CDC link on rationale for Hep B vax for infants - Mothering Forums

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Old 06-03-2012, 02:56 PM - Thread Starter
 
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Found this link recently and would like to share - as said in title, it discusses the rationale behind Hep B immunization for infants.


http://www.cdc.gov/mmwr/preview/mmwrhtml/00033405.htm


Pro rights (vaxes).
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Old 06-05-2012, 08:30 AM
 
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Thanks for posting this, mama.  I meet so many people who misunderstand the hep B vaccine.  Hep B is a real risk for children, there are thousands of cases a year of children under 10 contracting it, about half are NOT from their mothers, and children are far far more likely to develop a chronic lifelong case than adults, they are also at greater risk for liver cancer.  Even among adults there are a lot of cases among people who do not have particular risk factors (drug use, promiscuous sex)  Child to child transmission happens often enough that it's not "just" a STD, and I dont' think people realize that when they decide to wait until their child is older since their toddler isn't sharing needles.

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Old 06-05-2012, 08:37 AM
 
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http://www.chop.edu/service/vaccine-education-center/a-look-at-each-vaccine/hepatitis-b-vaccine.html

Quote:

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).

About 9,000 of the 18,000 children infected in the first 10 years of life caught the virus from their mother during birth. However, many young children didn't catch the disease from their mother. They caught it from either another family member or someone else who came in contact with the child. Because hepatitis B can be transmitted by casual contact, and because many people who are infected with hepatitis B virus don't know that they have it, it is virtually impossible to be "careful enough" to avoid this infection

 

The birth dose of Hep B is the only real chance we have of protecting children from catching hep b from their mothers at birth.  If that dose isn't given in the first twelve hours that chance ot protect the child is gone.  I felt comfortable skipping the birth dose because I know my hep B status, but many people who have hep B have no idea.  That's why the birth dose is public policy.

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Old 06-05-2012, 01:08 PM
 
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But every mother in the US is tested for HepB in pregnancy. I don't know how anyone can get out of the test? You get routinely tested for HepB/C, HIV, chlamydia, gonorrhea in pregnancy. Especially if you want a waterbirth (then it's absolutely necessary or they won't let you waterbirth).

 

 

Instead of making a one size fits all mentality, it is much better to focus on risks groups and deliver special programs to risk groups.

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Old 06-05-2012, 01:16 PM
 
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Not every woman in the us even receives prenatal care, let alone getting tested for all those things.
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Old 06-05-2012, 01:20 PM
 
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And if you read the link in the original approach it explains how they tried the risk group approach and it wasn't effective.
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Old 06-05-2012, 01:49 PM
 
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Also, Rachel didn't say that it is irresponsible of someone who knows their Hep B status at the time of giving birth to decline the vax. Quite the opposite. My ds did not receive Hep B at birth because it was not offered at the birthing center where I delivered, but I was tested and had it been positive I may have been risked out.

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Old 06-05-2012, 01:55 PM
 
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Originally Posted by Rrrrrachel View Post

Not every woman in the us even receives prenatal care, let alone getting tested for all those things.

83% of women received timely prenatal care, that is first trimester care, in 2001, obviously that was 11 years ago, but it is probably not hugely different now. So that is a good majority of women that know their HepB status.


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Old 06-05-2012, 01:56 PM
 
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And can very easily opt out of the birth dose of hep b.
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Old 06-05-2012, 02:29 PM
 
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In my state, women are not only tested prenatally but also at the time of delivery.
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http://www.chop.edu/service/vaccine-education-center/a-look-at-each-vaccine/hepatitis-b-vaccine.html

The birth dose of Hep B is the only real chance we have of protecting children from catching hep b from their mothers at birth.  If that dose isn't given in the first twelve hours that chance ot protect the child is gone.  I felt comfortable skipping the birth dose because I know my hep B status, but many people who have hep B have no idea.  That's why the birth dose is public policy.

I'm interested in understanding the context of those CHOP stats regarding pediatric transmission. I do also find it interesting that their statement regarding casual contact as a source of transmission is misleading & contrary to the CDC's position that casual contact is not problematic. They seem to imply that half of pre-vaccine era infections in children <10 years old are acquired from casual contact. While prolonged, close personal contact (such as household contacts might have) is indeed a risk factor, I find that their statement might mislead some people into thinking that casual social contact is a big risk for infection. I find misleading people using scare tactics to be a turn-off.
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Old 06-05-2012, 02:36 PM
 
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That's great that they test at the time of delivery! I didn't realize the turnaround was that fast but that's awesome. I'm not sure what you mean by the context of the chop stats. I have read that hep ban be spreads by sharing tooth brushes or razors as well as if children bite each other. So I guess it depends on how you define casual contact.
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Old 06-05-2012, 05:26 PM
 
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And can very easily opt out of the birth dose of hep b.

For many of us, it's very difficult to opt out of the birth dose of Hep B.

My child was given Hep B without my permission and against the written instructions in his chart.

And these parents had their newborn taken from them because they refused the hep B shot, even though there was no medical indication for the shot: http://www.thehealthyhomeeconomist.com/mother-who-questions-vax-at-hospital-has-newborn-taken-away/
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Old 06-05-2012, 05:35 PM
 
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Those are a handful of extreme and not typical examples.
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Old 06-05-2012, 05:39 PM
 
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Originally Posted by Rrrrrachel View Post

And can very easily opt out of the birth dose of hep b.

For many of us, it's very difficult to opt out of the birth dose of Hep B.

My child was given Hep B without my permission and against the written instructions in his chart.

And these parents had their newborn taken from them because they refused the hep B shot, even though there was no medical indication for the shot: http://www.thehealthyhomeeconomist.com/mother-who-questions-vax-at-hospital-has-newborn-taken-away/

Mine was given it without my permission also, they didn't even discuss it with me, they just did it. Same with the BCG. This was 22 years ago in Hong Kong. I wasn't very savvy all those years ago though unfortunately.


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Old 06-05-2012, 05:42 PM
 
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Those are a handful of extreme and not typical examples.

I doubt that you are an expert on what is typical hospital policy.
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Old 06-05-2012, 05:42 PM
 
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Those are a handful of extreme and not typical examples.

So that makes it okay?


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Old 06-05-2012, 05:47 PM
 
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No, it doesn't make it ok, but it doesn't change the fact that moms can decline hep b at birth.

I feel pretty confident that vaccinating children against their parents will is not hospital policy.
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Old 06-05-2012, 06:01 PM
 
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Thanks for posting this CDC link. I was under some false impressions, and I realize now that I need to take a better look at how many actual infant cases there are that are not passed from the mother.





Quote:
Originally Posted by Taximom5 View Post

For many of us, it's very difficult to opt out of the birth dose of Hep B.
My child was given Hep B without my permission and against the written instructions in his chart.
And these parents had their newborn taken from them because they refused the hep B shot, even though there was no medical indication for the shot: http://www.thehealthyhomeeconomist.com/mother-who-questions-vax-at-hospital-has-newborn-taken-away/

I've seen this link posted several times, and while I think it's awful that the parents had to go through that, but I do think that it's a pretty uncommon experience. I live in rural Kentucky and have had no problems saying "nope" to any and all newborn medical interventions. Also, we havent had a problem not leaving the babies side. I think it's pretty common for parents to remain with their babies at all times now a days. I know there are reasons that mothers and fathers get separated from their children at birth, but most people dont. Most people have no reason to ever have a nurse handling their baby, let alone to be away from them long enough for them to get shots. Most people are not getting their babies taken away because they declined a vaccine, in fact, this is the only recent instance Ive heard of.

*also, having your baby taken into state custody for less than 24 hours is hardly "any parents worst nightmare".

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Old 06-05-2012, 06:25 PM
 
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Thanks for posting this CDC link. I was under some false impressions, and I realize now that I need to take a better look at how many actual infant cases there are that are not passed from the mother.
I've seen this link posted several times, and while I think it's awful that the parents had to go through that, but I do think that it's a pretty uncommon experience. I live in rural Kentucky and have had no problems saying "nope" to any and all newborn medical interventions. Also, we havent had a problem not leaving the babies side. I think it's pretty common for parents to remain with their babies at all times now a days. I know there are reasons that mothers and fathers get separated from their children at birth, but most people dont. Most people have no reason to ever have a nurse handling their baby, let alone to be away from them long enough for them to get shots. 

 

1 in 8 babies is born prematurely - that's a lot of infants who may have to be in the NICU.  Yes, it's probably common for a full-term, healthy baby to be able to stay with mom, but many babies don't, and we've all read stories about babies given formula or circ'ed without parents' permission, so it shouldn't be surprising that some babies are also vaccinated without parents' permission.

 

I'm not saying it's common, but it happens.


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Old 06-05-2012, 06:38 PM
 
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Are babies really vaxed in the nicu? My doc wont even vax with a cold, it seems silly to vax with a child who is in the nicu.

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Old 06-05-2012, 06:43 PM
 
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Are babies really vaxed in the nicu? My doc wont even vax with a cold, it seems silly to vax with a child who is in the nicu.

 

I completely agree, but it happens.  It wasn't an issue in my NICU, but I've known moms with NICU babies who were given Hep B in the NICU, and were bullied about DTaP if they were already 2 months before discharge (even if they weren't even at term yet!!).


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Old 06-05-2012, 06:47 PM
 
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Current recommendations, I believe, say to vaccinate premies on schedule without adjusting for prematurity. That doesn't mean parents have to do that, though. They can always decline. smile.gif
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Old 06-05-2012, 07:03 PM
 
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Current recommendations, I believe, say to vaccinate premies on schedule without adjusting for prematurity. That doesn't mean parents have to do that, though. They can always decline. smile.gif

So you do you think the CDC is correct that it is safe to vaccinate premies on schedule without adjusting? Has the current vaccine schedule been studied in premature infants, so that they can be sure it is safe? Do the majority of parents of premies know they can decline, when many are told they cannot take their baby home from the NICU unless they are vaccinated for HepB?


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Old 06-05-2012, 07:05 PM
 
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I have never seen any indication parents are told they cant take their babies home without hep b.
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Old 06-05-2012, 07:08 PM
 
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And the recommendation I'm referring to comes from the aap not the CDC.

http://pediatrics.aappublications.org/content/112/1/193.full
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Old 06-05-2012, 07:21 PM
 
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I have never seen any indication parents are told they cant take their babies home without hep b.

 

Just because you haven't seen any indication of this, it doesn't meant it doesn't happen.

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And the recommendation I'm referring to comes from the aap not the CDC.

http://pediatrics.aappublications.org/content/112/1/193.full

Okay, then substitute the AAP for CDC in my questions.


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Old 06-05-2012, 07:27 PM
 
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Right, but just because you say so doesn't mean it does, either. I don't believe that parents are told that. When I see something that indicates to the contrary ill reassess that position.

If you follow the link I gave you you will see some of your questions answered there.
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Old 06-05-2012, 10:16 PM
 
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I think part of the problem some nonvaxing parents face is that great effort has been made (and successfully implemented widespread) to create systems that standardize the hep b processes in l&d units and in newborn nurseries so that at-risk babies dont miss postexposure prophylaxis. Reason being, the consequences of infection are so detrimental for those infants.

The standard encouraged (and implemented in all major facilities in my metroplex) involves a set of standardized admission orders for mothers & babies that are implemented in an almost automated way by staff. So it may not be that there is necessarily ill intent on the part of hospital staff, it may just be that they are sort of "on auto-pilot" due to the systems in place coupled with a relative rarity of experience working with nonvaxing parents.

I can also see how encounters with protective services might arise on occasion. Because policies regarding postexposure prophylaxis are time sensitive, if you have a situation for some reason where a mom cannot be tested within 12-24 hours of delivery & she refuses prophylaxis or if she's known positive & refuses then the concern again becomes the severity of consequences of potential infection in a newborn. I think some states may even have laws requiring cps to be notified in those cases. But I think it may be a bit of a scare tactic for anyone to imply that moms tested negative prenatally or at delivery will routinely be reported for deferring hep b vaccine.
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Old 06-05-2012, 10:23 PM
 
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Current recommendations, I believe, say to vaccinate premies on schedule without adjusting for prematurity. That doesn't mean parents have to do that, though. They can always decline. smile.gif

 

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.


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Old 06-06-2012, 06:25 AM
 
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And these parents had their newborn taken from them because they refused the hep B shot, even though there was no medical indication for the shot: http://www.thehealthyhomeeconomist.com/mother-who-questions-vax-at-hospital-has-newborn-taken-away/

 

I thought that was a case where the mother had been shown to be HepB positive, so the hospital had reasonable concern that the child would get the disease if not vaccinated? Sorry I don't have time right now to read your link and chase it up on other sites, but there was one recently like that. I bet there were other flags too. My friend who is a social worker says these scare stories in the press are never as clear cut as they are presented. 


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