Delaying schedule - feedback?

[Yo Becca]

Hey there -

i posted this in the sticky above, but actually noticed there's not a lot of activity on the stickies (I usually don't look at them more than once myself). But I am trying to sort out all the information I've been reading and make some informed decisions. Also, it turns out in last-minute twist that I will be returning to the US to have the baby, but still plan to delay and not start anything until I come back to the US around 4 months. Here's what I wrote the other day:

Hey ladies - I wanted to crash the party. I've learned a LOT from reading this thread, and I am so grateful for y'all's knowledge that you've shared. I am also trying to figure out a schedule I am comfortable with for our baby on the way.

With DD, I delayed a some vaccines a few months (mostly b/c I wasn't willing to vacc when she was less than 100% - and went for most of the shots b/c after her birth I lost all ability to research the issue and figure out my own path). We were going to delay some more, but decided to "catch up" before moving to China, where we weren't sure what our access to trustworthy meds would be. However, we declined the Varicella totally and will continue to do so until she reaches adolescence.

My circumstances: We live in Shanghai now. Although my understanding is that I will be able to get imported vaccs, I want his/her first doses to be in the US, so the first round won't be until 4 months. We'll be back in the US when s/he's 9 months. THe "heavy" loads I'm planning at those times reflect that, although hopefully we can do them a bit spread out. Also, we live in a place where HepB is prevalent, where cleanliness standards are NOT up to US/Euro standards, and where it is more common to eat out and have ayis (maids) prepare food/clean - so I feel HepB is important for the baby to get b/c I really can't control who/what s/he would come into contact with. (It's late, I'm incoherent - but HepB is here, and we have lots of friends with ayis who may or may not be tested for Hep who will undoubtedly be touching my baby, not to mention you can't stop strangers on the street from touching your kids even feeding them ). However, I would like to avoid doing the HepB at birth - delaying it until 4 months also. I figure up til then, it'll be a lil boobling.

I would appreciate feedback on this schedule - I'm no expert but am trying to find a path here.

4m: HiB, HepB, DTap
6-7m: HepB, DTaP
9m: HiB, HepB, DTap
12m: HiB
18m: DTaP
24m: MMR, HepA (ONLY if we are still in China, and after further research)
3 or 4: HepA

We'll figure out "boosters" later - depending on titres also.
Declining: Variacella
Unsure about: IPV (in the US, a no-brainer for me, but in Asia I'm torn - I know there are pockets of polio but that's all I know), and Prevnar/PCV.

Any thoughts/advice? Thoughts on prevnar or IPV? Is this the minimum # I can do for each of the ones I'm selecting? I'm a bit unclear on whether I'll need to do 3 or 4 doses of the HepB

TIA!!

[mamakay]

Research a bit more about Hep A and I think you'll probably decide to scratch that one off alltogether. It's not a serious disease like Hep B and C.

I'm guessing you want to do the DTaP because of pertussis?

And Hib because of bacterial meningitis?

[hikingmommy]

With my DD, we're selectively vaccing and delaying some.

I'd go for the IPV. I couldn't find any info. about problems from it. The only polio vaccs that cause problems are the oral drops they use in some developing countries. The injection is very safe. While it's such a rare disease, it's still out there and so serious.

Can you spread out the vaccs a bit? Many of the recommendations I've heard suggest giving as few vaccs at once as possible. The DTaP is already 3, so you're adding more onto 3 viruses for the baby to make antibodies for. (Yes, I know the viruses are dead, but it's still a lot of work for their bodies.)

I chose not to do Prevnar based on my research. It's too new for me to trust it and I didn't like what I read.

Check out http://www.909shot.com/ for more info. on different vaccs.

[Yo Becca]

Thanks ladies

Mamakay - good point on the HepA - I haven't really investigated it since I know I have a while. I want DTaP for tetanus also - and it sounds like the DTaP is actually likely to be safer than the ingredient shots separated.

hikingmommy - I'll check the website out. I do plan to stretch the shots out as much as I can - like the "4 months" shots will all be given within a few weeks of each other, but hopefully not all at the same time. I think it's such a racket that the peds charge a separate co-pay for every visit - so stretching out the shots means they cost so much more : . But that is my plan.

[prettypixels]

Becca, I'm curious as to why you're choosing to do the Hep B vax... I have been reading about this one and it is one that really makes me :. I wasn't aware that it was commonly transmitted via casual contact... what I read said only blood to blood type transmission, ie: needles, etc. Although in that case then why would it be prevalent just by virtue of location? Lots of IV drug use in Shanghai? I'm so confused by this one! I hope my question doesn't sound snarky at all, I really am curious. I had just decided we could skip Hep B until teen years (13 ish) when I read your post.

[prettypixels]

PS, the WHO doesn't report any polio in China for 2006...
http://www.emro.who.int/polio/
Although that doesn't necessarily mean it isn't there... just may not have been reported yet. (But I'd still want to vax for it, if it were me and I knew the vax was safe!)
This site says China's last case of polio was reported in 1999...
http://www.polioeradication.org/feat...files/chn0.asp
But again, no clue how good China's diagnoses and reporting abilities are!

[mamakay]

Originally Posted by prettypixels

Becca, I'm curious as to why you're choosing to do the Hep B vax... I have been reading about this one and it is one that really makes me :. I wasn't aware that it was commonly transmitted via casual contact... what I read said only blood to blood type transmission, ie: needles, etc. Although in that case then why would it be prevalent just by virtue of location? Lots of IV drug use in Shanghai? I'm so confused by this one! I hope my question doesn't sound snarky at all, I really am curious. I had just decided we could skip Hep B until teen years (13 ish) when I read your post.

China is unique in that toddler to toddler transmission of Hep B is supposedly very common there.

[prettypixels]

Maybe via biting, or something? Exchange of saliva on toys etc? Huh, that is so interesting!

I can also see the concern in health care situations...

I googled and found this interesting article about hep b discrimination in China, which is... interesting, but doesn't tell anything about child to child transmission.

http://www.chinadaily.com.cn/english...ent_364055.htm

I'll have to keep looking...

[mamakay]

http://72.14.203.104/search?q=cache:...&ct=clnk&cd=12

[Plummeting]

From prettypixel's article:

Hepatitis B is spread through the exchange of bodily fluids, such as contaminated blood, unprotected sex, shared needles and infected mother-to-baby contact. It cannot be contracted through casual contact, experts said.

"They will not infect people if their liver function indices are normal," Ouyang Wuzhi, a doctor with the Nanjing No 2 Hospital in Jiangsu Province, confirmed.

Not what the "experts" in the US would like you to believe, eh? From the way the CDC makes it sound, a child not vaccinated for Hep B is going to pick it up from a doorknob or a toilet seat or something. And Americans are falling for it. What does this say about us?

[prettypixels]

Wow, thanks for the link mamakay!!!

[lunadoula]

http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

http://www.hepnet.com/update5.html see horizontal transmission.

It is a reality that it happens (horizontal transmission), especially among in young children in developing countries. It has been documented among sports athletes as well. My understanding (and I'm no expert) is that it's very infectious.

[prettypixels]

Thanks for the links lunadoula, this is what I've been seeing too now that I'm probing it a bit deeper. Scary!!!!

[Plummeting]

Originally Posted by lunadoula

It is a reality that it happens (horizontal transmission), especially among in young children in developing countries. It has been documented among sports athletes as well. My understanding (and I'm no expert) is that it's very infectious.

It is a lot more infectious than AIDS. The experts say 100 times, in fact. However, it's still not a huge risk. The liver expert who did my uncle's transplant said it was very, very rare in the US - even among close household contacts.

It's no big secret that the reason China has such a huge Hep B problem is that they have big problems with selenium deficiency. Like any other disease, exposure to Hep B does NOT guarantee infection. Selenium status probably has a lot to do with that. We aren't experiencing a problem with selenium deficiency in the US. In some parts of the country, soil selenium is so high that residents who eat local food are warned not to supplement, due to the possibility of selenium toxicity. Plus, China has a huge problem with poverty. While America is going to get to that point if something doesn't change, we aren't quite so bad yet.

It's interesting that the article says:

The extent to which horizontal transmission occurs in Canada is unknown. It is likely that as socioeconomic standards rise, transmission to young children decreases. Good data from elsewhere suggested that most of hepatitis B markers fall in the second and subsequent generations of immigrants.

(emphasis mine, of course)

Then they use this example as proof that horizontal transmisssion is still a big concern in the US and Canada:

Nonetheless, there is a likelihood that horizontal transmission does occur to some extent. In the US, this has been studied in a Vietnamese refugee community. At age ten, seven percent of the children of non-carrier mothers were themselves carriers.10 These children must have been infected from sources other than their mothers.

Uh-huh. So they just told us that horizontal transmission is related to socioeconomics, then they used a study conducted in a refugee camp to prove that it's still a concern in modern day North America???? Okee dokee. I'm sorry, but 7% in a refugee camp hardly spells disaster for the rest of us. The fact that they don't have studies to show how often it happens to second, third, eight, tenth generation North Americans or Europeans who aren't living in poverty suggests to me that the numbers are so low it isn't worth studying. I hardly think my living conditions in middle class America correlate to the living conditions of refugees in camps. It isn't the coming to America part that offers instant protection from horizontal transmission. It's the rise in socioeconomic status, which I doubt is what people living in refugee camps are experiencing.

[mamakay]

In case anyone is wondering, the selenium/HepB thing in China isn't just antivax nonsense, either. It's the Chinese themselves that figured out that Hep B was endemic in the areas with the extreme selenium deficient soils, and that when they started supplementing selenium, the Hep B levels dropped.
The only justification for vaxing American kids for this is that they could, in theory, take their shoes off at a park and step on a hypodermic needle tossed out by an IV drug user. (or other strange, implausible scenarios like that).
The other reason (and this is officially acknowledged) is that getting everyone to get the vax makes the vax affordable enough for the people who need it.
And I guess you could say that I have a rather strong philosophical problem with the concept of forcing newborns to get a vaccine that causes demyelinating disorders so that IV drug users can afford their Hep B vaxes.

[lunadoula]

Originally Posted by Plummeting

Uh-huh. So they just told us that horizontal transmission is related to socioeconomics, then they used a study conducted in a refugee camp to prove that it's still a concern in modern day North America???? Okee dokee. I'm sorry, but 7% in a refugee camp hardly spells disaster for the rest of us. The fact that they don't have studies to show how often it happens to second, third, eight, tenth generation North Americans or Europeans who aren't living in poverty suggests to me that the numbers are so low it isn't worth studying. I hardly think my living conditions in middle class America correlate to the living conditions of refugees in camps. It isn't the coming to America part that offers instant protection from horizontal transmission. It's the rise in socioeconomic status, which I doubt is what people living in refugee camps are experiencing.

Not trying to be argumentative but a "refugee community" doesn't mean "refugee camp." It probably means a community/neighborhood that is mostly composed of recent refugees. Health and sanitation still could be valid concerns, as poverty/overcrowding are often issues with recent refugees. Just wanted to clarify though.

[Plummeting]

Originally Posted by lunadoula

Not trying to be argumentative but a "refugee community" doesn't mean "refugee camp." It probably means a community/neighborhood that is mostly composed of recent refugees. Health and sanitation still could be valid concerns, as poverty/overcrowding are often issues with recent refugees. Just wanted to clarify though.

You're right and I understand that. It was just an issue of what words I'm used to grouping together. How often do we say "refugee community" vs. "refugee camp"? It's just what tumbled out. I meant "refugees in refugee communities" and "refugee communities", not "refugees in camps" or "refugee camps". I'm definitely aware that there aren't tent villages in the US housing refugees from various countries. (I would put a laughing smilie right here, but I don't think it's appropriate to laugh over any kind of refugee situation.) It was just a semantics mix-up. I've been hung up on the refugee camps in northern Uganda lately....

Still, a refugee community is a FIRST generation community that is going to be suffering from issues of poverty and overcrowding. Has anyone here ever looked into the number of people that tend to live in the homes of poor immigrants? It's nothing like how many people the average North American resident has living in their own home. Nothing at all. And let's face it, how often do immigrants in America ever actually find the American dream they were looking for? Poverty is a huge, huge issue for people who come here with no money to begin with. So regardless of semantics, my situation and the situation of most Americans has little in common with that of Vietnamese refugees living in refugee communities. Very, very little. And like I said, the fact that this was the best they could do to convince us that horizontal transmission is a problem in North America suggests that the rate of horizontal transmission outside of situations like these is incredibly, incredibly low. If it was actually notable, they'd tell us about it. The CDC isn't exactly in the business of holding back information that would convince us to vaccinate.

[Yo Becca]

This group is such a treasure trove of information! My reasons for concern about HepB are related to the info discussed above, although I've learned even more from this discussion. While it doesn't seem to be a big threat in the US, and if we were living there full-time I'd decline it, it is very prevalent in China. The horizontal transmission info is very alarming. And it's obviously spreading beyond IV drug users or unprotected sexual partners.

The info about poverty and overcrowding is definitely a reality here. We live in Shanghai, a big city that looks a lot like NYC or other big cities in some areas. But if you peek down any alley, you see how a huge number of Shanghainese live - in open 1-2 bedroom apartments, the whole family (several generations) living together, cooking outside, washing dishes and food in the same containters (water?) used for bathing, *NO* understanding of germ theory or use of any cleaning products other than water and rags, no indoor plumbing - just a sink or hose in the alley shared by several families. Spitting is seen as healthy - more healthy than, say, blowing your nose in a tissue and throwing it away - so there's bodily fluids flung near and far. Every time I get my hands on an English-language newspaper, there's another scary story about food safety (noodles being sold in local stores made with carcinogenic BLEACH b/c it makes the texture better, fish being served in restaurants that has tested positive for carcinogenic antibiotics, less than 30% of fruits and vegetables sold locally would be legal to sell in the US or EU b/c of pesticides and chemicals, people dying from eating pork from pigs who were given steroids to lower their fat content, milk that won't make yogurt b/c the antibiotics in it kill the yogurt cultures, etc.) - not to mention the scary, lead-containing local water. There are MANY factors undermining people's health, and it's shameful that the government here isn't more aggressive at protecting citizens, and also shameful that multinational corporations profit so richly from furthering these problems with no consequences.

It's also different in that we have more contact with strangers here than in the US. Everyone who is at least middle class or even upper working class has an ayi in their home - maids who do cleaning, cooking, and in some cases childcare. Ayis generally come from the poorest communities, and many from rural communities where poverty, overcrowding, and healthy problems are very prevalent. They leave their families to come work in the big city - I think it's a horrible system that separates mothers and children, but for the women involved, it's an incredible opportunity and they are able to provide more for their families than they could closer to their homes. Everyone touches your kids - it's incredibly hard to prevent, including touching faces and trying to give them food. It's just a major cultural difference - things we see as rude and aggressive in the US are kind and normal here. It's standard for men to grow oneor two fingernails long - which are then used to pick their nose, teeth, and eyes, then they reach over to touch your kids. And sanitation is pretty much nonexistent. It's perfectly normal to many Chinese people to use the same rags for cleaning the toilet and the kitchen counters - even the dishes. And the cleaning agent of choice is tap water, often the same bucket of dirty water used to clean everything. I have been using women's restrooms for as long as I can remember, but I have never seen as much menstrual blood, urine and feces spread on floors, walls, toilets (well, mostly squatters), etc. in my whole life as I've seen in the past 4 months. I know all this doesn't mean HepB is everywhere or easily spread - but it makes me more cautious than I would be in the US, where I feel more in control of my environment and who my children have contact with.

So, some may think it's excessive, but I feel like the only way I can concretely protect my kids from HepB exposure here is to have the vaccine. I know it's not like catching a cold, but it seems more hardy than HIV and the data on horizontal transmission is quite alarming. I'm comfortable with that choice - just gotta sort out timing. SO grateful for everyone's thoughts, info and input!

(i hate to make it sound like China is so dirty - in some ways it's cleaner than the US. the streets are swept daily by people (not machines), so even though the smoking rate is high, there's no accumulated cigarret butts or litter, etc. It's just a whole other world of cleanliness standards, and it makes me more concerned about things I wouldn't blink an eye at in the US)

[caedmyn]

The book "Vitamin C Infectious Diseases and Toxins" has a section on preventing/treating/curing Hep B with vitamin C--I got the impression that it was very easy and quick to cure with the right doses of vitamin C. Something else for you to think about, anyway

[lunadoula]

Originally Posted by caedmyn

The book "Vitamin C Infectious Diseases and Toxins" has a section on preventing/treating/curing Hep B with vitamin C--I got the impression that it was very easy and quick to cure with the right doses of vitamin C. Something else for you to think about, anyway

Curing Hep B with Vitamin C??? I would love to see some research on that because to be honest that sounds like a lot of quackary to me. If it worked why would anyone even HAVE Hep B? And I do herbs/chiro/homeopathics/etc. so it's not like I'm "mainstream," but in the conditions Becca described there is no way I'd be relying on Vitamin C dude. : Btw Becca thank you for your post because wow, really makes me appreciate the public health system in a whole new way.