Hep b - Page 2

[Rrrrrachel]

Originally Posted by japonica 

True, but looking at infection rates in places that do not have it on the schedule for infants is a starting point for how many cases we are potentially dealing with. Even if the data is also not always the most reliable. It's a place to begin.

It's too bad that PHAC is so terrible at disseminating data. I'd like to take a look at the stats for chronic vs. acute cases in the provinces that do not have it on the schedule for infants. The Alberta document says that many chronic cases report infection stemming from blood transfusion (even these days?), body piercing, and occupational contact. It'd be interesting to know how many chronic cases in Alberta, Ontario and the like, can be attributed to infections during infancy and early childhood. Mackie says one-third of chronic cases are acquired in childhood, but he's basing it on data from Vietnam, India, and Alaska, of which the first two are developing nations and the last one has indigenous communities that resemble developing nations. I'd imagine as well that no one is running titers on the Canadian kids unless there's a reason for it, so it's difficult to estimate what the rates are. You'd think though, that they'd be basing their health policy decisions on good local data, even if it's just comparing one province to another. If there's going to be a rationale for implementing hep B at birth or two months in the provinces that do not currently offer it, then there should be substantial valid Canadian data to support it. Aside from the governmental cost-benefit analysis, we also have to incorporate the estimated rates of reaction to the hep B vaccine, even if they are "rare" and the risk-benefit ratio still sways in favour of instituting the infant vaccination program.

The rate of adverse reactions to hep b is exceptionally low compared to other vaccines, I believe.

[japonica]

That may be true. I'm not sure if there's a stand alone hep B vaccine in use in the pediatric population. I thought it was included in combos for the juvenile market.

[Rrrrrachel]

The two options in the us are recombivax and twinrix. Recombivax is hep b only, twinrix is hep a and hep b. hep a is not on the schedule until 12 months. So for infants it's exclusively the stand alone vaccine.

[kathymuggle]

Originally Posted by Rrrrrachel 


The rate of adverse reactions to hep b is exceptionally low compared to other vaccines, I believe.

Source, please.

Edited by kathymuggle - 1/10/13 at 10:56am

[Rrrrrachel]

The WHO, for one.

[Rrrrrachel]

And, since my statement was about what I believe, because I said so.

[japonica]

Originally Posted by Rrrrrachel 

The two options in the us are recombivax and twinrix. Recombivax is hep b only, twinrix is hep a and hep b. hep a is not on the schedule until 12 months. So for infants it's exclusively the stand alone vaccine.

Thanks. I was thinking of the Canadian options, which for BC and PEI that start at two months, it would be Infarix Hexa. The stand alone ones in Canada are generally for the 9-13 year olds, with the exception of NB, which does a stand alone hep B at birth.

[kathymuggle]

nm

Edited by kathymuggle - 1/9/13 at 8:02pm

[kathymuggle]

Well, to answer the OP:

I assume we are talking about if giving a newborn the vaccine has validity as a public health move.

It is pretty easy on the face of it: figure out if the serious newborn reaction rate is higher than the risk of the newborn contracting the disease.  

Perhaps one could compare the history of the disease in newborns in 2 places that are similar in makeup, but one has newborn hep b and one does not. Japonica mentioned New Brunswick gave newborn hepB.  One could compare that to another place that does not  - like PEI or Nova Scotia.  It might give us an idea of how much the infant hep b. vaccine  did or did not contribute to the epidemiology of the disease.

On this thread alone, we have conflicting figures from some very mainstream sources on hep B. prevalence before vaccines.  Chop said the prevalence was 18 000 by age 10 while CDC is saying 360 per year.  It is not reassuring.

Other general ideas:

- does hep. B at birth affect breastfeeding outcomes?  Breastfeeding is very important in terms of health.  

-do the fevers from Hep. B go sufficiently high that invasive procedures are done? High fevers in newborns are treated aggressively, and a doctor would not automatically assume a vax caused the high fever.    My nephew had a spinal tap over a high fever in infancy to rule out meningitis.  

-should national rates be the defining factor in Hep b. vax guidelines?  How about state guidelines or guidelines based on other demographics?

Edited by kathymuggle - 1/9/13 at 3:14pm

[Rrrrrachel]

.
Edited by Rrrrrachel - 1/11/13 at 1:52pm

[Rrrrrachel]

Originally Posted by kathymuggle 

Well, to answer the OP:

I assume we are talking about if giving an infant vaccine has validity as a public health move.

It is pretty easy on the face of it: figure out if the serious newborn reaction rate is higher than the risk of the newborn contracting the disease.  

Perhaps one could compare the history of the disease in newborns in 2 places that are similar in makeup, but one has newborn hep b and one does not. Japonica mentioned New Brunswick gave newborn hepB.  One could compare that to another place that does not  - like PEI or Nova Scotia.  It might give us an idea of how much infant hep b.  did or did not contribute to the epidemiology of the disease.

On this thread alone, we have conflicting figures from some very mainstream sources on hep B. prevalence before vaccines.  Chop said the prevalence was 18 000 a year in children, while CDC is saying 360.  It is not reassuring.

Other general ideas:

- does hep. B at birth affect breastfeeding outcomes?  Breastfeeding is very important in terms of health.  
-do the fevers from Hep. B go sufficiently high that invasive procedures are done? High fevers in newborns are treated aggressively, and a doctor would not automatically assume a vax caused the high fever.    My nephew had a spinal tap over a high fever in infancy to rule out meningitis.  
-should national rates be the defining factor in Hep b. vax guidelines?  How about state guidelines or guidelines based on other demographics?

This is not actually what I'm asking. I'm asking what people who OTHERWISE CHOOSE TO VACCINATE think of hepatitis b vaccine. Particularly vaccinating at birth vs waiting two months or longer.
Edited by Rrrrrachel - 1/10/13 at 4:40am

[Rrrrrachel]

CDC did NOT say it was 360, someone did some math based on some information and extrapolated that. The real rate of hep b is generally considered much higher, as much as ten times as high, as the reported rate because of how long it takes people to show symptoms. This is widely considered to be the case, you can find it in a wide variety of places.

Now, again, please show this forum the same respect you would like people to show the I'm not vaccinating forum.

[Turquesa]

The CDC said 1 in 100,000 children. At 36 million per census figures, how many children is that? It's not extrapolation, Rrrrrachel. It's simple math.

Extrapolation is what happens when a secondary-source, uncited website claims 18,000 children a year when the CDC itself (cited in my post above) said 26,000 reported cases TOTAL when the disease peaked. Are you seriously going to tell me that 70% of all of these cases were babies and children???

[pek64]

Originally Posted by Rrrrrachel 

This is the quote from the chop website

"Before the hepatitis B vaccine, every year in the United States about 18,000 children were infected with hepatitis B virus by the time they were 10 years old. This statistic is especially important because people are much more likely to develop liver cancer or cirrhosis if they are infected early in life, rather than later in life (most people are infected with hepatitis B virus when they are adolescents and young adults)."

It's a little awkwardly worded. I'm going to look around a little more and make sure it's saying what I think it is.

I know I'm late to see this, so I apologize if this point was already made.

Half of the 18,000, that's 9,000, got hep b from their mothers at birth. Screening should make it so that mandatory vaccination right after birth is unnecessary. Vaccination of those testing positive is another issue.

So, for those whose mothers test negative, that leaves only 9,000 who get infected before age 10.

[Rrrrrachel]

Originally Posted by Turquesa 

The CDC said 1 in 100,000 children. At 36 million per census figures, how many children is that? It's not extrapolation, Rrrrrachel. It's simple math.

Extrapolation is what happens when a secondary-source, uncited website claims 18,000 children a year when the CDC itself (cited in my post above) said 26,000 reported cases TOTAL when the disease peaked. Are you seriously going to tell me that 70% of all of these cases were babies and children???

As I already explained, twice, there is a big difference in reported cases and actual cases for hep b.

[Turquesa]

You don't know that they're "actual" unless they were reported. Your only alternative is conjecture and estimates.

[Rrrrrachel]

It's not "mine," and studying things like this does involve some statistical models and projections, but it's a lot more than guessing.

It's fact that hep b is much more common than reported. That's why it's the silent epidemic. That isn't conjecture on my part or anyone else's. you can easily confirm this for yourself.

This is now a pointless debate and exactly what I was trying to avoid. Thanks.

[Taximom5]

Originally Posted by Rrrrrachel 

I do think there are good reasons to vaccinate infants for hep b. I'm not a big fan of vaccinating at birth, though, when there's a pretty good idea about moms hep b status. 2 months seems soon enough. On the other hand, there is a significant number of women out there who have hep b and don't know it. What do y'all think? I guess I'm asking more as a public policy thing than what would you do for your kid thing.

Since it's standard practice to screen pregnant mothers for Hep B, this shouldn't even be an issue.  Even if you show up pregnant in the ER, with no prior prenatal care, they will run a screen.  When I had a miscarriage, and was sent to the ER, even with a record of prenatal care (which included a hep B test) at that same hospital,  they did ANOTHER hep B test, and told me it was standard.

[HappyHappyMommy]

Hi All,

As a reminder, the forum guidelines for this forum state "This is a support-only forum for those who are vaccinating selectively, on a delayed schedule or fully vaccinating on schedule. Members who aren't vaccinating should not post here to debate or argue accuracy or opinion of things posted. " Please edit all posts that are debating or arguing the accuracy or opinion of things posted. Please focus your posts to be of support.

In addition, if you have a concern about a post, please do not post to the thread about it. Rather, please flag the post or a PM a mod or an admin. Please edit any posts that discuss concerns whether another post is appropriate for this forum.

Thank you!
HHM

[Rrrrrachel]

I was trying to get the perspective of people who are generally in favor of at least some vaccines. Which is why I put it here.
Edited by Rrrrrachel - 1/11/13 at 1:49pm