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#61 of 100 Old 03-05-2009, 03:21 AM
 
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Let me try again:

Quote:
So maybe theoretically, it opens the way for all sort of stuff, the odds of one individual getting all of the theoretically possible diseases that might move in could be low.
Removing one colonizing species (hib, in this case) does open up room for other organisms (nontypeable h-flu, pneumococcus probably, etc) to colonize more often. But just like MOST people who get colonized with hib (everyone prevaccine) never develop "invasive hib disease", most people colonized with the other organisms aren't going to develop invasive disease from them, either.

Make sense?

ETA:

Quote:
the odds of one individual getting all of the theoretically possible diseases that might move in could be low.
The odds of any individual ever developing any life-threatening case of any bacterial disease is really pretty low. Pneumonia is sort of common, but most people never develop meningitis.
But we're all definitely going to be colonized with these bugs over and over again throughout life.
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#62 of 100 Old 03-05-2009, 03:21 AM
 
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tongue in cheek, if you are not getting this, hop over to the vaccine forum and read the HiB thread there... you will then REALLY not get it!
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#63 of 100 Old 03-05-2009, 03:27 AM
 
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Quote:
Originally Posted by anewmama View Post
Thought this was an interesting, Hib among Indigenous people.

http://www.healthinfonet.ecu.edu.au/...our_review.htm



I am not sure of the biology behind this.... ? anyone?
http://en.wikipedia.org/wiki/Plasmid
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#64 of 100 Old 03-05-2009, 04:03 AM
 
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ohhhh yeah, I'm following that thread too. I can only *try* to understand the back and forth, circular discussion there. (esp without any solid previous knowledge in the subject of disease...)

Ok, mamakay, i think i get it. But my ds is going bonkers in the kitchen, gotta go before i get back with another comment.

How do we mothers DO this all at the same time??? (deal with kids going up the wall, making meals, AND trying to figure out disease stats and the way bacteria work?!)
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#65 of 100 Old 03-05-2009, 06:29 AM
 
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Originally Posted by mamakay View Post
But we're all definitely going to be colonized with these bugs over and over again throughout life.
You're talking only about adults, right?
Not breastfeeding babies?
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#66 of 100 Old 03-05-2009, 07:04 AM
 
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Originally Posted by mamakay View Post
1)the breastfeeding protection is for all types of H-flu. So replacement doesn't matter there.

2)the breastmilk protection is really quite strong. But no, nothing is 100%.



No, because breastmilk doesn't create that kind of selective pressure. It's not in the best interest of a bacteria to cause invasive disease. It's an "accident" when that happens. And breastmilk doesn't prevent colonization, so there's no selective pressure on the bacteria to "evade" it.
But I have this Japanese study from 1999:
"...breastmilk may inhibit the colonization by respiratory bacterial pathogens of the throat of infants, by enhancing mucosal immunity against respiratory tract infection."

That's why I asked the question above about whether you talking about just adults or bf infants too.
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#67 of 100 Old 03-05-2009, 07:21 AM
 
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mamakay said:

"the key words here/thoughts here, since i haven't yet read the link paigeC posted (for others http://adc.bmj.com/cgi/content/extract/93/8/646 ), are "first colonization" at whatever age versus just a physiological phenomenon that young babies/toddlers under 2 cannot built an immune response. If they can build one after 2 more easily, then a child exposed to HiB after 2 could respond and not necessarily develop invasive HiB. However, if the issue is just the FIRST colonization PERIOD, then any child as you say, is at risk for when they first counter the bacteria if they are not vaccinated even past 2."

I would read that full article but dont have access. Anyone?

So to sum up what I understand now:

*If a mother is breastfeeding her child up until 2, the child will have pretty good protection against HI infections.
A nonbreastfed, unvaxed child has least protection.

*After age 2, IF children are able to make antibodies to native polysaccharides (unlike the under 2's), the child will have pretty good protection against HI infections, unless, maybe, he's never been colonized before.

(and I assume they ARE, since the article only states that the under 2's can't, which to me means that the over 2's CAN. ? )

(sorry for my posting spree, I've got some time on my hands right now!
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#68 of 100 Old 03-05-2009, 10:57 AM
 
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http://www.fetalneonatal.com/cgi/con...tract/93/8/670

(Hib in England)

Results: Increased disease risk was noted among children with frequent antibiotic use (adjusted OR (AOR) (trend) 1.51 (95% CI 1.06 to 2.13); p = 0.02) and from sole-parent households (AOR 2.56 (95% CI 1.24 to 5.29); p = 0.01). These two risk factors were further related to each other, consistent with previously reported associations between infection and social deprivation. In fully immunised children, receipt of all three doses of the primary course as an acellular pertussis-containing combination vaccine (DTaP-Hib) increased the risk of vaccine failure (OR 2.88 (95% CI 0.99 to 8.37), p = 0.01). Day care attendance between 2 and 5 years of age was linked with a dose-dependent reduction in risk (AOR (trend) 0.79 (95% CI 0.66 to 0.93); p = 0.01), possibly because of natural boosting of immunity.

So this study is saying that (vaccinated) children going to day care will be at a LESSER risk of contracting HiB because they may encounter it more often, boosting natural immunity. Interesting, since all other studies I've seen (and documents) say that being in day-care is a risk factor.

Would this hold true for unvaxed kids too, givng them a natural boost of immunity (which they theoretically began to acquire after age 2)?
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#69 of 100 Old 03-05-2009, 03:17 PM
 
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Quote:
Originally Posted by mamakay View Post
I probably would vax if I had a kid in daycare, though, because there are so many viruses floating around in daycares, and those little viruses predispose kids to invasive bacterial disease.
Other than that, I'm just thinking.
What about prevnar for a 2 year old in a more pre-school environment? I am not so worried about pneumococcal. I know meningitis is a possibility but I think (?) that is pretty rare. Pneumonia is more an issue (?). But the speed of illness and death from meningitis more common with HiB is more a worry to me.
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#70 of 100 Old 03-05-2009, 03:31 PM
 
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Quote:
Originally Posted by Spectrolite View Post
But I have this Japanese study from 1999:
"...breastmilk may inhibit the colonization by respiratory bacterial pathogens of the throat of infants, by enhancing mucosal immunity against respiratory tract infection."

That's why I asked the question above about whether you talking about just adults or bf infants too.
Do they base that on any hard science, or is that just a guess?

Breastmilk Igs might somewhat inhibit colonization in the sense of reducing the density of the colonizing organisms, but that's different from prohibiting colonization alltogether.
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#71 of 100 Old 03-05-2009, 03:34 PM
 
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Quote:
*If a mother is breastfeeding her child up until 2, the child will have pretty good protection against HI infections.
A nonbreastfed, unvaxed child has least protection.

*After age 2, IF children are able to make antibodies to native polysaccharides (unlike the under 2's), the child will have pretty good protection against HI infections, unless, maybe, he's never been colonized before.

(and I assume they ARE, since the article only states that the under 2's can't, which to me means that the over 2's CAN. ? )
Right, but I strongly suspect that the idea that something miraculously changes after age 2 is based on bad science. I think they're getting that idea from their experience with the old Hib polysaccharide vaccine. I, personally, think they might have "connected the dots" wrong there.
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#72 of 100 Old 03-05-2009, 03:39 PM
 
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Quote:
Originally Posted by Spectrolite View Post
http://www.fetalneonatal.com/cgi/con...tract/93/8/670

(Hib in England)

Results: Increased disease risk was noted among children with frequent antibiotic use (adjusted OR (AOR) (trend) 1.51 (95% CI 1.06 to 2.13); p = 0.02) and from sole-parent households (AOR 2.56 (95% CI 1.24 to 5.29); p = 0.01). These two risk factors were further related to each other, consistent with previously reported associations between infection and social deprivation. In fully immunised children, receipt of all three doses of the primary course as an acellular pertussis-containing combination vaccine (DTaP-Hib) increased the risk of vaccine failure (OR 2.88 (95% CI 0.99 to 8.37), p = 0.01). Day care attendance between 2 and 5 years of age was linked with a dose-dependent reduction in risk (AOR (trend) 0.79 (95% CI 0.66 to 0.93); p = 0.01), possibly because of natural boosting of immunity.

So this study is saying that (vaccinated) children going to day care will be at a LESSER risk of contracting HiB because they may encounter it more often, boosting natural immunity. Interesting, since all other studies I've seen (and documents) say that being in day-care is a risk factor.

Would this hold true for unvaxed kids too, givng them a natural boost of immunity (which they theoretically began to acquire after age 2)?
I would *think* that if they were breastfed, it would work like that. If they weren't breastfed, they would just be at an increased risk while very young, and then the risk would plummet quickly after several rounds of colonization or mild infection.
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#73 of 100 Old 03-05-2009, 05:12 PM
 
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I have a question about this too.

My daughter is 2 years old and has had no vaccines. We live in Minnesota with 5 cases of Hib reported in 2008. I didn't realize until I went into the doctor today that this is a big deal and that there is currently a vaccine shortage.

I guess what I really want to know is this: where can I find a current (2009) ingredient list that describes what the vaccine contains?

I would also be curious to find a fairly objective site that outlines statistics related to reported cases of bad reactions to the vaccine in the past year.

This is a difficult thing to decide!
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#74 of 100 Old 03-05-2009, 05:22 PM
 
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check out the package inserts for ingredients or this basic list:


From The Vaccine Book:

ActHIB contains:
HIB sugar/tetanus toxoid complex
sugar water
saline

PedVaxHIB contains:
HIB sugar/Neisseria protein complex
saline
225 micrograms of aluminum


the inserts:

http://www.novaccine.com/pdffiles/Ac...age_insert.pdf

http://www.novaccine.com/pdffiles/pe...age_insert.pdf

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#75 of 100 Old 03-16-2009, 03:20 AM
 
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To jump into the discussion a little late, look at Figure 5 in the following document:

http://bioinfo.bact.wisc.edu/themicr...emophilus.html

Take note, that this figure was pre 1985, so we're talking about the pre-vaccine era. Am I reading this chart right? It looks to me like it says that kids under 3 basically had no bacterial antibodies in their blood against HiB. If this was the case in the pre-vaccine era back when the bacteria was more prevalent, then maybe (with HiB at least) exposure isn't the primary key? With this bacteria, perhaps a very specific age-related immune system issue is the predominant factor?

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#76 of 100 Old 03-16-2009, 11:21 PM
 
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Yes, but what mamakay is pondering is that maybe it isn't about an age-related issue as much as the first time the body is colonized. In which case, a child older than 3 might still not have developed antibodies not from not being able to make them (although now exposure is reduced) but from not being 'properly' colonized. so the risk perhaps of invasive Hib in an older child might be as problematic in a younger child. Factor in to all of this right now is the fact that there is less HI around so the chances of ever being colonized might be slimmer. So the risk could push into a later age.

Go back a few pages and I posted a link about Hib in the UK and the impact of it on adults.

It was primarily the big unknowns and the fact that my daughter is in a daycare environment that I elected to do this one. I was ok with breastfeeding protection I felt she might be getting when she was unvaccinated and in daycare earlier, but now that her breastfeeding is tapering off (she still does, just not as much), I was a little worried with the unkowns.
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#77 of 100 Old 03-17-2009, 10:14 PM
 
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Quote:
Originally Posted by anewmama View Post
Yes, but what mamakay is pondering is that maybe it isn't about an age-related issue as much as the first time the body is colonized. In which case, a child older than 3 might still not have developed antibodies not from not being able to make them (although now exposure is reduced) but from not being 'properly' colonized. so the risk perhaps of invasive Hib in an older child might be as problematic in a younger child. Factor in to all of this right now is the fact that there is less HI around so the chances of ever being colonized might be slimmer. So the risk could push into a later age.

Go back a few pages and I posted a link about Hib in the UK and the impact of it on adults.

It was primarily the big unknowns and the fact that my daughter is in a daycare environment that I elected to do this one. I was ok with breastfeeding protection I felt she might be getting when she was unvaccinated and in daycare earlier, but now that her breastfeeding is tapering off (she still does, just not as much), I was a little worried with the unkowns.
Yeah. What I was trying to point out is maybe the obvious - that colonization maybe doesn't matter that much in kids under 3 at all (other than in a purely negative way) because if their blood generally has no ability to mount an immune response to the polysaccharide capsule (this is why the polysaccharide vaccine didn't work well) -- then, if it invades, you're in trouble. This is why I was asking if the risk of invasive HiB is predominately an age-related risk for young kids, irrespective of exposure and colonization. Colonization with HiB as a child under 3 is probably not a good thing - ever.

What happens in older kids though - now, yeah, that is up for question. Once you gain the ability to mount an immune system response and the bug isn't around for you to develop immunity then is vaccination more important?

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#78 of 100 Old 03-18-2009, 02:28 AM
 
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Is it so that we don't yet know how long immunity lasts with the hib vax?

Does this mean that if it lasts, say 10 yrs, then the bacteria has a chance to revive itself and those whose vax immunity has waned are at risk again? There is no adult booster i assume?
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#79 of 100 Old 03-18-2009, 03:41 AM
 
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http://emedicine.medscape.com/article/218271-overview

Quote:
"In England and Wales, the Hib vaccine was introduced in 1992, and the number of invasive Hib cases in children and adults dramatically decreased. Some felt that this was because of herd immunity due to interruption of transmission from immunized children to those who were unvaccinated. Since 1998, the number of Hib cases has been rising, and, in 2002, 134 cases occurred in children aged 4 years or younger. The increase in invasive Hib in England and Wales was also seen in persons aged 15 years and older and reached prevaccine levels. This was associated with reduced antibody concentration in the older age group. This reduction in herd immunity may be due to reduced transmission of Hib organisms from persons who were vaccinated to adults who were unimmunized, providing fewer opportunities for boosting of natural immunity."
ETA: BTW, sorry for the previous posts re-stating some things that had already been stated. I was thinking aloud before reading the whole thread. I can never find enough consecutive time to sit down in front of my computer and focus on much of anything.

I am beginning to think the risk of Hib is looking more and more scary for the unvaccinated.

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#80 of 100 Old 03-18-2009, 05:30 AM
 
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Quote:
Originally Posted by serenitii View Post
http://emedicine.medscape.com/article/218271-overview



ETA: BTW, sorry for the previous posts re-stating some things that had already been stated. I was thinking aloud before reading the whole thread. I can never find enough consecutive time to sit down in front of my computer and focus on much of anything.

I am beginning to think the risk of Hib is looking more and more scary for the unvaccinated.

I do the same thing all the time, it seems, so apologies from me too. I read something, find it important, then get up from the computer to cook dinner, then return to the comp, read something else, forget it, etc etc. It's hard to keep up with this kind of discussion....esp when i'm new to it...


Re the risk of Hib looking scarier for the unvaxed. but if we want to lower the risks, would that mean the individual, once vaxed as an infant, would have to be boostered all throughout his life to keep the risk at a minimum?
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#81 of 100 Old 03-19-2009, 05:27 AM
 
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http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

Quote:
Recently, there has been an increase in The Netherlands in the number of cases of invasive disease caused by Haemophilus influenzae serotype b (Hib). [snip] The strains were collected from 1983 from 2002, covering a time period of 10 years before and 9 years after the introduction of the Hib vaccine in the Dutch national vaccination program. MLVA revealed a sharp increase in genetic diversity of Hib strains isolated from neonates to 4-year-old patients after 1993, when the Hib vaccine was introduced. Hib strains isolated from patients older than 4 years in age were genetically diverse, and no significant change in diversity was seen after the introduction of the vaccine. These observations suggest that after the introduction of the Hib vaccine young children no longer constitute the reservoir for Hib and that they are infected by adults carrying genetically diverse Hib strains.
Maybe the US is headed down the same theoretical path.

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#82 of 100 Old 03-19-2009, 07:05 AM
 
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genetically diverse strains= strains not covered by the hib vax?
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#83 of 100 Old 03-19-2009, 03:58 PM
 
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Quote:
Originally Posted by serenitii View Post
To jump into the discussion a little late, look at Figure 5 in the following document:

http://bioinfo.bact.wisc.edu/themicr...emophilus.html

Take note, that this figure was pre 1985, so we're talking about the pre-vaccine era. Am I reading this chart right? It looks to me like it says that kids under 3 basically had no bacterial antibodies in their blood against HiB. If this was the case in the pre-vaccine era back when the bacteria was more prevalent, then maybe (with HiB at least) exposure isn't the primary key? With this bacteria, perhaps a very specific age-related immune system issue is the predominant factor?
Do you know how to find the original research that graph is based on?

I found evidence that might conflict with that graph.

http://indianpediatrics.net/april2000/april-414-417.htm

Quote:
The results demonstrated that a high percentage of infants from 1.5 months to 13 months of age had an anti-PRP concentration considered to be protective and their GM anti-PRP titers were also higher than the protective level. Serum anti-PRP in the first few months of age were considered to be maternally acquired and were expected to decrease with time(1,2). In this study, at 6.5 months of age GM anti-PRP titers and the percentage of infants having anti-PRP at protective level showed a decline, but they were not significantly different from those at other ages.
Quote:
The results obtained from our study suggest that the majority of the infants have high concentrations of maternally transferred anti-PRP and have also acquired the natural immunity to Hib at an early period of life
They have a Finish and a Gambian reference for conflicting evidence. Maybe those are the research that figure 5 chart comes from? I'll go see if I can find it...
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#84 of 100 Old 03-19-2009, 04:12 PM
 
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Ok..the indian (well, turkish, actually) study says:

Quote:
In Finland, anti-PRP concentrations were not detected to be within protective level in almost all children under 6 months age(5).
Reference 5 is:

Quote:
5. Peltola H, Kayty H, Sivonen MS, Makela H. Haemophilus influenzae type b capsular polysaccharide vaccine in children: A double-blind field study of 100,000 vaccinees 3 months to 5 years of age in Finland. Pediatric 1977; 60: 730-737.
That's the Finnish 1977 trial the old hib polysaccharide vax was approved in the US with. They were probably just looking at the immune response to the vax. I don't have access to the fulltext, though.

Then about the Gambian study, they say:

Quote:
In Gambia, 60% of infants born to mothers immunized with Hib Conjugate vaccine and 26% of infants of unvaccinated mothers had protective anti-PRP concentration at two months of age(4). In our study the percentage of infants with protective anti PRP antibody level was approximately similar to those found in Gambian infants whose mothers received the Hib vaccine during pregnancy.

Here's the Gambian study. It doesn't tell us anything because those infants were being vaccinated.
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#85 of 100 Old 03-19-2009, 04:55 PM
 
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Quote:
Originally Posted by Spectrolite View Post
genetically diverse strains= strains not covered by the hib vax?
No, they are saying that kids who are infected are now being infected by adults, not other kids. I think they may be speculating that the change in reservoir might be a significant finding when looking for an explanation for the increase in the number of infections.

ETA: When we suddenly change the way bacteria circulate and colonize humans, we can't always predict what will happen. Maybe when kids had and commonly shared genetically similar strains they were better able to mount an immune response but now that they are being exposed to genetically diverse strains more frequently, they are more susceptible. This, of course, also implies some level of vaccine failure but with the stuff I've been reading about DTaP being known to reduce the response to Hib when the shots are given together... who knows?

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#86 of 100 Old 03-19-2009, 05:14 PM
 
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Also...this is slightly off topic, but I'm going to stick this link here so I don't lose it:

http://pediatrics.aappublications.or...tract/81/6/886

Quote:
In recent months much controversy has focused on interpretations of new data concerning the safety and efficacy of Haemophilus influenzae type b vaccines.1-3 These controversies led the Infectious Disease Committee (Redbook Committee) of the Academy of Pediatrics (AAP) on Nov 13, 1987, to issue by telegram a change in recommendations for the H influenzae type b polysac-charide vaccine. Then, on Dec 22, 1987, the US Food and Drug Administration (FDA) licensed a new, more immunogenic, H influenzae type b conjugate vaccine (Prohibit-Connaught).
So putting it all together for the timeline:

According to this (you have to squint to read it)
http://i45.photobucket.com/albums/f7...rion/upeB6.jpg

..in late October or early November of 1987, there was a NIH meeting where the AAP was made aware of this: (tho the study didn't pass peer review until 1988)

http://jama.ama-assn.org/cgi/content...ct/260/10/1423

November 13 of 1987: AAP issues alert

December 22: FDA approves first (not as effective as the ones we use now) conjugate vaccine

January of 1988: ACIP makes recommendation for all kids 15 months and older to be given the new conjugate vaccines instead of the scary polysaccharide ones they were getting.
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#87 of 100 Old 03-19-2009, 05:16 PM
 
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Quote:
Originally Posted by mamakay View Post
Do you know how to find the original research that graph is based on?
I think this might be it but I haven't read it yet (I can't nab more than a few mins at a time today to read anything. ) The chart says the data is pre-1985.

http://www.pubmedcentral.nih.gov/art...i?artid=273954

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#88 of 100 Old 03-19-2009, 05:27 PM
 
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Originally Posted by serenitii View Post
No, they are saying that kids who are infected are now being infected by adults, not other kids. I think they may be speculating that the change in reservoir might be a significant finding when looking for an explanation for the increase in the number of infections.

ETA: When we suddenly change the way bacteria circulate and colonize humans, we can't always predict what will happen. Maybe when kids had and commonly shared genetically similar strains they were better able to mount an immune response but now that they are being exposed to genetically diverse strains more frequently, they are more susceptible. This, of course, also implies some level of vaccine failure but with the stuff I've been reading about DTaP being known to reduce the response to Hib when the shots are given together... who knows?
So...why did it that happen there, but not in the US? Different vaccine? You'd think it would have already happened here if it was going to, but both Hib carriage and invasive disease are at an all time low in the US in adults. Or could it be the fact that we (generally, not sure about the Netherlands) do an extra booster dose or two?
Could doing too few shots in the series have allowed circulation in kids to have continued (albeit at a lower level than prevax), and there's where the selective pressure for genetic diversity came from?
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#89 of 100 Old 03-19-2009, 06:03 PM
 
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Originally Posted by serenitii View Post
I think this might be it but I haven't read it yet (I can't nab more than a few mins at a time today to read anything. ) The chart says the data is pre-1985.

http://www.pubmedcentral.nih.gov/art...i?artid=273954
The IgG goes along with that chart (sorta), but the IgM doesn't. The IgM response is more in line with the Turkish study. With the IgM, there is a slow build from age 6 months that just continually increases.

Also, on this page, there's (only one...I wish it was a larger study) a 6 month old baby with meningitis, and both the IgM and IgG increase significantly over the 6 days the baby is in the hospital.
(first patient here)
http://www.pubmedcentral.nih.gov/pag...geindex=5#page

And he says:

Quote:
The greatest increase in IgG titers obtained in serum samples
from these patients was about 50-fold, which
was observed in a child who was 4 years and 8
months old, and the greatest increase in IgM
titers was about 25-fold, which was observed in
the youngest child (6 months old)
.
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#90 of 100 Old 03-19-2009, 09:42 PM
 
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Also, on this page, there's (only one...I wish it was a larger study) a 6 month old baby with meningitis, and both the IgM and IgG increase significantly over the 6 days the baby is in the hospital.
However, serodiagnosis of H. influenza type b infections might be limited to older children and adults, since it has been found that most young children do not respond with antibody formation either to natural H. influenza infections or to vaccination with purified capsular polysaccharide (12-14). The children with H. influenza infections included in this study (even the 6-month-old child) showed specific antibody responses. Furthermore, it is known that several types of bacteria possess antigens which cross-react with type b polysaccharide (5,18) (e.g., E. coli K-100 [15], pneumococci [19], and other bacteria [1]). Therefore, it is conceivable that such organisms could give rise to antibodies that cross-react with H. influenza type b polysaccharide, which might explain the initial titers, in addition to previous H. influenzae type b infections.

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