Why Jab Children to Protect Adults?

February 26, 2008 by
Filed under: Vaccine/Disease Analysis 

Hepatitis A

First, let’s look at the Vaccine Information Statement that doctors are required by Federal Law to present to you before vaccinating your child…

http://www.immunize.org/vis/v-hepa.pdf

We are told that some people should be routinely vaccinated with hepatitis A vaccine: (those in bold are considered at increased risk)

  • All children 1 year (12 through 23 months) of age.
  • Persons 1 year of age and older traveling to or working in countries with high or intermediate prevalence of hepatitis A…For more information see www.cdc.gov/travel
  • Children and adolescents through 18 years of age who live in states or communities where routine vaccination has been implemented because of high disease incidence.
  • Men who have sex with men, persons who use street drugs, persons with chronic liver disease, persons with clotting disorders, persons who work with HAV-infected primates or who work with HAV in research laboratories.


Other people might get hepatitis A vaccine in special situations:

• Hepatitis A vaccine might be recommended for children or adolescents in communities where outbreaks of hepatitis A are occurring.

“Hepatitis A vaccine is not licensed for children younger than 1 year of age.”

Why are they recommending this vaccine for children?

On the CDC FAQ page  for Hep A:

“In children aged <6 years, 70% of infections are asymptomatic; if illness does occur, it is typically not accompanied by jaundice. Among older children and adults, infection is typically symptomatic, with jaundice occurring in >70% of patients.” http://www.cdc.gov/Ncidod/diseases/hepatitis/a/faqa.htm

Now Dr. Margolis, MD, director of the division of viral hepatitis at the CDC, speaking at the 5th Annual Infectious Diseases in Children Symposium West (no age range of the children is given) states the following:

“It’s got a long incubation period, an average of one month from exposure, and expression of the disease is age dependent, 85% of kids infected are asymptomatic,” Margolis said.

http://www.ivillage.com/forums/node/67105735

Again, there is no reason given for recommending this shot for children.

So most children, including those they recommend the shot for, don’t have any symptoms with Hep A, and most will be immune after infection. So WHY vaccinate them? Why not target adults?

“Unlike hepatitis B and hepatitis C, hepatitis A causes no long-term liver damage and usually does not cause death. There is no chronic carrier state with hepatitis A. Having had the disease produces lifelong immunity from future hepatitis A infection.”

http://www.cdc.gov/Ncidod/diseases/hepatitis/a/faqa.htm

This doctor spoke out in one of the congressional hearings which can be found here:

VACCINES—FINDING THE BALANCE BETWEEN PUBLIC SAFETY AND PERSONAL CHOICE

http://commdocs.house.gov/committees/gro/h…/hgo62560_0.htm

“My name is Ronald Kennedy, and I am a professor of microbiology and immunology and obstetrics and gynecology at the University of Oklahoma Health Sciences Center. I am a research scientist and teach medical and graduate students.

Two specific vaccines come to mind, hepatitis A and hepatitis B. I will not go into a long-winded scientific process and simply state that the chance of an infant or child getting either hepatitis A or hepatitis B is close to none or nonexistent. When the potential for exposure does exist, those risk factors are easily identified. Even more disturbing is that hepatitis A causes a self-limiting infection and does not cause chronic disease. It is my opinion that parents should be made aware of the risks and benefits of each vaccine where the chance for infection during infancy is minimal to nonexistent.”

(Find the rest of his statements within the link provided)
***************
The WHO explains:

Infection with HAV induces lifelong immunity.

In countries highly endemic for hepatitis A, almost all persons are infected in childhood with the virus without showing symptoms, effectively preventing clinical hepatitis A in adolescents and adults. In these countries, large-scale vaccination programs are not recommended.

http://www.who.int/vaccines/en/hepatitisa.shtml

“Reports of outbreaks, especially those involving young children, increased. Because most young children have asymptomatic or unrecognized infection, they play an important role in hepatitis A virus transmission as a source of infection.”

http://www.docguide.com/news/content.nsf/n…nology&count=10

“Because infection among children is typically mild or asymptomatic, outbreaks often are identified only when adult contacts (typically parents) become ill (7,90). Poor hygiene among children who wear diapers and the handling and changing of diapers by staff contribute to the spread of HAV infection; outbreaks rarely occur in child care centers in which care is provided only to children who are toilet trained.”

http://www.cdc.gov/mmwr/preview/mmwrhtml/r…_cid=rr5507a1_e

So we are now beginning to see that they want to vaccinate the children who usually have no symptoms of disease, to keep them from spreading it to older children and adults who would normally have more obvious symptoms:

“The high number of cases in children suggests that vaccinating children should have a strong ‘herd immunity’ effect, such that by vaccinating one child you prevent him or her from becoming infected and from transmitting an infection to other children and adults,” Armstrong said.

(Dr. Gregory L. Armstrong, of the US Centers for Disease Control and Prevention in Atlanta, Georgia)
From the same author:

“CONCLUSIONS: These results suggest a large reservoir of infection in children and that interruption of transmission in children may substantially reduce incidence of hepatitis A overall.”

http://www.ncbi.nlm.nih.gov/entrez/query.f…4&dopt=Abstract

Pediatrics 2002 May;109(5):839-45

“Hepatitis A virus infections in the United States: model-based estimates and implications for childhood immunization.”

Well, at least sanitation is still being given some credit for the decreasing rates:

“Hepatitis A Much More Prevalent Than Thought

Health officials say the undercount appears to be largely the result of undetected infections in young children who are a reservoir of virus to infect susceptible adults, and vaccinating these children should dry up the pool.

The CDC receives reports of some 26,000 cases of acute hepatitis A each year. (yet they estimate over 80,000 cases per year) The incidence is dropping by about 4.5 percent a year, thanks to improvements in sanitation.”

(My prediction, in 10 years this drop in incidence will be credited to the vaccine.)

Source: Adam Marcus
HealthScoutNews Reporter

And the CDC makes the same admission here:

“The overall incidence of hepatitis A has declined in the United States over the past several decades primarily as a result of better hygienic and sanitary conditions (e.g., improved water supplies, sewage disposal, and food sanitation and less crowded living conditions).”

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4812a1.htm

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Most people don’t realize that it’s the drug company producing the vaccine that lobbies state by state to get their vaccine mandated for all children. Seems like a huge conflict of interest.

From an article that appeared in the Sacramento Bee in July 2001:

Legislature ends effort to add required vaccines
By ED FLETCHER

The hepatitis A legislation, AB 182, carried by Assemblyman Juan Vargas, D-San Diego, was approved by a 76-1 vote in the Assembly before it stalled in the Senate.
While the decision to avoid making the vaccine mandatory may not sit well with proponents, one health care association hailed the legislative inaction.

“The vaccine is a good vaccine, but the bottom line is that it is working the way we are doing it right now,” said Bruce Pomer, executive director of the Health Officers Association of California.

Pomer said he was surprised that in the face of heavy lobbying from the company that produces the vaccine the committee did not pass the bill mandating hepatitis A vaccinations.

“(GlaxoSmithKline) was hell bent to try to get this through,” Pomer said. “It restores my faith in the system.” The company did not sponsor the legislation, as they did in years past, but was active in lobbying for the bill. Company officials did not return telephone calls.”

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They are lobbying for a vaccine for a self limiting disease that is basically undetectable in most children but confers life time immunity. Besides, the disease itself can hardly be considered deadly.

“Methods. We identified HA-related deaths in California from 1989 to 2000 with multiple-cause-of-death files and calculated mortality rates and rate ratios.
Results. We identified 402 HA-related deaths between 1989 and 2000; the annual age-adjusted HA-related mortality rate was 1.20 deaths per 1 million persons. Older individuals, men, Latinos, and American Indians/Alaska Natives had elevated mortality rates. Liver conditions and non-A viral hepatitis infections were more common among HA-related deaths than among all other deaths.”

http://www.ajph.org/cgi/content/abstract/95/5/900

“Mortality rates for large epidemics are less than 1 per 1,000. (Note: The mortality rate among people over age 50 who contract hepatitis A is higher: about 1.8 percent.) Rarely does Hepatitis A cause liver failure, and it does not lead to development of cirrhosis of the liver or chronic hepatitis.”

http://health.usnews.com/usnews/health/inf…t.overviewa.htm

“No patient with HAV infection alone developed complications, and all recovered fully.

It was demonstrated that HAV infection may have a more severe clinical course in patients with underlying CLD*, particularly among older individuals.”

http://www.blackwell-synergy.com/doi/abs/1…journalCode=jvh

“The overall mortality rate among reported cases of hepatitis A is 0.3%, but it is 1.8% among persons >50 years. Symptoms generally last up to 2 months; there is no chronic (long-term) form of the disease.”

http://wwwn.cdc.gov/travel/contentHepAEthiopianAdoptees.aspx

From the same WHO link above, it is summed up precisely why children will end up included in the vaccine recommendation:

“In countries where hepatitis A is highly endemic, exposure to HAV is almost universal before the age of 10 years. In such countries clinical hepatitis A is usually a minor public health problem, and large-scale immunization efforts against this disease should not be undertaken. In developed countries with low endemicity of hepatitis A and with high rates of disease in specific high-risk populations, vaccination of those populations against hepatitis A may be recommended. The high-risk groups include injection-drug users, homosexual men, persons travelling to high-risk areas, and certain ethnic or religious groups. However, it should be noted that vaccination programs targeting specific high-risk groups may have little impact on the overall national incidence of disease.”

As with the Hep B vaccine, it’s too difficult to get the high risk adults to come in for a vaccine, so they will target the helpless children instead. I say, if an adult is worried about infection, let them get their own vaccine and spare the child.

Last but not least, is there even a spot left on a child to give this injection?

7-doses-1-visit.jpg

*CLD = chronic liver disease

Comments

4 Comments on Why Jab Children to Protect Adults?

  1. UNCDoc on Wed, 26th Mar 2008 4:18 am
  2. I’m frankly surprised that there is no comments on this particular posting. I am a neonatologist, with an autistic child, and a strong supporter of vaccination. However, there is a very good point being made here. In the neonatal intensive care unit, where I work, there is often reason to vaccinate for hepatitis B, often because of some of the smallest babies needing multiple blood transfusions, and therefore putting them theoretically “at risk”, although I don’t generally give it until they are at least 1800 gm in weight (which, in my world, is pretty good size). Also, it is important to give it when the mother is hepatitis B positive or unknown with high-risk behaviors.
    That being said, I don’t believe that universal vaccination against hep B for children should be mandated. When they grow up and decide to enter a field where they are exposed to blood and blood products, such as medicine, then it can be mandated by their employer.
    The same goes with the HPV vaccine. It is spread by sexual activity, and is not going to be picked up in childhood (although there are certainly horror stories about sexual abuse cases presenting with HPV). Much of the force behind proposed mandates on HPV vaccines is sociopolitical, unfortunately. No one wants to be considered a person “at risk for HPV infection” and therefore getting a vaccine could be seen as almost a stigma. Therefore, the AAP, if which I am a supportive member generally, seeks to have every child get it, in true politically correct fashion. If we ever develop a vaccine for HIV, look for it to implemented in similar “everyone is at risk” fashion.
    Cervical cancer is a horrible disease, as is hepatitis, but I’m not sure that they should be considered in the same category as H. influenza, pneumococcus, polio, or rubella. I consider rubella of great importance mainly because of the fact that even the most sexually pure can catch it at the time of pregnancy, leading to devastating (and preventable with vaccine) effects on the developing baby.
    I’m new to this web site. Hopefully the conversations are reasonable and free from ad hominem. Thank you for allowing me to put forth my 0.02.

  3. MinorityView on Wed, 26th Mar 2008 10:23 am
  4. Hi UNCDoc,
    Welcome to insidevaccines. We are happy to host a range of opinions. I just want to point out that the article above is on mandatory Hepatitis A vaccination for children, not HPV or Heptatitis B.

  5. Jupiter on Thu, 27th Mar 2008 7:10 pm
  6. Hey there, UNCDoc. Welcome!

    Part of the reason why they make some of the vaccines universal is because it’s not worth it to the manufacturer to produce if they don’t get a universal recommendation from the ACIP.
    Also, the way the WHO works out the vaccine price tiering is by mass production and sales in the developed world (primarily the US) which allows the manufacturing costs to go down enough to where the developing world can afford it.
    It’s really in India and China where the HepB vaccine will have a great impact, but they couldn’t afford it at all until millions of doses were sold here first.

    We talk about it a bit on this page:

    http://insidevaccines.com/wordpress/?page_id=66

    Feel free to join our discussion forum, too. (it’s a little easier to have a discussion in the forum format. )

    http://insidevaccines.com/discussions/phpBB3/

  7. Marconi on Sun, 30th Mar 2008 9:34 pm
  8. UNCDoc, welcome.

    Perhaps there was no comment, since the article relates to Hepatitis A, which any doctor can tell you isn’t exactly the plague.

    Re your comments, there are two issues I see:

    1) Are you saying that babies are given blood transfusion which have not been screened, or cannot be guaranteed to be cleared for Hepatitis B? It hought that didn’t happen these days.

    2) I’m puzzled as to why the assumption is that HPV is primarily an issue relating to sexual activity.

    Could you please go to Pubmed, punch in these numbers, read the articles and get back to us?

    PMID: 12791874
    PMID: 16288396
    PMID: 13679205
    PMID: 11174573
    PMID: 17133162
    PMID: 8623809
    PMID:10213899
    PMID: 12002819
    PMID: 8551271

    Your thoughts on this would be interesting.

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