICU babies who were given Hep B in the NICU, and were bullied about DTaP if they were already 2 months before discharge (even if they weren't even at term yet!!).

[Rrrrrachel]

Current recommendations, I believe, say to vaccinate premies on schedule without adjusting for prematurity. That doesn't mean parents have to do that, though. They can always decline.

[Mirzam]

Originally Posted by Rrrrrachel 

Current recommendations, I believe, say to vaccinate premies on schedule without adjusting for prematurity. That doesn't mean parents have to do that, though. They can always decline.

So you do you think the CDC is correct that it is safe to vaccinate premies on schedule without adjusting? Has the current vaccine schedule been studied in premature infants, so that they can be sure it is safe? Do the majority of parents of premies know they can decline, when many are told they cannot take their baby home from the NICU unless they are vaccinated for HepB?

[Rrrrrachel]

I have never seen any indication parents are told they cant take their babies home without hep b.

[Rrrrrachel]

And the recommendation I'm referring to comes from the aap not the CDC.

http://pediatrics.aappublications.org/content/112/1/193.full

[Mirzam]

Originally Posted by Rrrrrachel 

I have never seen any indication parents are told they cant take their babies home without hep b.

Just because you haven't seen any indication of this, it doesn't meant it doesn't happen.

Originally Posted by Rrrrrachel 

And the recommendation I'm referring to comes from the aap not the CDC.

http://pediatrics.aappublications.org/content/112/1/193.full

Okay, then substitute the AAP for CDC in my questions.

[Rrrrrachel]

Right, but just because you say so doesn't mean it does, either. I don't believe that parents are told that. When I see something that indicates to the contrary ill reassess that position.

If you follow the link I gave you you will see some of your questions answered there.

[amnesiac]

I think part of the problem some nonvaxing parents face is that great effort has been made (and successfully implemented widespread) to create systems that standardize the hep b processes in l&d units and in newborn nurseries so that at-risk babies dont miss postexposure prophylaxis. Reason being, the consequences of infection are so detrimental for those infants.

The standard encouraged (and implemented in all major facilities in my metroplex) involves a set of standardized admission orders for mothers & babies that are implemented in an almost automated way by staff. So it may not be that there is necessarily ill intent on the part of hospital staff, it may just be that they are sort of "on auto-pilot" due to the systems in place coupled with a relative rarity of experience working with nonvaxing parents.

I can also see how encounters with protective services might arise on occasion. Because policies regarding postexposure prophylaxis are time sensitive, if you have a situation for some reason where a mom cannot be tested within 12-24 hours of delivery & she refuses prophylaxis or if she's known positive & refuses then the concern again becomes the severity of consequences of potential infection in a newborn. I think some states may even have laws requiring cps to be notified in those cases. But I think it may be a bit of a scare tactic for anyone to imply that moms tested negative prenatally or at delivery will routinely be reported for deferring hep b vaccine.

[Bokonon]

Originally Posted by Rrrrrachel 

Current recommendations, I believe, say to vaccinate premies on schedule without adjusting for prematurity. That doesn't mean parents have to do that, though. They can always decline.

Have you ever had a child in the NICU?  I have.  Someone tells you that you have to do something so that your baby can be healthy?  Most new parents don't question that. 

I was so blindsided when my first was born and was in the NICU that there isn't much I wouldn't have believed.  I was prepared for a full-term, healthy child and didn't have the wherewithal to research anything while on mag. sulfate and critically ill.

Please don't assert that a new parent with a sick child can "just decline!" whatever a health care provider says is important.  It's not that black and white and I'm pretty sure you know that.

[prosciencemum]

Originally Posted by Taximom5 

And these parents had their newborn taken from them because they refused the hep B shot, even though there was no medical indication for the shot: http://www.thehealthyhomeeconomist.com/mother-who-questions-vax-at-hospital-has-newborn-taken-away/

I thought that was a case where the mother had been shown to be HepB positive, so the hospital had reasonable concern that the child would get the disease if not vaccinated? Sorry I don't have time right now to read your link and chase it up on other sites, but there was one recently like that. I bet there were other flags too. My friend who is a social worker says these scare stories in the press are never as clear cut as they are presented. 

[Rrrrrachel]

Originally Posted by Bokonon 

Have you ever had a child in the NICU?  I have.  Someone tells you that you have to do something so that your baby can be healthy?  Most new parents don't question that. 

I was so blindsided when my first was born and was in the NICU that there isn't much I wouldn't have believed.  I was prepared for a full-term, healthy child and didn't have the wherewithal to research anything while on mag. sulfate and critically ill.

Please don't assert that a new parent with a sick child can "just decline!" whatever a health care provider says is important.  It's not that black and white and I'm pretty sure you know that.

Parents can decline vaccination.  It is that black and white.  Premies with underlying health issues are NOT recommended to get the hep b vaccine at birth, anyway, so I think this is sort of a moot point and kind of a straw man.

A few extreme examples that tug on the heart strings are not what we should shape public health policy around.

[lilbsmama]

Originally Posted by Adaline'sMama 

*also, having your baby taken into state custody for less than 24 hours is hardly "any parents worst nightmare".

I completely, whole-heartedly, disagree. 

[nia82]

It depends on the state and hospital where you give birth at. Some places will tell the parents all sorts of lies. The hospital I had DS in didn't do shots, it was up to the peds, and the old guy we saw first was totally cool about everything, the young lady the next day tried to pressure us and we basically had to kick her out. Nobody could have played a CPS card on us as we are well educated about our rights. Most parents however don't know this. They really don't, and they are vulnerable, just having gone through a birth, having a new baby, they can be scared into many things. 

As for targeting risk groups - like I said, instead of turning over to infants, they should have worked harder on the risk groups, and not just give up on them. By the time those kids are old enough to engage in risky behavior, HepB has long worn off. It wears off rather quickly. My sister, a MD who takes the shot because she works with patients that have it and in the lab a lot with blood products, has to repeat this thing every 4 years because titers fall off that quickly for her. It is said 10 years is enough, but not for her and coworkers of her. She knows many people who have to repeat it frequently. Of course I don't do it because I don't work with blood, patients, trash or anything else. 

So another question: is the risk of getting HepB that much higher in the US than Europe? Because it never was on the radar when I grew up. Only ever for druggies and prositutes or if you wanted to spend time in Asia as it's pretty endemic there... 

[Rrrrrachel]

Again, it's not just risky behavior that results in Hep B infection.  

[Super~Single~Mama]

nm

[amnesiac]

Originally Posted by Rrrrrachel 

Again, it's not just risky behavior that results in Hep B infection.  

Originally Posted by nia82 

As for targeting risk groups - like I said, instead of turning over to infants, they should have worked harder on the risk groups, and not just give up on them. By the time those kids are old enough to engage in risky behavior, HepB has long worn off. It wears off rather quickly. My sister, a MD who takes the shot because she works with patients that have it and in the lab a lot with blood products, has to repeat this thing every 4 years because titers fall off that quickly for her. It is said 10 years is enough, but not for her and coworkers of her. She knows many people who have to repeat it frequently. Of course I don't do it because I don't work with blood, patients, trash or anything else. 

So another question: is the risk of getting HepB that much higher in the US than Europe? Because it never was on the radar when I grew up. Only ever for druggies and prositutes or if you wanted to spend time in Asia as it's pretty endemic there... 

Most infections acquired in adulthood are acute in nature and they resolve while infection in infancy or early childhood commonly results in a lifelong chronic infection. So if your aim is to eliminate chronic infections & carriers, infants would be your target population. How to go about that of course is debatable.

I don't know if there's a more current graphic out there somewhere, but this will give you an idea of global distribution: http://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/viral-hepatitis-figure3.html

I'm also not sure why a healthcare worker would be getting multiple booster doses frequently. According to the CDC, booster doses are not needed and neither is routine serology for healthcare workers who have documentation of response to the initial series since they are still protected due to anamnestic immune responseeven if antibody levels decline.

[nia82]

Odd, her hospital requires a certain level of titers. As do all the places there... As with other diseases a low titer is regarded as no protection. 

http://www.rki.de/SharedDocs/FAQ/Impfen/HepatitisB/FAQ05.html;jsessionid=AFB0C60DB59B87C0D7CBE4D5EA451EF0.2_cid290?nn=2375548

Hm the RKI does not agree with the CDC and in fact states that there is no data to prove such long immunity as claimed by that other link (CDC source). In fact, they recommend re-vaccination every 10 years if risk of exposure is there (e.g. being a health care professional, living in Asia). 

Edited by nia82 - 6/6/12 at 11:16am

[amnesiac]

My apologies - my assumption was that we were talking about a USA facility. I suppose it's just like anything else - recommendations vary from one part of the world to another. In a highly endemic area I can see how they'd be much more conservative in their protocols.

[nia82]

It's actually a very low-endemic area - Germany. It's the recommendation. When I got my 3 hepB shots in 1998 I was advised to get one every 10 years for the rest of my life to maintain immunity and to have titer checks every 5 years as it wanes so quickly in many people... This is a common recommendation by doctors there. So I'm a tad baffled by the CDC recommendations. I don't get any more hepB shots but it's interesting to read up on it (I would consider hepB titer tests if I was going to live in Asia, which I won't).

[katelove]

Originally Posted by nia82 

It's actually a very low-endemic area - Germany. It's the recommendation. When I got my 3 hepB shots in 1998 I was advised to get one every 10 years for the rest of my life to maintain immunity and to have titer checks every 5 years as it wanes so quickly in many people... This is a common recommendation by doctors there. So I'm a tad baffled by the CDC recommendations. I don't get any more hepB shots but it's interesting to read up on it (I would consider hepB titer tests if I was going to live in Asia, which I won't).

In Australia Hep B boosters used to be recommended as well. That recommendation changed a number of years ago (can't remember exactly when) after it was found that low titres didn't mean no immunity. Antibody levels will rise following exposure in a person who has low titres so they are still considered immune.

However, if after the initial series of vaccinations, the persons titres don't rise above a certain level that person in not considered immune but nor are boosters likely to help.