Tag: hepatitis B

Vaccines – Year in Review 2018

Another year has passed and although anti-vaccine folks keep talking about those 300 vaccines in pipeline, there were few new developments in the vaccine world in 2018.

Bob Sears got in trouble with the Medical Board of California over vaccine exemptions.
This happened in 2018.

Well, maybe that’s not entirely true.

Vaccines – Year in Review 2018

So what can we say about 2018 when it comes to vaccines?

Well, we did get some new ones!

  • approved by the FDA in late 2017, a new hepatitis B vaccine for adults, Heplisav-B, the formal recommendation for its use from the ACIP came on February 21, 2018
  • although it was both approved by the FDA and formally recommended by the ACIP in late 2017, Shingrix, the new shingles vaccine, became more widely available in 2018 – well kind of – there have been a lot of shortages due to high demand for the vaccine
  • Vaxelis, a hexavalent vaccine that combines DTaP-IPV-Hib-HepB into one shot was FDA approved on December 21, 2018, but likely won’t be available for a few more years
  • FluMist, the nasal spray flu vaccine, returned

And we lost one… Last year was the first full year that Menomune, an older meningococcal vaccine, was no longer available. It was discontinued because of low demand, as we began to use the newer vaccines, Menactra and Menveo instead.

In other immunization news:

  • a 2017 shortage of yellow fever vaccine continued into 2018
  • a shortage of monovalent pediatric hepatitis B vaccine will continue into 2019 (doesn’t affect combination vaccines with hepatitis B)
  • Gardasil 9 received an expanded recommendation – women and men between the ages of 27 and 45 years can now get vaccinated and protected with this HPV vaccine
  • the hepatitis A vaccine got a lower age recommendation – at least in special situations – “HepA vaccine be administered to infants aged 6–11 months traveling outside the United States when protection against HAV is recommended.”
  • the recommendation to use a third dose of MMR to control outbreaks of mumps was formally approved
  • the WHO updated its recommendations for use of the dengue fever vaccine (Dengvaxia) to makes sure that only dengue-seropositive persons are vaccinated, as they found an increased risk of severe dengue in seronegative people who were vaccinated
  • Of the 163 million to 168 million doses of flu vaccine that will be distributed in the United States for the 2018-2019 season, more than 80% will be thimerosal free.
  • China had an issue with substandard DTaP vaccines made by one company in one part of the country
  • India had an issue with contaminated polio vaccines made by one company in one part of the country – bivalent oral polio vaccines (two strains) still contained all three strains of polio vaccine virus
  • Measles cases and deaths spiked globally because of gaps in vaccination coverage

If you didn’t hear about any of those things in the news, you may have heard about the death of two young children in Samoa after they received an MMR vaccine. That tragedy almost certainly was caused by an error in administering/mixing the vaccines, and not because there was anything wrong with the vaccines themselves.

Need help getting educated about vaccines? Despite continued outbreaks, 2018 was a good year for vaccine advocates and vaccine education.

Several good books about vaccines were published, including:

And in case you missed it, we found out that:

Of course, for most of us, none of this is really news. We know that vaccines are safe, effective, and necessary.

And sadly, Betty Bumpers died. We can honor her legacy by continuing her work and helping to make sure that every child gets vaccinated and protected.

More on Vaccines Year in Review 2018

First Day Deaths and the Hepatitis B Vaccine

Worldwide, one million babies die within 24 hours of their birth?

Why?

“The initial 24 hours of a child’s life are the most dangerous with over one million newborns around the world dying each year on their first and only day of life, according to Ending Newborn Deaths, a new report by Save the Children. The research reveals of another 1.2 million tragic losses: stillbirths where the heart stopped beating during labour. In total, 2.9 million babies die in their first month. Most of these deaths occur because of premature birth and complications during birth – such as, prolonged labour, pre-eclampsia, and infection.”

WHO on One Million Babies Die Within 24 Hours Of Birth

It ain’t vaccines…

First Day Deaths and the Hepatitis B Vaccine

Of course, that doesn’t keep anti-vaccine folks from trying to correlate the two things, especially with the hepatitis B vaccine.

The neonatal mortality rate is actually similar among developed countries…

Korea for example, gives a birth dose of hepatitis B vaccine.

The 2017 Immunization Schedule for South Korea includes all of the US vaccines, plus BCG and Japanese encephalitis vaccines.
The 2017 Immunization Schedule for South Korea includes all of the US vaccines, plus BCG and Japanese encephalitis vaccines. The birth dose of hepatitis B was added to their schedule in 1991.

In general, Korea’s immunization schedule looks a lot like the one used in the United States. And Korea has both a lower infant and neonatal mortality rate than the United States and most European countries.

What about the idea that the United States has 50% more first day deaths than all other developed countries combined?

That’s likely true.

But not because of vaccines.

In addition to our higher population, this reflects “significant gaps between babies born to wealthy, well-educated urban mothers and those born to poor, less-educated mothers,” among other factors.

“In the United States, many suspect increases are due to more high-risk pregnancies caused by the rising prevalence of obesity, diabetes, hypertension and cardiovascular disease, more older women having children, advancements in fertility treatments that result in multiple births, and the high rate of cesarean sections – all of which increase the risk a mother faces during pregnancy and childbirth. Recent studies in the U.S. also suggest that poor quality care and better counting of maternal deaths may play a role.”

State of the World’s Mothers 2014

First day deaths are a serious issue.

It shouldn’t become yet another talking point anti-vaccine folks use to scare parents away from vaccinating and protecting their kids.

More on Myths About Newborn Deaths

Why Don’t People with HIV or HepB Have to Wear Badges?

There is a very good reason why people with HIV and hepatitis B don’t have to wear distinctive badges.

Have you ever thought that people with HIV should wear badges???
Have you ever thought that people with HIV should wear badges???

And whether or not they work in a hospital, it has nothing to do with the fact that they don’t pose a risk to others, and it has nothing to do with health care workers who refuse to get a flu shot and have to wear a mask.

Confidentiality Rules and Civil Rights

Hopefully we have gotten over a lot of the misinformation and stigma that once kept kids with HIV and hepatitis B out of schools and teens and adults out of work.

“Ryan White confidentiality guidelines have helped allay the fears that many people living with HIV have around unwanted disclosure and HIV discrimination.”

Building Trust: Confidentiality and the Ryan White HIV/AIDS Program

And of course, that’s why people with HIV and hepatitis B don’t have to “wear any distinctive badges or clothing.”

The Americans with Disabilities Act (ADA) is the most powerful law safeguarding the rights of children in public and private schools and daycare centers. The law also prevents any organization or business from discriminating against a person because of a real or perceived disability, such as an infectious disease.

A second law, Section 504 of the Rehabilitation Act, bars schools, colleges and other organizations receiving federal funding from discriminating against children with disabilities. Section 504 identifies chronic liver disease as a “hidden disability.”

Legal Protections for Children with Viral Hepatitis

In fact, laws protect people with HIV/AIDS and other conditions, so that no one would try and make them “wear any distinctive badges or clothing.”

“Almost 30 years after the onset of the epidemic, HIV stigma and discrimination—fed largely by ignorance and animus—persist and continue to have a forceful impact on people living with HIV.”

HIV Stigma and Discrimination Persist, Even in Health Care

Or at least you would hope no one would try and make them wear a badge…

More on Rights of People with HIV and Hepatitis B

Which Vaccines Don’t Prevent the Spread of a Disease?

As most folks know, Dr. Bob Sears has been put on probation by the California Medical Board.

Most vaccines don't prevent the spread of diseases?
Most vaccines don’t prevent the spread of disease???

Surprisingly, that hasn’t kept him from posting dangerous misinformation about vaccines, including his latest idea that “most vaccines don’t prevent the spread of a disease.”

Which Vaccines Don’t Prevent the Spread of a Disease?

If vaccines don’t prevent the spread of disease, then how did we eradicate, eliminate, and control so many diseases?

Dr. Bob Sears actually reassured parents that measles wasn't deadly in developed countries, neglecting to mention the dozens of people who have died in outbreaks in Europe - another well-nourished population with lower vaccination rates than the U.S.
At least seven people have died in Italy with measles over the last few years. That’s not so good for Italy.

When was the last time you saw someone with small pox, rubella, diphtheria, or polio, for example?

It is true that vaccines don’t prevent the spread of some infections though.

There is tetanus, for example, but guess what?

Tetanus isn’t contagious.

Any others?

Well, unlike most other vaccines, the meningococcal B vaccines are not thought to decrease nasal carriage of the meningococcal B bacteria. So if you are vaccinated and an asymptomatic carrier of the bacteria, you could theoretically spread it to someone else, as could someone who is unvaccinated.

Still, the MenB vaccines can protect you from getting actual meningococcal B disease, and if you don’t have meningococcemia or meningococcal meningitis, you won’t expose and spread it to someone else. That’s why the MenB vaccines are especially useful in outbreak situations.

Any others? After all, Dr. Bob did say that “most vaccines don’t prevent the spread of a disease.”

Vaccines That Don’t Prevent the Spread of a Disease

There are a few other examples of vaccines that don’t prevent the spread of a disease.

“I also warn them not to share their fears with their neighbors, because if too many people avoid the MMR, we’ll likely see the diseases increase significantly.”

Dr. Bob Sears in The Vaccine Book

Of course, any vaccine that is delayed or skipped won’t work to prevent the spread of a disease.

Just like they are seeing measles outbreaks and deaths now, because of low vaccination rates, in Ukraine there were 17,387 cases of diphtheria and 646 deaths from 1992 to 1997. Also high, were cases of measles (over 23,000 cases in 1993) and pertussis (almost 7,000 cases in 1993).

And because of waning immunity, vaccines don’t do as good a job of preventing the spread of pertussis and mumps as we would like. Still, that’s only when the vaccines don’t work, and even then, as Dr. Bob says, they do work to reduce the severity of symptoms.  During recent mumps outbreaks, the rates of complications are far below historical levels. The same is true for pertussis.

Have you ever seen or heard an unvaccinated child with pertussis? It is truly heartbreaking, especially when you realize how easily it could be prevented.

We typically see the same thing with flu. Even when the flu vaccine isn’t a good match or isn’t as effective as we would like, it still has a lot of benefits, including reducing your risk of dying.

“IPV induces very low levels of immunity in the intestine. As a result, when a person immunized with IPV is infected with wild poliovirus, the virus can still multiply inside the intestines and be shed in the faeces, risking continued circulation.”

Inactivated poliovirus vaccine

Does the fact that IPV, the inactivated polio vaccine, can sometimes lead to infections and shedding mean that it doesn’t prevent infections?

Of course not!

“IPV triggers an excellent protective immune response in most people.”

Inactivated poliovirus vaccine

Most people vaccinated with IPV will be immune, won’t get wild polio, and so won’t be able to get anyone else sick.

Vaccines reduce disease by direct protection of vaccinees and by indirect protection of nonimmune persons. Indirect protection depends on a reduction in infection transmission, and hence on protection (immunity) against infection, not just against disease. If a vaccine were to protect only against disease, and not at all against infection, then it would have no influence on infection transmission in the community and there would be no indirect protection (vaccination of one person would have no influence on any others in the community). It would be possible to reduce disease with such a vaccine but not to eradicate the infection.

Plotkin’s Vaccines

But because IPV doesn’t provide indirect protection, we still use OPV in parts of the world where polio is more of a problem.

Vaccines work. Even the few that don’t prevent the spread of infections, still help to reduce disease.

What’s the Difference Between Infections and Disease?

Wait, is there a difference between infection and disease?

Yes there is, something that Dr. Bob, who actually wrote a book about vaccines, seems to have overlooked.

An infection is simply the presence of a virus, bacteria, or other organism in your body.

A disease, on the other hand, is a virus or bacteria in your body causing signs and symptoms.

All vaccines work to prevent disease, or at least they do when you actually get vaccinated.

A very few don’t prevent infections and the spread of infections, but that is not a good reason to skip or delay your child’s vaccines. In fact, it is one of the reasons why it is important to have high vaccination rates! Even natural infections don’t always keep you from becoming asymptomatic carriers that can infected others. Many people who have natural typhoid (remember Typhoid Mary?) and hepatitis B infections go on to become chronic carriers without any symptoms, but still able to infect others.

If you understand that a few vaccines don’t prevent the spread of infections, then you should understand that you can’t hide in the herd and expect to be protected, even though most folks around you are vaccinated.

What to Know About Vaccines and the Spread of Disease

Despite what Dr. Bob says, almost all vaccines work to prevent the spread of disease and infections, at least they do when you get your kids vaccinated.

More on Vaccines and the Spread of Disease

Are More People Dying of Viral Hepatitis?

We have two vaccines to protect folks against viral hepatitis.

The first, against hepatitis B, was developed in 1981, but was replaced by an improved vaccine in 1989. It wasn’t added to the immunization schedule until 1991 though. Next came the hepatitis A vaccine in 1996.

Are More People Dying of Viral Hepatitis?

Although we don’t often think of them that way, these types of hepatitis can cause life threatening infections. Hepatitis B can even cause cancer!

Are deaths from hepatitis really skyrocketing?
Are deaths from hepatitis really skyrocketing?

So why would more people be dying of hepatitis A and B after we developed vaccines to help prevent them, a new idea being pushed by anti-vaccine folks?

They aren’t.

For example, there were 31,582 cases of hepatitis A and 142 deaths in 1995, just before the vaccine was approved. In 2016, there were just over 2,000 cases and 70 deaths.

What about hepatitis B?

The record high for yearly new cases was in 1985. In 2016, we are near record lows, with 3,218 new cases and 1,698 deaths.

Why are people still dying of hepatitis B?

Because even though far fewer people are getting new infections, there are still an estimated 850,000 to 2.2 million adults in the United States who already have chronic hepatitis B infections.

“…rates of acute Hepatitis B in the United States have declined by approximately 82% since 1991.”

Hepatitis B FAQs for the Public

So how can they say that hepatitis deaths are skyrocketing?

It’s easy. It is classic anti-vaccine propaganda. To fool folks, they talk about “all strains” of hepatitis and not just vaccine-preventable types.

Remember, there are multiple types of hepatitis, including A, B, C, D, and E. These are all caused by different viruses, even though they all cause hepatitis.

And since 2006, the incidence of hepatitis C has been climbing sharply. Tragically, so have the number of deaths. In 2016, there were 18,153 deaths from hepatitis C, which is not yet vaccine-preventable.

Hepatitis deaths are increasing.

All strains? Nope. Just the non-vaccine preventable strains. Deaths from hepatitis A and hepatitis B have greatly decreased since the pre-vaccine era.

All ages? Nope. Children have been protected from rising hepatitis deaths, as they are not typically at high risk for hepatitis C, which is causing the surge in deaths, and they should be vaccinated and protected against hepatitis A and hepatitis B.

What to Know About Viral Hepatitis Deaths

Viral hepatitis deaths are increasing, but only for non-vaccine preventable strains.

More on Viral Hepatitis Deaths

 

Can Vaccines Cause Cancer?

We know that several vaccines can prevent cancer, including the human papillomavirus (HPV) vaccines and hepatitis B vaccine.

A cancer treatment vaccine, Provenge, has also been approved by the FDA to treat metastatic prostate cancer. Others are in development.

What Causes Cancer?

It seems like everything causes cancer, doesn’t it?

Did you see the media reports about coffee?

“Cancer is a complex group of diseases with many possible causes.”

American Cancer Society on What Causes Cancer?

Some of the most common causes of cancer include:

  • genetic mutations
  • smoking and tobacco
  • heavy alcohol use
  • unprotected exposure to UV rays in sunlight
  • infections

Fortunately, we can protect ourselves from many of these common causes of cancer.

Can Vaccines Cause Cancer?

Vaccines don’t cause cancer, but that doesn’t stop anti-vaccine websites from saying that they do.

“Cancer is part of our new normal. One in two men and one in three women will receive a cancer diagnosis in their lifetimes. But it’s not just adults. If you can’t bring yourself to focus on this topic for you, please do it for your children.”

Louise Kuo Habakus (Fearless Parent) on Do Vaccines Cause Cancer?

Cancer can definitely become part of your “new normal” if you or a friend or family member gets diagnosed.

National Cancer Institute Surveillance, Epidemiology, and End Results Program cancer statistics.
National Cancer Institute’s Surveillance, Epidemiology, and End Results Program cancer statistics.

Fortunately, cancer rates have been stable, with declining mortality rates. In children, cancer rates have been rising, but only slightly, and nothing like the boom in rates that some folks describe.

Anti-vaccine folks promote the idea that more people are sick, more people have cancer, and in general, everyone is unhealthy, because it fits with their idea that vaccines are dangerous for everyone.

How do they link vaccines and cancer?

They often push the idea that vaccines cause cancer because the original polio vaccines were found to be contaminated with SV40, or simian virus 40. SV40 has not been linked to cancer though.

What about formaldehyde?

Some vaccines contain formaldehyde and formaldehyde is carcinogenic, so how can you say that vaccines don’t cause cancer?

While some vaccines do contain formaldehyde, remember that it is also naturally found in our bodies.

“Carcinogens do not cause cancer at all times, under all circumstances.”

American Cancer Society

It is the long-term exposure to high amounts of formaldehyde, usually inhaled formaldehyde, that is the big concern. Those most at risk would be workers who might be exposed to inhaled formaldehyde. The small amount of formaldehyde in vaccines is safe and does not cause cancer.

Another anti-vaccine talking point? Misusing vaccine package inserts to make you think that vaccines aren’t properly evaluated for mutagenicity and carcinogenicity.

“To ensure the safety of new vaccines, preclinical toxicology studies are conducted prior to the initiation of, and concurrently with, clinical studies. There are five different types of preclinical toxicology study in the evaluation of vaccine safety: single and/or repeat dose, reproductive and developmental, mutagenicity, carcinogenicity, and safety pharmacology. If any adverse effects are observed in the course of these studies, they should be fully evaluated and a final safety decision made accordingly. ”

M.D. Green on the Preclinical Toxicology of Vaccines

They are.

Vaccines are safe and necessary. They don’t cause cancer.

What to Know About Vaccines and Cancer

Several vaccines can prevent cancer and there is even a vaccine that can treat cancer. Vaccines don’t cause cancer though.

More on Vaccines and Cancer

What to Do If Your Child Is Exposed to Hepatitis B

Hepatitis B is a vaccine-preventable disease.

“In the United States, based on national health surveys, there are approximately 850,000 persons living with chronic HBV infection. However, estimates based on other methods and data yield estimates as high as 1.29 to 2.2 million persons with chronic HBV infection.”

Manual for the Surveillance of Vaccine-Preventable Diseases

That doesn’t mean that your child can’t be exposed at some point though.

What to Do If Your Child Is Exposed to Hepatitis B

Hepatitis B is mainly spread through blood and body fluids, which is why some folks consider the hepatitis B vaccine an STD vaccine.

“If you are concerned that you might have been exposed to the Hepatitis B virus, call your health professional or your health department. If a person who has been exposed to Hepatitis B virus gets the Hepatitis B vaccine and/or a shot called “HBIG” (Hepatitis B immune globulin) within 24 hours, Hepatitis B infection may be prevented.”

CDC on Hepatitis B FAQs for the Public

It is also possible to get hepatitis B from exposure from an infected family member or caretaker, or much more rarely, in a daycare or school setting.

So what do you do if your child is exposed to hepatitis B?

It depends.

Kids should complete the three dose hepatitis B vaccine series by the time they are 18 months old.
Kids should complete the three dose hepatitis B vaccine series by the time they are 18 months old.

Not surprisingly, one of the biggest factors that will determine what needs to be done is whether or not your child has completed a three dose hepatitis B vaccine series.

First things first though.

Before going any further, you will want to confirm that the person that exposed your child actually has hepatitis B (has a positive HBsAg level).

Next, confirm that it was a real exposure, which the AAP Red Book defines as “a discrete, identifiable percutaneous (eg, needlestick, laceration, bite or nonintact skin), mucosal (eg, ocular or mucous membrane), or sexual exposure to blood or body fluids.”

Keep in mind that the hepatitis B virus is not spread by casual contact, like hugging, kissing, holding hands, or even sharing silverware. It can be spread by having unprotected sex or sharing needles with someone who is infected, but also by coming into contact with open sores, getting bitten, sharing personal-care items, sharing chewing gum, or an unintentional needle stick at a doctor or dentist office or from a needle picked up in the community (park, playground, or street, etc.).

And of course, a newborn baby can be exposed if their mother has hepatitis B.

Biting and Hepatitis B

Young kids, especially toddlers, often go through a biting phase.

Do you have to worry about hepatitis B every time your child gets bit or bites someone?

Fortunately, no.

If any of the kids involved include one that is known to have hepatitis B, then talk to your pediatrician and follow the exposure guidelines.

Keep in mind that one of the reasons we don’t have to worry about these very low risk situations is because most kids are now vaccinated. There were more reports of kids and adults getting hepatitis B in unusual ways in the pre-vaccine era.

What to Do If Your Unvaccinated Child Is Exposed to Hepatitis B

If your unvaccinated child, or incompletely vaccinated child, is exposed to hepatitis B, you should talk to your pediatrician or local health department about starting post-exposure prophylaxis as soon as possible and preferably within 24 hours of the exposure (and not longer than 7), including:

  • a dose of HBIG
  • the first dose of hepatitis B vaccine, with plans to complete the three dose series as quickly as possible over the next 6 months

If you aren’t sure if the person had hepatitis B, then your unvaccinated child should likely just complete the three dose hepatitis B series without getting HBIG.

What to Do If Your Vaccinated Child Is Exposed to Hepatitis B

Unfortunately, if your vaccinated child is exposed to hepatitis B, you can’t simply assume that your child is protected and ignore the exposure. That is, unless your child has already had testing to confirm that he was a responder to the hepatitis B vaccine series – a HBsAb level of 10 or greater.

Since this titer test isn’t routinely done, your child will likely need a booster dose of the hepatitis B vaccine. A dose of HBIG isn’t needed.

If you aren’t sure if the person that exposed your child had hepatitis B, then your fully vaccinated child doesn’t need any additional treatment.

Getting Exposed to Hepatitis B in a Healthcare Setting

It should be noted that the guidelines are a little different and more aggressive if you are exposed in a healthcare setting vs your child having a nonoccupational exposure to hepatitis B.

Why?

There is probably more risk of getting infected from an occupational exposure where patients might be sick with hepatitis B. That’s why post-exposure testing on the exposed person is routinely done.

And since they are at risk for continued exposures, post-treatment testing, if required, to confirm a good response to the hepatitis B vaccine is also usually done.

What to Know About Getting Exposed to Hepatitis B

Hepatitis B exposures can come from more than just having sex or getting stuck with a needle. Learn what to do if your child is exposed to hepatitis B, especially if they aren’t already fully vaccinated and protected.

More on Getting Exposed to Hepatitis B