Do Preemies Frequently Crash After They Get Their Hep B Shot?
We hear it over and over from the usual suspects.
And they have been posting about it for years.
It is always the same story too, that they have heard stories from NICU nurses that they get crash carts ready before giving preemies their vaccines.
A crash cart or code cart is a self-contained, wheeled cart with trays and drawers that include all of the supplies you need in a medical emergency.
Of note, none of these posts are actually from neonatologists or NICU nurses.
They are all from folks who had supposedly read or heard about the posts from the NICU nurses, but in reality, they are likely familiar with them because it has become a common anti-vaccine talking point.
As I’m sure you have guessed, they aren’t true.
For one thing, premature babies do not frequently crash after getting their hepatitis B vaccine.
“Vaccines are immunogenic, safe and well tolerated in preterm infants. Preterm infants should be vaccinated using the same schedules as those usually recommended for full-term infants, with the exception of the hepatitis B vaccine, where additional doses should be administered in infants receiving the first dose during the first days of life if they weighed less than 2000g because of a documented reduced immune response.”
If you are like most people, you have heard so much anti-vaccine misinformation that you figure it is safe to assume that everything these folks say isn’t true.
If you are a true skeptic, you will still do your research on any new claims just to make sure.
Why Can’t You Give Blood After Getting a Vaccine?
Although you may not have heard of any restrictions on donating blood after getting vaccinated before, it makes sense once you think of it.
You actually have to wait:
for up to 8 weeks after getting the smallpox vaccine
for up to 4 weeks after getting the MMR (because of the rubella component), chickenpox, and Zostavax vaccines.
for up to 3 weeks after getting the hepatitis B vaccine
for up to 2 weeks after getting the measles, mumps, oral polio, or yellow fever vaccines
If you notice that these are almost all live vaccines, it becomes very easy to see why you can’t donate blood shortly after being vaccinated.
Blood donation is “Acceptable if you were vaccinated for influenza, tetanus or meningitis, providing you are symptom-free and fever-free. Includes the Tdap vaccine. Acceptable if you received an HPV Vaccine (example, Gardasil).”
American Red Cross Eligibility Criteria: Alphabetical
Live vaccines can create a temporary viremia (virus particles in the blood), which could then be transferred to someone else in donated blood.
Could you get an infection this way?
Remember, you would only be getting the attenuated or weakened vaccine virus strain and even then, it would be a very small amount. If the person getting the vaccine doesn’t get sick from getting the vaccine, why would someone who was getting a much smaller dose through a blood donation.
Still, there is a theoretical risk, especially if the person who received the blood donation had an immunodeficiency, so people aren’t supposed to donate blood shortly after getting these vaccines.
But what about the hepatitis B vaccine. It isn’t a live virus vaccine.
The risk with this vaccine is that a very recently vaccinated donor might test positive for HBsAg (this only happens temporarily), leading the donation center to actually think that they had a hepatitis B infection, disqualifying them from ever donating blood again.
Does any of this mean that vaccines aren’t safe?
Of course not!
Just consider some of the other restrictions on donating blood:
You are not eligible to ever donate if you ever tested positive for hepatitis B, even if you were never sick.
“Although we give vaccines in my office every day, I oppose HB 3063. As you consider HB 3063, I thought you should have the real-world data from the largest pediatric practice in Oregon with the most patients who will be affected by your proposed bill.”
Paul Thomas goes on to explain why his patients haven’t received all of their recommended vaccines.
One reason is that he doesn’t even offer the rotavirus vaccine, although he doesn’t mention that. But how do you make an informed choice about a vaccine when the vaccine isn’t even available to you?
“Most of my patients make the educated decision not to give one vaccine-hepatitis B – to their infants. This is because you catch hepatitis B from sex and IV drug use so if a child is born to a mother that does not have hepatitis B, the child is at no risk of getting this disease. Preschool and young school-aged children are not at risk for hepatitis B, which is why most countries in the developed world only recommend this vaccine for at-risk groups and not for everyone.”
Since he doesn’t think they are at any risk when they are younger, does Dr. Thomas advocate that his patients catch up on their hepatitis B series when they are older? Does he mention that until we switched to a universal vaccination program, some infants were missed and developed perinatal hepatitis B? Or the risks of needle sticks, etc.?
“These are the kinds of details and nuances that we must discuss with every vaccine. Whether we are talking about vaccines, antibiotics, ADD medication, or even a surgical procedure, we spend a good deal of time with our patients providing what we in medicine call “informed consent.” We explain the risks and benefits of the recommended medical intervention, the risks and benefits of not doing the intervention, and the alternatives. These conversations are best had in the privacy of a doctor’s office, not in the state legislature. As each child is different, we do not believe there should be any one-size-fits-all medicine. “
“Finally, I am also concerned that thousands of families will either leave Oregon-as tens of thousands of families have left California – or leave the public school system and homeschool instead. While I have nothing against homeschooling, I believe this would result in a large and unfortunate loss of revenue for Oregon’s already underfunded public schools. “
It’s a good reminder that the one lesson Oregon can learn from California is to make stricter rules on what counts as a medical exemption…
“We all have the same goal, which is to help Oregon’s children survive and thrive. No one wants a recurrence of infectious diseases in Oregon or anywhere in the United States. “
If Paul Thomas’ real motivation was to stop the outbreaks of vaccine-preventable disease and keep states from passing new vaccine laws, then maybe he should stop scaring parents away from vaccinating and protecting their kids.
“I hired an independent data expert, Dr. Michael Gaven, MD, to analyze the outcomes from my practice as part of a quality assurance project. Dr. Gaven studied the outcomes for those patients born into my practice during the past decade, since I opened my doors on June 1 2008.”
What outcomes? Is it how many of the kids in his practice developed vaccine-preventable diseases unnecessarily?
No, Paul Thomas published data that he thinks says that his unvaccinated kids get less autism than everyone else, except that there is a lot of bias in the numbers, we don’t know how many kids left his practice (especially any who might have developed autism), or even what criteria he uses to diagnose kids with autism. The numbers likely aren’t even statistically significant.
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
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.
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
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.