Kaytee

I know you did't ask me, but Hep B is pretty prevalent righ tnow. Its being brought in from Mexico

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Lissa

Does this mean that I need to be immunized?

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Ari2

The strongest argument for Hepatitis B vaccination is the potential for chronic disease and its possible consequences. In addition to a short-term illness, Hep B can cause chronic hepatitis. This can progress to cirrhosis and liver failure, requiring a transplant. It also significantly raises the risk of liver cancer. Unfortunately, if you get Hep B as a young kid you are at greater risk to get the chronic disease than if you got it as an adult. While people like to scoff at the idea of young kids getting Hep B ("I don't think my baby has multiple sex partners or shares IV drug needles" etc), prior to the vax being offered nearly 20% of the US cases of chronic Hep B were from childhood infection.

In comparison, the Hep B vax is safe and usually provides decades-long immunity. While none of us like to think this way, we can't entirely predict whether our kids will have multiple sex partners, engage in safe sex, use IV drugs, or do other risky stuff when they are older. So for most the benefit of the vax outweighs the possible risks of the disease.

For Hep A, the situation is different. Unlike Hep B (or Hep C), Hep A has no chronic state. It is spread by ingesting the the virus, usually on food that has been handled by someone who didn't wash up properly after using the bathroom. (In contrast, Hep B is blood-borne.) If you get Hep A naturally, you are immune for life. In developed countries, Hep A is most frequent in kids ages 5-17, and the majority of infected kids either have no symptoms at all or very mild symptoms.

Here's the main rationale for the vax as I see it: Hep A can be a nasty disease, especially after childhood. Case reports (so a little iffy) before the vax put the death rate in the US at 0.01-2%. Short of death, people can develop what is called "fulminant Hep A", which means big-time liver problems that can lead to problems clotting (so you bleed like stink) and encephalopathy. In 30-60% of cases, people with fulminant Hep A recover spontaneously (so they don't need a transplant or other big intervention) and have no long-term problems. The remaining 70-40% (the fact that there is a huge range here should raise some concerns about 1) the quality of the data and 2) the variability of the people involved) generally recover completely but require a lot of care. The ones who don't are the 0.01-2% who die and the unknown-but-likely-also-very-small percent who had long-term problems.

In contrast, the Hep A vax is also seen as being safe. The long-term efficacy, however, is unknown. So no one can say how long the immunity of the vax or any boosters will last. It is known that the body mounts 10-100 times less of an immune response to the vax than to the natural viral infection.

HTH.

Lissa

Do adults need to be immunized if they weren't as children?

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Ari2

The most recent CDC stats are from 2006. These show a steady decline in Hep B in the US since the mid-to-late 80s. For 2006 the overall rate was 1.6 cases per 100,000 people with a total of less than 5,000 cases reported in the US.



The CDC also puts the prevalence of chronic Hep B as low (less than 2%) throughout North America, including Mexico. You can see it on this map (I can't get it to display): http://wwwn.cdc.gov/travel/image.ashx?i=256

But I don't know more recent figures.

Ari2

For Hep A you probably get infected as a kid, didn't realize it because you had no symptoms, and are now immune for life. The CDC and others have also noted that US adults seem to have strong herd-immunity: More people are immune and this is decreasing the risk of transmission to the non-immune. To be careful, you can take all the sensible precautions: washing your food, eating a clean-appearing restaurants. For adults, the vax isn't recommended except for a few exceptions: men who have sex with men, people who travel to risky places, people with possible occupational exposures, drug users (especially IV drugs), and folks with chronic liver disease or who rely on infusions of clotting factors because of some sort of clotting problem.

For Hep B, the vax recommendation for adults is similar: No vax unless you are in a high-risk group (e.g., HIV+, end-stage kidney disease, chronic kidney disease, occupational exposure, the same sex and lifestyle stuff as with Hep A, people with household members with Hep B, etc.). But with Hep B it is not uncommon to get a blood test to show whether you are immune if there is a concern or if you need proof of immunity for work in a hospital, clinic, or other higher-risk place. This usually isn't done for Hep A.

Lissa

Thanks AGAIN Ari.

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Ari2

Np, Lissa.

Ari2

So you have the measles vax scheduled for next week, you have titers scheduled for June/July to determine immunity, and you have decided against the MMR and will defer further scheduling until age 3. This is a schedule, even if it is abbreviated, delayed, and not established all at once (I understand your caution after Nicole's reaction).

To have no schedule at all would mean random vaxes at random intervals. This wouldn't work for anyone, the ped, the clinic, or the parent. And if a parent decides the kid will be vaxed early in life, this needs to be established early.

I'm not saying that every kid needs to follow the recommended schedule. While I think it can cause problems on a larger scale, I believe parents should have a say in the vaxes their child receives. But to do this requires some sort of schedule, be it the CDC's, Dr. Sears', or something like you have put together with your doc.

It seems like we probably aren't in that big of disagreement about this and just misunderstood each other a bit.

Kaytee

Yep. For the most part. There is no schedule though, other then we keep going. The immunity testing is not for the measles vax she will be getting as it takes 6 months before they can even begin to test it. So she is being tested for the IPV, DTaP, and Hep B.
So the schedule I follow is just in my head lol. Her doc is perfectly fine with it. The problem with schedule that I have (personally) is it locks you into a time table thing, and we don't do that. As of yesterday she was not getting the measles vaccine at all because her doc could not find it for me. So we were not going to give it. When she called and said she found it, I made an appointment.

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If you can't stand behind our troops, feel free to stand in front of them!
http://www.spcnicholasidalski.com