Friday, December 3, 2010

Let's Learn About Hepatitis B Infection and Vaccination


Due to the overwhelming complexity of the vaccine topic and the overwhelming amount of information available, this post does not represent a debate or assertion. I simply hope to provide basic access to information about the vaccine with some questions tossed in so that parents can begin their own research.



Hepatitis B

Hepatitis B, also abbreviated HBV, is a viral, infectious illness. The virus enters the liver, causing inflammation called Hepatitis. Hepatic (liver) + itis (inflammation) = inflammation of the liver.

The lightest cases are asymptomatic (meaning the person has no symptoms). The general cases include body aches, vomiting, mild fever, dark urine and jaundice. The worst cases develop into liver disease. The illness typically lasts 2-3 weeks, but some people are at risk of becoming chronic carriers or chronically infected.

HBV is transmitted through blood. Transmission routes include sexual contact, blood transfusions, contaminated needles and childbirth. Some people warn that other routes such as sharing razor blades could possibly transmit the virus.

Diagnosis is made by assay (testing) to find evidence of the virus (viral antigens or antibodies). It should be noted that these tests are fairly complicated and unreliable.

You can read a summary of the illness, symptoms and test procedures here:

Hepatitis B Treatment Summary

Like any illness, it runs its course in the average person.

Hepatitis B infection does not usually require treatment because most adults clear the infection spontaneously."
http://www.gastro.theclinics.com/article/S0889-8553(06)00102-6/abstract

That being said, contracting the illness during childhood is the opposite of other mild illnesses. You know how chickenpox is generally mild during childhood but generally severe during adulthood? It appears to be the opposite for HBV. If a child has HBV, he is more likely to have a chronic infection.

What treatments exist? There are seven antiviral medications and an immunoglobulin shot (HBig). For infants, HBig is used and if given within 12 hours after birth, has a 90% protection rate. http://onlinelibrary.wiley.com/doi/10.1111/j.1525-1446.2009.00790.x/abstract

Now, the existence of an immunoglobulin shot made me stop and wonder why infants are being routinely vaccinated if the HBig has a 90% efficacy rate. Most vaccines top out at 85% efficacy and the HepB vaccine in particular has a very spotty efficacy track record.

“Hepatitis B vaccination is recommended for health care workers but has a nonresponse rate of 5% to 32% and an unknown duration of immunity. The duration of immunity imparted by an initial vaccination regimen is not known, and there are no universal recommendations for monitoring immune status and the need for booster doses”

So right off the bat, regardless of the risk of Hepatitis OR the risk of the vaccine, why even bother with the vaccine at all? 

It also casts a different view of the CDC’s advice on HepB administration:

Hepatitis B vaccine (HepB). (Minimum age: birth)
At birth:
• Administer monovalent HepB to all newborns before hospital discharge.
• If mother is hepatitis B surface antigen (HBsAg)-positive, administer HepB and 0.5 mL of hepatitis B immune globulin (HBIG) within 12 hours of birth.
• If mother’s HBsAg status is unknown, administer HepB within 12 hours of birth. Determine mother’s HBsAg status as soon as possible and, if HBsAg-positive, administer HBIG (no later than age 1 week).

Hepatitis B Vaccine Summary

According to the 2010 CDC vaccine schedule, infants in America will receive the Hepatitis B Vaccine (HepB) at birth, 1-2 months and 6-18 months for a total of 3 doses. Children ages 11-18 then require 2 doses of the booster vaccine, 4 months apart.

Here are the HepB brands available for infant vaccination:



Comvax (Merck) This is a combo vaccine of Hib and Hep B: http://www.merck.com/product/usa/pi_circulars/c/comvax/comvax_pi.pdf

Pediarix (Glaxosmithkline) This is a super combo vaccine of Diptheria, Tetanus, Pertussis, Polio and HepB:

*Twinrix is only for ages 18 and up*

The virus is grown in yeast proteins and 0.5mg (250mcg) of aluminum hydroxide are included as an adjuvant. The aluminum content in all HepB vaccines exceeds the EPA limit of 25mcg for infants.

Adverse Reactions

According to the vaccine insert, these were the recorded adverse reactions during trials:

LOCAL REACTION (INJECTION SITE)
Injection site reactions consisting principally of soreness, and including pain, tenderness, pruritus,
erythema, ecchymosis, swelling, warmth, and nodule formation.
BODY AS A WHOLE
The most frequent systemic complaints include fatigue/weakness; headache; fever (≥100°F); and
malaise.
DIGESTIVE SYSTEM
Nausea; and diarrhea
RESPIRATORY SYSTEM
Pharyngitis; and upper respiratory infection
Incidence Less Than 1% of Injections
BODY AS A WHOLE
Sweating; achiness; sensation of warmth; lightheadedness; chills; and flushing
DIGESTIVE SYSTEM
Vomiting; abdominal pains/cramps; dyspepsia; and diminished appetite
RESPIRATORY SYSTEM
Rhinitis; influenza; and cough
NERVOUS SYSTEM
Vertigo/dizziness; and paresthesia
INTEGUMENTARY SYSTEM
Pruritus; rash (non-specified); angioedema; and urticaria
MUSCULOSKELETAL SYSTEM
Arthralgia including monoarticular; myalgia; back pain; neck pain; shoulder pain; and neck stiffness
HEMIC/LYMPHATIC SYSTEM
Lymphadenopathy
RECOMBIVAX HBR
Hepatitis B Vaccine (Recombinant) 9987433
PSYCHIATRIC/BEHAVIORAL
Insomnia/disturbed sleep
SPECIAL SENSES
Earache
UROGENITAL SYSTEM
Dysuria
CARDIOVASCULAR SYSTEM
Hypotension

According to the vaccine insert, these were the reported reactions in real-world use:

Hypersensitivity
Anaphylaxis and symptoms of immediate hypersensitivity reactions including rash, pruritus, urticaria, edema, angioedema, dyspnea, chest discomfort, bronchial spasm, palpitation, or symptoms consistent with a hypotensive episode have been reported within the first few hours after vaccination. An apparent hypersensitivity syndrome (serum-sickness-like) of delayed onset has been reported days to weeks after vaccination, including: arthralgia/arthritis (usually transient), fever, and dermatologic reactions such as urticaria, erythema multiforme, ecchymoses and erythema nodosum
Digestive System
Elevation of liver enzymes; constipation
Nervous System
Guillain-Barré Syndrome; multiple sclerosis; exacerbation of multiple sclerosis; myelitis including
transverse myelitis; seizure; febrile seizure; peripheral neuropathy including Bell's Palsy; radiculopathy; herpes zoster; migraine; muscle weakness; hypesthesia; encephalitis
Integumentary System
Stevens-Johnson Syndrome; alopecia; petechiae; eczema
Musculoskeletal System
Arthritis, Pain in extremity
Hematologic
Increased erythrocyte sedimentation rate; thrombocytopenia
Immune System
Systemic lupus erythematosus (SLE); lupus-like syndrome; vasculitis; polyarteritis nodosa
Psychiatric/Behavioral
Irritability; agitation; somnolence
Special Senses
Optic neuritis; tinnitus; conjunctivitis; visual disturbances
Cardiovascular System
Syncope; tachycardia.

Here is a compiled list of authoritative, peer-reviewed articles on adverse reactions after HepB administration:
http://guggiedaly.blogspot.com/2011/02/articles-on-adverse-reactions-after.html?spref=fb

Please visit http://www.medalerts.org to search the government VAERS database. This database is maintained by the CDC and FDA to collect vaccine reactions and contains a description of the adverse reaction.

For 2010, there were 938 adverse vaccine reactions.


For 2010, there were 20 deaths (18 infants) reported for the HepB vaccine.

For 2010, there were 2,799 cases of Hepatitis B.

Please visit http://www.cdc.gov/mmwr/mmwr_wk.html to view the mortality and morbidity database. This is maintained by the CDC to collect and report on infectious disease.

Please visit http://wonder.cdc.gov/ to view death cases compiled by the CDC.

I dug around in the infant death section of the wonder site and could not find any reported infant deaths in the earliest record (2005) for Hepatitis B, acute or chronic.


Conclusions

The illness seems to be mild for most adults and does not have high mortality rates. It is not easily transmitted. Adults can receive the 3-dose vaccine series, and indeed, many in the healthcare fields and other at-risk demographics DO get the vaccine. They can also take the immunoglobulin or the available anti-viral medications.

The vaccine is not as bad as other vaccines in terms of ingredients. It does contain a high amount of aluminum for infants. It does contain yeast proteins that might cause an allergic reaction. Since the vaccine series is fairly ineffective and an immunoglobulin exists, it leaves me wondering why this vaccine is even promoted.

The CDC weekly report shows almost 3,000 cases of Hepatitis B for 2010. I find it sad that we have had routine 3-dose vaccination for ALL infants plus a 2-dose vaccination for ALL children for many years now, and we still have a high number of cases.

I would not expose my newborn, infant or child to this vaccination series. If my child became an at-risk demographic as a teenager or young adult, I would review the data at that time and let my child make a choice about her body. The facts just do not add up for this particular vaccine.

What is also troubling to me is a little tidbit I found in the vaccine insert:


the following guidelines are recommended for persons who have been exposed to hepatitis B virus such as through(1) percutaneous (needlestick), ocular, mucous membrane exposure to blood known or presumed to contain HBsAg, (2) human bites by known or presumed HBsAg carriers, that penetrate the skin, or (3) following intimate sexual contact with known or presumed HBsAg carriers.”

Do you see what I see?

Additional Resources:

This site compiled all the HepB vaccines along with ingredients, manufacturer and more:

Ian’s parents call for safer vaccines and better accountability after his death:

Use the vaccine calculator to build your child a customized vaccine schedule:

InsideVaccines has a LOT of information on HepB and the vaccine:

All package inserts are listed here:

One stop shop for all the links you need:

A general overview of how to research any vaccine or illness:

22 comments:

  1. I think I see what you see is it that fact that "needle-stick" is a risk factor? well isn't that ironic

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  2. Thank you so much for the great resource, Guggie! I look forward to reading the rest of the series!

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  3. Awesome Guggie- I'll repost to Informed Parenting later today!

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  4. Excellent post! I'm not against all vaccines, personally, but this one didn't make sense for us either. I look forward to more! :)

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  5. I appreciate this as I research this for our family. Thank you!

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  6. Thanks so much for this Guggie - it's extremely informative. We have a smaller list of vaccines on our routine schedule here, but I'm somewhat ashamed to admit that I gave all those on the schedule unquestioningly, except for the new MeNZb meningitis vaccine. I'll be buying Dr. Sears' vaccine book if we have another child & look forward to more informative blogs from you.

    I think what has turned me off researching vax more is that few people lay it out vaccine by vaccine, as sensibly as you do. I hear a lot of people screaming 'vaccines are poison!', but as someone with a father born pre WWII who came close to death with some childhood illnesses, I need a little more to work with than that - especially if I'm going to convince my partner!

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  7. When I was a child, I was put in a daycare center where 4 children were diagnosed with HepB. My mother doesn't remember all of the details from what had happened since it was so long ago. I understand being concerned for your children, but vaccines are put out for a reason. We used to take our children around other children to give them the chicken pox until children died from it. Now we vaccinate. Even before we fully were able to "eradicate" polio, the vaccine caused several side effects. Unfortunately, not every one can handle every thing. I hope that there is more study into the vaccines, and that the CDC finds better avenues to prevent disease, and I hope that no one ever has to go through what that family did again. But, to not have your children vaccinated is negligent. I understand concern. But we always have to weigh the pros and cons with each decision we make for our children. The CDC has weighed these pros and cons.

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  8. Guess I'm just going to have to be negligent in the eyes of some anonymous person. I can live with that.

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  9. Vaccines are a medical intervention forced onto a healthy, functioning infant/child. To protect a child from vaccination is not neglect, since it is not depriving the child of anything or ignoring an existing medical condition.

    Since vaccination is an additional intervention without medical indication, I can turn this around and claim that those who vaccinated are abusing their children. If you gave your child Tylenol when not sick, antibiotics when not sick, Benadryl without allergies, insulin without diabetes, it would be clearly seen as an assault on their bodies and abusive. The same goes for vaccinations.

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  10. What I found unfortunate was that I chose not to get my newborn the HEP B vax at birth. At 6 weeks however there was a whooping cough out break at my other childrens school and I wasnt going to risk newborn death from whooping cough. Only catch was I had to get whooping cough with 5 other vax's including Hep B. Having the choice of separating vaccinations taken away from me is wrong.
    Then I continued to separate what I could (so the 5 in one was given every two months but I didnt get the other needle with it, I left that until a later date). So my son is now 2 and has JUST finished his 1 year vax's. We were not entitled to any childcare rebate until he was up to date. Again, this is frustrating as he was covered for most things but still we were punished for not vaccinating to the schedule...

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  11. Wow since the whole of the UK dont vaccinate for Hep B and both the UK and NZ dont vaccinate for chickenpox (and perhaps other countries i dont know of yet).. that makes alot of neglectful people out there. Its a wonder that they have any adult population at all.. and they have state sponsored medical system.

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  12. Webmeg, you have been misinformed. I see you are in Australia. We are a totally unvaxed family and we have access to Childcare rebate, Childcare assistance, and Family assistance. All we had to do was send a form to Medicare that said that we had chosen not to vaccinate. My children show up as permanently vaccinated although they have never seen a needle. I even get the fully vaccinated bonus - which i give to a vaccine charity.

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  13. Love this. This is one of the most well-researched and logically laid out posts I've seen on this subject. I'm always being asked why I don't vaccinate my daughter, posts like this really help me get the point across to people when I don't have the time to spell it all out for them. I think I will be following your blog... if I can figure out how... o.0

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  14. Unless a parent is concerned with their child possibly getting bit by a child who has Hep B.......which I think would be a rare situation. I would not allow the Hep B vax. The CDC always looks at the huge picture....not individual families or children. That's what they do. It makes sense that they would be making this routine, based on the way they do things. That said, as a parent, you decide about these things. Years ago my health plan kept hounding me to vax my middle school age daughter with Hep B....telling me well you don't know what she might be doing.....OK, piss me off......if I feel my daughter is at risk, or she thinks she might be at risk, then I will do it, but NOT before. Now leave me alone! They were very annoyed by me, but that's what happens and now it's little babies getting it because they don't want to deal with parents like me!!!!! I guarantee you this is why it is now routine, but you can say NO!

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  15. The neglectful parent is the one who allows the establishment to dictate what kind of vaccines are injected into their child's body and doesn't question anything....now that's neglectful.

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  16. Thank you so much for the information! I am hoping to become a mother in the next year. I have been a nurse for the last 13 years and have been forced to take many vaccinations I did not feel I needed. I am so glad so many people are opening their eyes to this topic. I will not be giving my future children the Hep B vaccine or many other ones; and am seriously thinking about a home birth to avoid the fear of having the hospital staff do something without my permission. I work in a hospital and see how "things" are done everyday...It makes me sick...good luck to all of you :0)

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  17. I agreed with so many on here about not allowing someone else judge or decided what is best for our OWN children. I believe that blindly following the CDC is neglectful, that being lazy and not researching the facts is negligent. We chose to leave a highly referred ped as he told me I wanted my child dead since I was questioning some vaccines..really? My being vocal on my child's health was obviously something he hadnt had to deal with often.
    I chose not to do the Hep B.As you pointed out, the ways to contract the disease pose pretty slim to none opportunities for my children: no needle sharing, no sex and no daycare. It was more of a risk to vaccinate on this one than it was to let their healthy and perfect bodies function the way that nature intended.

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  18. Hi there!

    Thank you for the info. I was wondering if you know of a source or website that tells you what the "safe" amount of any of these chemicals are for infants. For example: you mentioned the amount of aluminum in the hep b vaccine is way above the amount they tell us is safe for infants. I'd like this info for most of the chemicals in the vaccines, where can I find it? My 2nd son is due in about 5 weeks and I do not want to vaccinate him at all. I've brought up the topic with my husband and he is nervous about it. Im trying to gather info for him, he has not done any amount of research and couldn't even tell you what vaccines there are. Thank you!

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  19. Probably the easiest to navigate that gives the fullest context is the vaccine ingredient calculator from http://www.nvic.org/. You enter in your child's age/weight, select the vaccines and it will give you information.

    You can also check out the EPA website for human safety limits. Be sure to keep a critical eye on the routes. For example, the safety limit for aluminum is based on studies using IV administration. Vaccines are intramuscular, not intravaneous.

    Another example...the EPA limit for thimerosal is based on ingestion of methyl mercury. But vaccines contain ethyl mercury and again, are intramuscularly injected, not ingested. (Well, one in the US is ingested but does not contains thimerosal).

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  20. wow, great, I was wondering how to cure acne naturally. and found your site by google, learned a lot, now i’m a bit clear. I’ve bookmark your site and also add rss. keep us updated. john

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  21. Hepatitis B is also transmissible through mucousal fluids (including saliva) as is mentioned on the CDC website and in numerous studies. It is transmissible through shared toothbrushes and forks. When you go to a restaurant you don't know how clean their dishes are. You are at risk. A percentage of children did get it before the vaccine- and it could prove fatal. They aren't just recommending it for no reason to hurt your child. If it was only transmissible through blood I wouldn't bother but people don't realize its also transmissible through normal bodily fluids.

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  22. Yes, as with other illnesses in the vaccine debate, mortality and morbidity is a toss up between the rare complications of an unchecked disease and the rare complications of a vaccination.

    Still, what you have stated here is not quite accurate. As the CDC reminds us,

    "HBV is found in highest concentrations in blood and in lower concentrations in other body fluids (e.g., semen, vaginal secretions, and wound exudates). HBV is efficiently transmitted by percutaneous or mucous membrane exposure to infectious blood or body fluids that contain blood. The primary risk factors that have been associated with infection are unprotected sex with an infected partner, birth to an infected mother, unprotected sex with more than one partner, men who have sex with other men (MSM), history of other STDs, and illegal injection drug use."

    Of course, since everyone is vaccinated at birth and onwards, and since all medical professionals and most food handlers and anyone attending college is vaccinated, what are your worries? I guess you mean to imply that the vaccine doesn't work, which is also what I found in the information shared in my article. Shooting everyone up with it isn't going to magically change its failure.

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