9/04/2010

Vaccines: When Concern isn't Anti-Vaccine, Why Hep B is on the Schedule, and Why I Vaccinate my Children

In the previous post, I wrote about anti-vaccine rhetoric being riskier than vaccine injuries. A friend commented that we shouldn't lump all people who are concerned about vaccines as anti-vaxxers. I don't. I never have. Here's the response (and some additional thoughts) I wrote, although I'd also recommend looking directly at the comments in the previous piece, since the comments there may end up being rather interesting.
...
I don't lump people with concerns about vaccines into the anti-vax category; I didn't do that in this piece, nor am I aware that I have done that in any piece I have written. 

Everyone should be concerned about vaccines, medications, and the treatments they use. They should be informed consumers and make the best decisions they can about their health care choices.

Not everyone can be safely vaccinated. They are clearly not anti-vaccine. In addition, there are others who need to space out vaccines. They are clearly not anti-vaccine. 

The nine folks or so who had commented over at Huff were clearly against vaccination PERIOD. Many of the posters at AoA are clearly, admittedly and proudly anti-vaccine at the same time that they are clearly, admittedly, and proudly in favor of giving their children chelators, hbot, IVIG, nicotine patches, oxytocin, and other unproven (in regards to autism) treatments. In other words, they refuse to vaccinate their children on unfounded fears about relative risks while at the same time placing their children at far greater risks from the treatments in order to cure their children of autism. I'm not talking about children with accompanying medical illnesses who get needed and doctor-guided medical treatment (while noting that many such doctors may be giving these parents incredibly BAD medical advice and harming these children).

There are no easy answers; there are an overabundance of questions, and when we fail to both think and act rationally and show compassion to those facing tremendous challenges all while being called on to make incredibly difficult decisions, we short ourselves and our community. 

Less compassion, though, is merited to those who stridently, proudly, and deliberately intend to destroy the vaccine program because they believe it to be the root of all evils. 


...

Many people are concerned about Hep B. Age of Autism, Wakefield, and Kirby turned towards the Hep B vaccine last year as their other vaccine culprits were resoundingly debunked. 

Hep B vaccine is a favorite of die-hard anti-vaccine people. They tout the disease as a sexually transmitted disease and write screeds that there are no needles, drug users, or prostitutes in their homes so babies don't need the vaccine.  The truth is that Hep B worldwide is a huge problem and it isn't just about needles or prostitutes. Death because of Hep B is almost entirely preventable with vaccine use. 

According to WHO:

"Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease.
The virus is transmitted through contact with the blood or other body fluids of an infected person - not through casual contact.
About 2 billion people worldwide have been infected with the virus and about 350 million live with chronic infection. An estimated 600 000 persons die each year due to the acute or chronic consequences of hepatitis B.
About 25% of adults who become chronically infected during childhood later die from liver cancer or cirrhosis (scarring of the liver) caused by the chronic infection.
The hepatitis B virus is 50 to 100 times more infectious than HIV.
Hepatitis B virus is an important occupational hazard for health workers.
Hepatitis B is preventable with a safe and effective vaccine."
And here, in a concise nutshell, is why babies are inoculated against Hep B: "The virus incubation period is 90 days on average, but can vary from about 30 to 180 days. HBV may be detected 30 to 60 days after infection and persist for widely variable periods of time."

The factsheet continues:
"All infants should receive the hepatitis B vaccine: this is the mainstay of hepatitis B prevention.
The vaccine can be given as either three or four separate doses, as part of existing routine immunization schedules. In areas where mother-to-infant spread of HBV is common, the first dose of vaccine should be given as soon as possible after birth (i.e. within 24 hours).
The complete vaccine series induces protective antibody levels in more than 95% of infants, children and young adults. After age 40, protection following the primary vaccination series drops below 90%. At 60 years old, protective antibody levels are achieved in only 65 to 75% of those vaccinated. Protection lasts at least 20 years and should be lifelong.
All children and adolescents younger than 18 years old and not previously vaccinated should receive the vaccine. People in high risk groups should also be vaccinated, including:  
persons with high-risk sexual behaviour;
partners and household contacts of HBV infected persons; 
injecting drug users; 
persons who frequently require blood or blood products;

recipients of solid organ transplantation;
those at occupational risk of HBV infection, including health care workers; and
international travellers to countries with high rates of HBV.
The vaccine has an outstanding record of safety and effectiveness. Since 1982, over one billion doses of hepatitis B vaccine have been used worldwide. In many countries where 8% to 15% of children used to become chronically infected with HBV, vaccination has reduced the rate of chronic infection to less than 1% among immunized children.
As of December 2006, 164 countries vaccinate infants against hepatitis B during national immunization programmes - a major increase compared with 31 countries in 1992, the year that the World Health Assembly passed a resolution to recommend global vaccination against hepatitis B."

There are good reasons for having children vaccinated against Hep B. Are the risks here in the US as great as they are elsewhere? No, they're not, but it doesn't mean there is no risk. According to NNii, these are the main reasons why infants and children should receive the Hep B vaccine (I don't know what's with the apparent code in the quotation; I've kept it there since I'm quoting verbatim):
"Why Parents Should Vaccinate Their Children against HBV 
While HBV is most effectively transmitted from one person to another through blood and body fluids by sexual contact, injection drug use, or occupational exposure,
  •  As many as 16%-30% of hepatitis B cases have no known source of infection.[fn]CDC.Sentinel Counties Study of Viral Hepatitis (1992-1993, unpublished data)[/fn] [fn]CDC, National Immunization Program (NIP). (2004). Hepatitis B. In Epidemiology and prevention of vaccine-preventable diseases (“The Pink Book”) (8th ed.). Atlanta: Author.[/fn]
  • Mothers who have chronic HBV infection can transmit the virus to their newborns. They are often unaware that they are HBV infected. There are specific recommendations for the management of infants born to either HBV infected mothers or to mothers with unknown HBV infection status.[fn value=”1”][/fn]
  • For children, the most common sources of HBV infection is from their mother at birth or subsequently, or by transmission from an infected household contact.[fn value=”2”][/fn] 
  • Unvaccinated children in families with no known risk factors are still at risk of infection through normal play activities. The sources of their infection are unknown but HBV could be transmitted through contact of non-intact skin (as occurs in school yard abrasions), by sharing contaminated inanimate objects (such as toothbrushes, towels, or bed sheets), and by being bitten.[fn]Shapiro CN, McCaig LF, Gensheimer KF, et al (1989). Hepatitis B virus transmission between children in day care. Pediatric Infectious Diseases Journal 8:870-875.[/fn] [fn]Oleske J, Minnefor A, Cooper R Jr, et al (1980). Transmission of hepatitis B in a classroom setting. Journal of Pediatrics 97:770-772.[/fn] [fn]Daseda CC, Shapiro CN, Carroll K, et al. (1994). Hepatitis B virus transmission between a child and staff member at a day-care center. Pediatr Infect Dis J13; 828-30.[/fn] Thus, children whose families seemingly are not at risk of HBV infection may also be at risk of becoming HBV-infected, as there is no way to know which child will eventually be exposed. 
  • Teenagers have increased risk of HBV exposure when they become sexually active.
For these reasons, HBV vaccine is recommended for everyone 18 years and younger, starting with the first dose shortly after birth (prior to discharge from the newborn nursery).[fn value=”1”][/fn] Of course, anyone with risk factors should also be immunized no matter what their age.[fn value=”1”][/fn]"
When we get our information from sources who insist that vaccines are injected into the bloodstream, that studies of a dozen monkeys or a case series of a dozen children are persuasive science but studies with a half a million children or more are not, we're going to make decisions based on misinformation and fear instead of on reliable information. Sites that provide a voice to such heated, dismally wrong rhetoric promulgate misinformation. We have to, in order to reject the information we are exposed to, actively consider it and question it; otherwise we accept it wholesale, without the realization that we have done so. Reading such sites convey real risks that we may, without any overt awareness, accept bad information as good information and proceed to make poorly informed decisions. 


We should make our health care decisions based on factual information and reason. We should, I believe, where we can safely vaccinate ourselves and our children, do so, both to protect ourselves and our community. I do believe in the greater good and personal responsibility. Not everyone, though, does. And not everyone who chooses to forgo vaccination is doing so because they shun the common good. 


I accept, acknowledge, and appreciate that vaccination is a personal decision. It is, though, a personal decision with public and community ramifications. People get to make their own health care decisions, but it doesn't mean that at times there aren't consequences to those decisions. It also doesn't mean that the community doesn't have the right to insist that in order to partake in community programs individuals have to be vaccinated. 


Because I am aware that not everyone around my children is vaccinated and that vaccination is not 100% effective, I choose to have my children vaccinated in order to give them the best possible chance to avoid catching an infectious disease. We can't avoid all possible infectious disease through vaccination; we must watch, sometimes helplessly, as our children fight infections. Where I can safeguard my children, I will.


*I have friends who do not vaccinate their children. I am not condemning them; I am stating my position. I respect individuals' rights to make different healthcare decisions. 


I do not, though, believe people who are disseminating inaccurate information have a right to do so without being countered. 



9 comments:

Autism Mom Rising said...

I'm sorry Kim. I meant that philosophically, that in general they shouldn't be lumped together, as so often they have, not that you specifically have done that. People will always make bizzare comments on those websites and there are those out there who would tie anyone who questions to those others. I was cautioning against that.

My son's entire body turned yellow within an hour of getting a Hep B shot. That is why I wish I had done more research. If I had done so I would have seen that, not having that condition myself and since he wasn't going to daycare, he did not need to have it at birth. It could have waited. We still, back then, we would have choosen to do most other vaccines on schedule.

My son has some weird immune system glitches whereby he suffers from systemic inflammation, from brain, to GI tract, to urinary tract and he suffers badly from it. Until we get a handle on that we are keeping him away from massive pro-inflammatory agents like aluminum. In his case it is not the viruses about which I worry, it is the aluminum.

KWombles said...

Thanks for clarifying. I agree with you philosophically on the need to not lump reasonable caution in with those who are not well grounded in reality. :-)

I think that the standard policy of vaccinating for hep B on the first day of birth has some real risks, but I also understand why the medical establishment has the policy; with there being no absolute way to know if the mother transmitted the disease (despite not testing positive for it), there is a clear need to err on the side of caution.

However, that means some babies may get the vaccine and suffer an adverse event. That's why I believe that vaccination should remain a personal decision: we each have to live with the consequences of our decisions. It's also why parents need to have good information, why doctors should spend more time in educating patients, and why nurses should have a thorough grounding in these issues since they are most likely to engage in patient education.

Autism Mom Rising said...

I have had people cyber yell at me: "You're anti-vaccine, you're anti-vaccine", even after I explain to them that I am a Menningitis survivor and therefore could never be comprehensively anti-vaccine. The very matter of my having certain concerns, in their minds, renders me in the "anti-vax" category.

We know that some people get Guillane Barre from flu shots. That is not in dispute. And, some babies have anaphalactic (sp?) reactions to shots. Yet, I don't know of any program that studies these people to find out what makes them vulnerable to such reactions, in order to protect similiar others in the future. Why aren't they studying this, I wonder?

People don't like having to stick their arm out or their child's without knowing their individual risk. I think making an effort to study those who have been geniunely vaccine injured to learn what is different about them could go a long way in restoring faith in the vaccine program (by those who have lost it, I mean), much more so than the shaming and coersive tactics that are upon them now.

I have this rare sensitivity to medication. I cannot take meds, even at 5 year old's doses, without severe side effects. It is debilitating. So, if I cannot take prescription meds even at a five year old doses I have serious concerns about what might happen if a med (or vaccine) is injected directly into my bloodstream, so I don't get flu shots. As far as I know they have not studied people like me (a rare subset of people of Celtic decent, this med sensitivity).

True anti-vaxxers don't like talking to me because, unlike them, I do believe vaccines work. They use the fact that some people who have been vax'd get the disease for which they had the shot as evidence that vaccines don't work at all. I disagree. That person could have a primary immune deficiency, in which case you could give him 100 shots and none of them would take. There are a lot of reasons why an INDIVIDUAL might get a disease for which he had a shot. I don't agree that disease went away just because of modern sanitation. That might be true for Typhoid, but not Polio and some of these others. The arguments just fall short. Small pox is the perfect example. It had to be the vaccine. Within 100 years that disease was erradicated in all but small pockets in the countryside, where they didn't have sanitation problems like the urban areas.

Thanks Kim for providing an area for nuanced discussion. I literally have found no other place that tolerates that and I've looked. You and I remind me of (metaphorically speaking) the difference between a liberal republican and a conservative democrat. They agree on most things, they only differ on where they lay their emphasis.

KWombles said...

You always provide plenty to think about and discuss.

I think that if one is interested in genuine dialogue, yelling at people isn't particularly effective. I would, however, argue that I don't tolerate anything. Okay, maybe going to the dentist. But just barely! :-)

Tolerate, to me, means to put up with and to do so with no genuine interest or appreciation for whatever it is one is tolerating.

I appreciate when folks leave thoughtful comments offering their opinions, and I'm happy to discuss things. I get frustrated occasionally when folks (and they know who they are) choose to twist or misrepresent what I'm saying, but even then I'm not tolerating them. They took the time to come visit and share of themselves, even if what they shared wasn't particularly nice. :-) I can and do appreciate that. Acceptance, appreciation, and accommodation aren't just about our kids. It's about each other, too.

Alright, to the meat of your concerns, that people out there don't even tolerate people who think differently and you don't quite fit at the anti-vax sites, and you are unwelcomed by the pro-vax sites.

KWombles said...

By and large, people don't accept those with differences; they use these differences as excluders to create a tight-knit ingroup. So, I have no doubt that if you commented at other places like Huff, Respectful Insolence, and other large sites, that you'd be castigated and marked as an anti-vaccine person because some of your rhetoric is similar in tone to true anti-vaxxers and that's enough to signal to the pro-vax folks their excluding criteria.

These particular sites aren't meant to locate commonalities across the group despite the differences (well, at least not in regards to vaccine/science issues); the more heated the discussions, the more page views. They aren't about community building (and neither is AoA), except for that broader categorization of pro-anti, and using another group to define themselves in opposition to. That's okay; there's nothing wrong with that. Each person gets to decide what to do with his or her own site and what the purpose is. Orac's site is about providing scientific information rebutting woo with a heavily snarky tone. I veer to snarky upon occasion, too. In fact, I've been called Orac in a skirt several times by someone who didn't appreciate where some of my posts went.

I believe that we have more important things within the autism community itself to work on than personally hammering down every person we disagree with (even when that works as a stress reliever); it may be that in real life these people are sweethearts who work hard and across party lines and use the online forum to vent. I have a feeling, though, that you see more of the true person when he is protected under a cloak of anonymity online than you would in real life, where he can wear a social mask.

So how do I handle areas where I know we (a general we, not specific to you) disagree, even on issues of basic facts (or interpretations of facts)? It depends on who it is I'm disagreeing with and what the context is. Is the person selling other people something? Doing harm to the greater good? Intentionally out to hurt another? Continually engaging in misrepresenting someone's position? Lying? Then, I may counter and sometimes I will use terms like dumbass. I may choose to not respond. I try to ask what purpose my countering it would serve and what tact best serves this and go from there.

I know that we don't agree on some very basic things regarding scientific and medical information, AMR, and yet I don't need to label you because of that or argue you on each point. I'm sure we have different spiritual and religious beliefs, and I'm good with that; I try to view differences in other areas in the same light.

So what happens is, at least to my mind, is deciding if you are trying to convert me to your way of thinking, and am I trying to convince you I'm right, or are we sharing where we're coming from so that we can better understand and support each other? I believe the latter to be true.

I believe that we need to redraw the lines from a black and white dividing line (pro/anti vax, alternative treatments/traditional, curebies/neurodiversity -- none of which are accurate dividers) that keeps families separated and unsupported to something similar to what interfaith groups have, we will be able to accomplish the more important goals of making the world a better place for our children. And indeed, if we cannot get past polarizing two-dimensional thinking, how will we ever be able to teach our autistic children something beyond literal thinking?

lizsjohns said...

I believe vaccines are a problem, maybe not all but something strange is going on. I believe there are people in control doing some funny things. I am always finding some kind of new evidence backing up the conspiracies for example ~ Anyone ever hear of the Georgia Guidestones? Go ahead and take a look, I was shocked to see this on State/Government property!

You believe what you want but as long as you continue believing everything is alright then you are going to get a rude awakening call only after it's too late to fix or change it...

Wife and mother of 3 beautiful girls
Seattle, Wa

KWombles said...

Liz,

I appreciate you taking the time to visit the blog and comment.

I think perhaps you missed the point of the post. It's important to be aware of the potential risks of vaccines, medications, and treatments. We should be well-informed, scientifically literate and make the best choices we can for our families. I'm not particularly interested in beliefs; what matters is what the evidence shows, the logic and reasoning behind hypotheses that can't be or haven't been tested, and the potential risks.

One of the skeptic's tools is that extraordinary claims require extraordinary evidence. I don't believe that the vague threat that some day I will be in for a rude awakening because I choose to be well-versed in the scientific literature and rational in my decision making is sufficiently rigorous evidence. I may indeed be in for one, but it is science that will provide the evidence for that, not conspiracy theories.

:-)

Mrs. C said...

Hi, Kim! Was my last comment "overly rude?" Because it wasn't meant to be, but I don't see it anywhere... it's your blog, and sorry if I offended you, but I do think gardasil, flu and chickenpox are un-necessary shots in terms of things that ought be remotely required for school attendance.

So, did you delete my comment or did it wind up in spam?

KWombles said...

Mrs. C,

no, it was fine; it's over at the wordpress countering (countering.wordpress.com); the comments only show at the particular blog you put it on. :)I responded back to it. If you want to copy and paste it here, too, that's okay by me.

I've got about an equal number of readers at both blogs, so I'm keeping them both updated; I just stagger the blogposts.

I almost never delete a comment!