Risks of Hep. B. Pros/Cons of vaccinating an adult with risk of being bitten?

[ericswifey27]

How's that for a title

Any Hep. B experts out there?

I work in a special needs class with students with severe communication delays and today one of them communicated with me by biting me. Hard. It broke the skin and it hurt like h*$l. In any case, the school nurse lectured me, saying I would have to immediately fill out an accident report go to the workman's comp doctor and make sure I am up to date on all my Hep. B. vaccinations.: Then she lectured me on the importance of infants having Hep. B. vaccines and that I am putting my infant at a huge risk, which I think is a load of crock personally.

Honestly, I no longer vaccinate my children, and I didn't plan on vaccinating for myself any furthur either. But I don't want to be at risk of being hospitalized for 6 months due to contracting Hep B. either. (I know, I am sure the nurse was exaggerating just a tad)

So... what are my risks? There is a definite possibility of me being bitten by a student again. How readily is Hep. B. transmitted through bites? If I were to get through a bite, how easily could it be transmitted to my breastfed infant? Not at all, right, since the wound would be on another part of my body, not my breast. Also, what are the most likely and unlikely symptoms. How treatable? What are the risks of the Hep B vaccination for me as an adult?

And if I decide not to get the vaccine can they fire me:? I know I can get an exemption for my children for the schools but as an employee of a public school it may be different.

:

Ugh. I really wish I had seen that bite coming.

[Spy]

First of all, it is very unlikely that any of your students would have HepB to give you in the first place. Then, even with regular biting the chances are not big. And somehow I think that if you're going to be bitten to blood regularly, you would learn to see it coming pretty damn quick The only reason you didn't see it coming this time is that it probably doesn't happen on a daily basis, right? So the chances are pretty slim. And why are we worried specifically about Hep B and not HIV, syphilis, rabies, tetanus, etc...??

Are your students children or adults, by the way?

[meggles]

Proper wound care goes along way.

Not so sure on the specifics of the Hep B vaccine, but I know I received all the required doses, yet I am not immune. Just something to think about--you could go ahead and get the vax and not be able to get positive titers at all.

[mamakay]

HepB actually does transmit pretty well through bites, and in the 80's a lot of SN kids did end up with HepB when institutionalized. But the kids you're working with probably aren't institutionalized, so that lowers the odds of there being an issue a lot.
As an adult, if you were to get HepB, you'd probably clear it (I want to say there's over a 90% probability that you'd clear it? I'd need to look it up, though) but you would probably shed for a short while before your immune system kicked in and killed it off, and during that time, in theory (not sure what the probability is exactly) you could transmit it to your bf'ing infant.
There's aren't any symptoms at all. It's a silent infection that shows up later in life as liver failure or liver cancer. Most people who catch it as adults clear it, but babies are more likely to carry it for life and end up with problems down the road.

So, it's a realistic worry, sorta.
FWIW, daycare workers don't end up seropositive for HepB any more often than the general population, and you'd think they'd be at an increased risk of being bitten. (Makes sense to me). So that's a good sign for someone in your situation, I think.
So as long as the biter wasn't ever institutionalized or put in a really low quality childcare environment I think you're ok.
Can you find out if the biter has any risk factors for HepB? I ask because there is an effective postexposure prophylaxis for HepB (the immune globulin, HBIG). So that's another option.

The risk with the vax is a pretty rare incidence of demyelination/autoimmune stuff. Like multiple sclerosis. It's pretty rare, I think, but it really does appear to happen sometimes. (It's awardable under the VICP now.)

[ericswifey27]

Originally Posted by Spy

First of all, it is very unlikely that any of your students would have HepB to give you in the first place. Then, even with regular biting the chances are not big. And somehow I think that if you're going to be bitten to blood regularly, you would learn to see it coming pretty damn quick The only reason you didn't see it coming this time is that it probably doesn't happen on a daily basis, right? So the chances are pretty slim. And why are we worried specifically about Hep B and not HIV, syphilis, rabies, tetanus, etc...??

Are your students children or adults, by the way?

True, definitely didn't see that coming at all. I will now ask the Special Day Class teacher who is a known biter and will have quicker reflexes. The school nurse wasn't concerned at all about HIV transmission through saliva, and didn't mention rabies either. Her only concern seemed to be Hep B.
Oh, and they are kids- about 7-10 years old.

Originally Posted by meggles

Proper wound care goes along way.

Not so sure on the specifics of the Hep B vaccine, but I know I received all the required doses, yet I am not immune. Just something to think about--you could go ahead and get the vax and not be able to get positive titers at all.

Re: wound care. I flushed it out with hexochlorosomethingwhatever for 5 min per school protocol.

And good reminder re: vaccination does not always equal automatic immunity.

Originally Posted by mamakay

HepB actually does transmit pretty well through bites, and in the 80's a lot of SN kids did end up with HepB when institutionalized. But the kids you're working with probably aren't institutionalized, so that lowers the odds of there being an issue a lot.
As an adult, if you were to get HepB, you'd probably clear it (I want to say there's over a 90% probability that you'd clear it? I'd need to look it up, though) but you would probably shed for a short while before your immune system kicked in and killed it off, and during that time, in theory (not sure what the probability is exactly) you could transmit it to your bf'ing infant.
There's aren't any symptoms at all. It's a silent infection that shows up later in life as liver failure or liver cancer. Most people who catch it as adults clear it, but babies are more likely to carry it for life and end up with problems down the road.

So, it's a realistic worry, sorta.
FWIW, daycare workers don't end up seropositive for HepB any more often than the general population, and you'd think they'd be at an increased risk of being bitten. (Makes sense to me). So that's a good sign for someone in your situation, I think.
So as long as the biter wasn't ever institutionalized or put in a really low quality childcare environment I think you're ok.
Can you find out if the biter has any risk factors for HepB? I ask because there is an effective postexposure prophylaxis for HepB (the immune globulin, HBIG). So that's another option.

The risk with the vax is a pretty rare incidence of demyelination/autoimmune stuff. Like multiple sclerosis. It's pretty rare, I think, but it really does appear to happen sometimes. (It's awardable under the VICP now.)

I don't think he was instutionalized at all, but I will ask the nurse would info she can give me. The HIPPA law means I probably won't even be able to ask that:

Re: shedding. The possiblity of passing it to my infant is the most bothersome. What about from the Hep vax itself. If I were to get vaccinated, couldn't I shed from the vaccine and pass it to my baby through breastfeeding as well then? Or would it be too "weakened"


HBIG. Thanks, I will ask the school nurse about that. And risk factors for the student. Although I am sure she won't be able to tell me anything, which really bothers me. It's affecting me, I should know so that I can make an informed decision, ykwim?

Thanks everybody for your input.

[Science Mom]

Originally Posted by ericswifey27

I don't think he was instutionalized at all, but I will ask the nurse would info she can give me. The HIPPA law means I probably won't even be able to ask that:

Re: shedding. The possiblity of passing it to my infant is the most bothersome. What about from the Hep vax itself. If I were to get vaccinated, couldn't I shed from the vaccine and pass it to my baby through breastfeeding as well then? Or would it be too "weakened"


HBIG. Thanks, I will ask the school nurse about that. And risk factors for the student. Although I am sure she won't be able to tell me anything, which really bothers me. It's affecting me, I should know so that I can make an informed decision, ykwim?

Thanks everybody for your input.

Under the circumstances, the school would be obligated to inform you if the child were Hepatitis and/or HIV positive; you should be able to ascertain the child's vaccine status as well. The vaccine is administered during pregnancy with no adverse fetal effects when the vaccine's benefits clearly outweigh the potential harm but is not done routinely. The effects via breastmilk are unknown although it is a recombinant vaccine and goes to the gut so I would imagine that there are no adverse effects. Hepatitis B virus can be transmitted via breastmilk.

SM

[insider]

Originally Posted by Science Mom

The vaccine is administered during pregnancy with no adverse fetal effects when the vaccine's benefits clearly outweigh the potential harm but is not done routinely.

I'm looking at the "no adverse fetal effects" clause. That's not something that is known, so this statement is not verifiably true. The safety assessments are based only on very limited and extremely narrow epidemiology. For instance, it is known that aluminum causes abnormal gene expression in the brain in amounts lower than what is in the HepB vaccine, so exposing a developing fetal brain to aluminum is definitely a safety hazard, the implications of which have never been studied on an epidemiological level. You can't claim the vaccine causes no adverse fetal effects when there've been no studies whatsover to asses the effect of the altered gene expression caused by aluminum.

There are a few other known hazards of aluminum-containing vaccines, especially HepB, but suffice it to say, it's not a vaccine that can be called safe based on only a very small limited amount of purely epidemiological comparisons.

I'm sure you meant "no adverse fetal effects" based on the available information, but when the available information is so lacking then I like the idea of adding the qualifying statement that it hasn't really been studied to any degree of depth. Don't want to give people a false impression of security. This vaccine has after all been linked to the development of multiple sclerosis and to brain infiltration of aluminum - and that data appears way more solid than the critically limited epidemiology calling it "safe".

JMO

[Science Mom]

Originally Posted by insider

I'm sure you meant "no adverse fetal effects" based on the available information, but when the available information is so lacking then I like the idea of adding the qualifying statement that it hasn't really been studied to any degree of depth. Don't want to give people a false impression of security. This vaccine has after all been linked to the development of multiple sclerosis and to brain infiltration of aluminum - and that data appears way more solid than the critically limited epidemiology calling it "safe".

JMO

That would be correct and a more accurate qualifier to have made.

SM

[ericswifey27]

Originally Posted by Science Mom

Under the circumstances, the school would be obligated to inform you if the child were Hepatitis and/or HIV positive; you should be able to ascertain the child's vaccine status as well. The vaccine is administered during pregnancy with no adverse fetal effects when the vaccine's benefits clearly outweigh the potential harm but is not done routinely. The effects via breastmilk are unknown although it is a recombinant vaccine and goes to the gut so I would imagine that there are no adverse effects. Hepatitis B virus can be transmitted via breastmilk.

SM

According to the school nurse, not even she is privy to information on which of her students have HIV, unless the parent has signed a waiver allowing her access to that information. I am guessing this is due to the HIPPA law in effect. So unfortunately it looks like they are not obligated, which is starting to piss me off. If they could just tell me what kind of real risks I am looking at I would have a better idea of what action (or non action) on my part would be most appropriate.

I for one am extremely leery of vaccines while pregnant or breastfeeding. Why do you feel there would likely be "no adverse effects"? I hope it's not coming across as snarky, actually it is just that I am not clear about the meaning of "recombinant" and how that might have less of an impact on a fetus or nursing baby, versus a live vaccine for example.

[sophiekat]

after reacting severely to the hep b vax myself i have to say i wouldn't recommend it to anyone. but that's anecdote, not data

[ericswifey27]

Yeah, I just got off the phone with the school nurse and she was completely unhelpful and 100% rude. She was quite snarky about being unable to provide with any information of what the student may have been exposed to, and said she would not explain the HBIG to me, to ask my doctor, she had no time:

And my doctor, that I have a lot of confidence in, well I couldn't reach him yesterday and his office is closed on Wednesdays.:

And I called in sick just to get this crap taken care of.

I guess this has turned in to a Pity party for me. Sorry, continue....

[ericswifey27]

Originally Posted by sophiekat

after reacting severely to the hep b vax myself i have to say i wouldn't recommend it to anyone. but that's anecdote, not data

Sophie, can you tell me what happened? This is exactly one of my concerns.

[mamakay]

The more I think about it, the more I think you're probably ok. The kid was probably vaccinated in infancy, and the HepB vax does seem to work ok.
And he probably wasn't ever exposed.
And bites aren't *that* for-sure when it comes to transmission.

HBIG is what you'd need if you were exposed, I'm pretty sure. I don't think the vax alone would help you out by itself, although they usually do both.
And the IG is a blood product, which means it carries it's own risks of transmitting other pathogens. So I wouldn't do that unless it was for sure that the kid was HB+.
And the chances that the kid is HB+ are really very, very low.

[mamakay]

Read through here and see if any of it pertains to your situation:

http://www.cdc.gov/MMWR/preview/MMWRhtml/rr5011a1.htm

(I haven't read it yet)

ETA:

Good news from the link:

Feces, nasal secretions, saliva, sputum, sweat, tears, urine, and vomitus are not considered potentially infectious unless they contain blood. The risk for transmission of HBV, HCV, and HIV infection from these fluids and materials is extremely low.

For human bites, the clinical evaluation must include the possibility that both the person bitten and the person who inflicted the bite were exposed to bloodborne pathogens. Transmission of HBV or HIV infection only rarely has been reported by this route

Lookin' good...

This talks a little more about postexposure prophylaxis:
http://findarticles.com/p/articles/m...96891663/pg_12

[sophiekat]

Originally Posted by ericswifey27

Sophie, can you tell me what happened? This is exactly one of my concerns.

i was working as an EMT my last year at university and the hep b vax was recommended for all of us to get. i had the first (its a series of 3) and was getting sick a lot more than usual. had the second right before winter break and shortly thereafter thought i had mono. i was tested and tested and tested and never came up + for mono (which i shouldn't have because i had it in high school) but kept being told that i had "atypical mono" (both in that i'd already had it and never tested positive for it) -- i was exhausted all the time, all my lymph nodes were constantly, largely swollen, liver function tests came back abnormal, my spleen was enlarged, i was in a lot of pain and couldn't fight anything (colds, strep, bronchitis -- i had EVERYTHING that goes around college campuses : : ). even though all this was happening i still got the last shot of the series : and all my symptoms got worse x1000. i had drs telling me i had lupus, MS, leukemia -- and others telling me that nothing was wrong, i was just overworked trying to decide on a law school & graduate with honours and needed to give myself a break -- and one who told me i must have picked up some "foreign" bug when i lived in vienna and london the year before i had to stop working, barely graduated on time.
since then i've had lots of issues with severe chronic fatigue, have had to change a lot of plans. i NEVER had any doc connect any of this to the hep b series until my now-dh was doing an immunology rotation in med school and saw other reactions to this vax. he came home and called me (we were 3000 miles apart at this point as i was in law school) and said "this sounds an awful lot like you." my docs at the time dismissed him as being a typical med student who wants to diagnose everyone with everything

anyway, that's the novel version.

[Science Mom]

EW, They have to inform you if the child has any health concerns that may affect you; perhaps it is time to speak to the principal or even the school board. I don't mean to sound alarmist because chances are you are fine but I am sure you would like to verify that and rightfully so.

As far as the vaccine for you, it would be a series of 3 doses and I was referring to the fact that it is a recombinant vaccine i.e. select fragments of the hep b genome are used to illicit an immune response as opposed to a live vaccine that contains whole virions that can be shed in breastmilk. I am speculating that a recombinant vaccine, if shed in breastmilk would most likely not affect your baby but there are no data to support that.

SM

[mamakay]

What sort of effectiveness does the vaccine alone have as a post exposure prophylaxis?

[Science Mom]

MK, Here are the CDC recommendations:
http://wonder.cdc.gov/wonder/prevgui...9/p0000359.asp

and in Europe, HBIG and HB vax are recommended within 1-7 days.

SM

[wallacesmum]

MK - wasn't the institutionalization issue due to some seriously unethical, intentional exposure? Just asking, in case it sounds like it is the fact of institutionalization, rather than that particularly heinous treatment of children, that is the issue.

[mamakay]

Originally Posted by Science Mom

MK, Here are the CDC recommendations:
http://wonder.cdc.gov/wonder/prevgui...9/p0000359.asp

and in Europe, HBIG and HB vax are recommended within 1-7 days.

SM

SM...that's from 1984!

I posted the 2001 recommendation a few posts ago.

I don't think it answers the question of how well the vax alone without HBIG works as a postexposure prophylaxis, either, though.

I'm thinking the vax alone won't do much in this situation. She'd need the IG.