CDC link on rationale for Hep B vax for infants - Page 2 - Mothering Forums
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#31 of 49 Old 06-06-2012, 05:36 AM
 
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Originally Posted by Bokonon View Post

 

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.

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#32 of 49 Old 06-06-2012, 05:40 AM
 
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*also, having your baby taken into state custody for less than 24 hours is hardly "any parents worst nightmare".

I completely, whole-heartedly, disagree. 


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#33 of 49 Old 06-06-2012, 06:12 AM
 
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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... 

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#34 of 49 Old 06-06-2012, 06:18 AM
 
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Again, it's not just risky behavior that results in Hep B infection.  

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#35 of 49 Old 06-06-2012, 06:38 AM
 
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nm

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#36 of 49 Old 06-06-2012, 07:06 AM
 
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Again, it's not just risky behavior that results in Hep B infection.  

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Originally Posted by nia82 View Post

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.
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#37 of 49 Old 06-06-2012, 07:49 AM
 
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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). 

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#38 of 49 Old 06-06-2012, 02:30 PM
 
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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.
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#39 of 49 Old 06-06-2012, 05:42 PM
 
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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).

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#40 of 49 Old 06-06-2012, 06:31 PM
 
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Originally Posted by nia82 View Post

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.

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#41 of 49 Old 06-06-2012, 06:40 PM
 
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Ummm...Just wanted to say something here that might cause everyone to stop and think.  If a mother is identified with a Hep B infection prenatally, it is unknown if she will transmit it to the infant.  In these cases it is NOT the Hep B vaccine that is recommended, but the HBIG (immunoglobulin) shot.  It is still recommended that the baby gets 3 doses of the Hep B vaccine to prevent FUTURE transmission from the mother out of utero (such as through breastmilk or blood) but the birth dose of Hep B vaccine does not exist to protect the baby from in utero exposure.  Only HBIG can do that.  It's not known what percentage of babies born to Hep B positive mothers will be born with Hep B, but the (sensible) CDC protocol is to give HBIG to them all.  (And Hep B vaccine to cover future exposure, however if they are going to be immediately adopted, and not going to be further exposed to the mother so might not have any greater risk factor to get Hep B in the future, it is not actually needed.)

 

Think about it if you brought your unvaccinated child to the ER with a tetanus possible wound.  They would give them the immunoglobulin (TIG) for the existing wound, then a dose of tetanus containing vaccine (for later wounds, in hope that you would complete the other 2 doses for the series.)  It works the same.

 

I know this because I am a midwife and we had a woman with Hep B when I was a student.  It was my job to research what to do and how to obtain HBIG for a birth center birth (next to impossible, she eventually had to transfer for a hospital birth just for the HBIG availability).


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#42 of 49 Old 06-06-2012, 06:43 PM
 
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So what I was trying to say is that the birth dose does not exist to protect babies from getting active Hep B infection from their Hep B positive mothers.  It exists to protect them from LATER (external to the uterus) exposure.  So I still don't understand why the primary injection is given at birth to babies who have little risk factors.  Why not just do the first one at 2 months of age like we do for DTaP?  Or later? 


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#43 of 49 Old 06-06-2012, 06:50 PM
 
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That's interesting nuku, that's not what I had read before. It was my understanding that the birth shot was to protect the baby from transmission at birth. Sounds like I need to do some more reading.
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#44 of 49 Old 06-06-2012, 06:57 PM
 
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I didn't know it either until faced with the situation, and neither did the midwives I worked with, because it's rare to have a client with active Hep B.

 

Here is a huge amount of info if you are interested:

http://www.immunize.org/askexperts/experts_hepb.asp

 

Scroll down to where it says "Pregnancy, perinatal, and infant hepatitis B issues".

 

I'd imagine that most OBs might know about HBIG who work with a more high risk population than us homebirth midwives, I hope they do at least!


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#45 of 49 Old 06-06-2012, 07:01 PM
 
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I had always read that the birth dose was to protect from transmission from mom, but I guess I misunderstood and it meant transmission in those first days and not in utero. Either way, thanks for the knowledge!
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#46 of 49 Old 06-06-2012, 07:47 PM
 
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No problem!  I love getting correct and exact information, I imagine you are a lot like me in that aspect, even though our vaccine choices differ.


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#47 of 49 Old 06-06-2012, 08:53 PM
 
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Gosh Nia, I was thinking you were saying she was a healthcare professional living in Asia! Dunno about Germany - I suppose they are acting in a cautious, feelgood sort of way. I'm sure a lot of countries like the US find that since anamnastic response in the absence of antibody levels has been shown to offer protection for at least 20 years in initial responders so the cost isn't really justified.
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Ummm...Just wanted to say something here that might cause everyone to stop and think.  If a mother is identified with a Hep B infection prenatally, it is unknown if she will transmit it to the infant.  In these cases it is NOT the Hep B vaccine that is recommended, but the HBIG (immunoglobulin) shot.  It is still recommended that the baby gets 3 doses of the Hep B vaccine to prevent FUTURE transmission from the mother out of utero (such as through breastmilk or blood) but the birth dose of Hep B vaccine does not exist to protect the baby from in utero exposure.  Only HBIG can do that.  It's not known what percentage of babies born to Hep B positive mothers will be born with Hep B, but the (sensible) CDC protocol is to give HBIG to them all.  (And Hep B vaccine to cover future exposure, however if they are going to be immediately adopted, and not going to be further exposed to the mother so might not have any greater risk factor to get Hep B in the future, it is not actually needed.)

Sure HBIG protects somewhat in the immediate period but it is BOTH vaccine and HBIG that are recommended not just HBIG. So why also give vaccine to those babies born to positive/unknown status mothers? Because if you're going to intervene, you want it to work & HBIG alone isn't adequate to achieve the goal of preventing infant infection. "For an infant with perinatal exposure to an HBsAg-positive and HBeAg-positive mother, a regimen combining one dose of Hepatitis B Immune Globulin (Human) at birth with the hepatitis B vaccine series started soon after birth is 85%–95% effective in preventing development of the HBV carrier state. Regimens involving either multiple doses of Hepatitis B Immune Globulin (Human) alone or the vaccine series alone have 70%–90% efficacy, while a single dose of Hepatitis B Immune Globulin (Human) alone has only 50% efficacy." Babies born to mothers with a high viral load are going to need all the help they can get.
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#48 of 49 Old 06-06-2012, 09:03 PM
 
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Where is that quote from? When we researched it we just found the rec was HBIG alone. But no matter what, even if the best rec is HBIG plus hep B vaccine, this is for hep B positive mamas and their babies. It still makes little sense to me to start the Hep B series in an hours old newborn for those babies that are not at risk?

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#49 of 49 Old 06-07-2012, 09:21 AM
 
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Just click on it - it's from the Talecris HBIG PI but it's on the NabiHB PI as well. I'm sure you can also find it in some of the MMWRs, particularly the ones from the late 80s-early 90s.

I personally agree with you that a birth dose isn't so necessary for infants born to negative moms & I think all negative families should easily be able to make an informed choice to decline. As I mentioned previously, the rationale of that strategy is to create a system less likely to miss babies due to the severity of the consequences: "because errors or delays in documenting, testing, and reporting maternal HBsAg status can and do occur, administering the first dose of Hepatitis B vaccine soon after birth to all infants acts as a safety net." I've had situations where HBIG was given to the wrong baby in the nursery & once it was even given to the mom. I've also had incorrect labs ordered or results misinterpreted numerous times. I'm not saying I think the current US strategy is the right/wrong/best approach but from the perspective of TPTB, it's considered to be of greater benefit to vax babies that might not be high risk than it is to miss ones that need it.
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