Tag: pregnancy

Vaccines and the Latest Autism Prevalence Report

The Autism and Developmental Disabilities Monitoring (ADDM) Network recently released a report that showed a 15% increase in autism prevalence rates.

What does that have to do with vaccines?

Well, nothing, unless you are an anti-vaccine group that is continually trying to associate vaccines with autism.

Trends in Autism Prevalence

Just about everyone understands that autism prevalence rates have been increasing over the years. It is what makes some folks think that there is a real autism epidemic.

Using ADDM Network numbers, it is easy to see the trend:

  • 1 in 150 children in 2000
  • 1 in 150 children in 2002
  • 1 in 125 children in 2004
  • 1 in 110 children in 2006
  • 1 in 88 children in 2008
  • 1 in 68 children in 2010
  • 1 in 68 children in 2012
  • 1 in 59 children in 2014 (the latest, 2018 report of children born in 2006)

As in previous years, this new report generated headlines from anti-vaccine groups, who continue to think that any increase in autism rates is a new reason to blame vaccines.

Of course, as it is has been shown over and over again, vaccines are not associated with autism.

These CDC reports should even take away any last idea that they are.

Why?

If there was any association with vaccines, then why are autism rates so widely different in the 11 states that are tracked by ADDM?

Are immunization rates different in those states?

Autism and Developmental Disabilities Monitoring (ADDM) Network

Anyone who has read the latest report on autism rates understands that it “is not a representation of autism in the United States as a whole, but is instead an in-depth look at the 11 communities in the ADDM Network.”

Those communities have changed for each report, but this time they were in Arizona, Arkansas, Colorado, Georgia, Maryland, Minnesota, Missouri, New Jersey, North Carolina, Tennessee, and Wisconsin.

key-finding-asd-prevalence
Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014 (2018 report)

Even then, the ADDM Network doesn’t look at all of the children in those states. They are mostly looking at children near large institutions that are hosts for the ADDM Network, such as the University of Arkansas for Medical Sciences, Johns Hopkins University, and Rutgers University, etc.

The 325,483 8-year-olds in the latest ADDM Network report were born in 2006 and live in:

  • part of Maricopa County in metropolitan Phoenix, Arizona
  • 75 counties in Arkansas
  • Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, and Jefferson counties in Colorado
  • Clayton, Cobb, DeKalb, Fulton, and Gwinnett counties in Georgia
  • Baltimore County, Maryland
  • parts of two counties (Hennepin and Ramsey) including the large metropolitan cities of Minneapolis and St. Paul, Minnesota
  • Franklin, Jefferson, St. Charles, St. Louis, and St. Louis City counties in Missouri
  • Essex, Hudson, Union, and Ocean counties in New Jersey
  • Alamance, Chatham, Forsyth, Guilford, Orange, and Wake counties in North Carolina
  • Bedford, Cheatham, Davidson, Dickson, Marshall, Maury, Montgomery, Rutherford, Robertson, Williamson, and Wilson counties in Tennessee
  • Dane, Green, Jefferson, Kenosha, Milwaukee, Ozaukee, Racine, Rock, Walworth, and Waukesha counties in Wisconsin

Why is this important?

“Autism prevalence among black and Hispanic children is approaching that of white children,” said Dr. Stuart Shapira, associate director for science at the CDC’s National Center on Birth Defects and Developmental Disabilities. “The higher number of black and Hispanic children now being identified with autism could be due to more effective outreach in minority communities and increased efforts to have all children screened for autism so they can get the services they need.”

It shows that “there continue to be many children living with ASD who need services and support, now and as they grow into adolescence and adulthood.”

Immunization Rates and the Autism and Developmental Disabilities Monitoring Network

It also helps to dispell any last ideas that vaccines are associated with autism…

Just look at the immunization rates in the ADDM Network counties (4 doses of DTaP, 3 doses of IPV, one dose of MMR, 3 doses of Hib, 3 doses of HepB, 1 dose of Varicella, 4 doses of Prevnar, flu shot, and 1 dose of HepA by age 36 months) and compare them to the autism rates in those same counties.

 

County Autism Rate Immunization Rates
Maricopa (AZ) 1 in 71 DTaP 82%, IPV 91%, MMR 90%, Hib 91%, HepB 93%, Var 88%, Prev 75%, flu 32%, HepA 78%
Boulder (CO) 1 in 72 DTaP 87%, IPV 95%, MMR 93%, Hib 89%, HepB 90%, Var 93%, Prev 80%, flu -%, HepA 65%
Jefferson (CO) 1 in 72 DTaP 86%, IPV 93%, MMR 91%, Hib 90%, HepB 94%, Var 90%, Prev 83%, flu 48%, HepA 69%
Cobb (GA) 1 in 59 DTaP 83%, IPV 94%, MMR 91%, Hib 88%, HepB 93%, Var 91%, Prev 80%, flu 40%, HepA 21%
Baltimore (MD) 1 in 50 DTaP 91%, IPV 95%, MMR 95%, Hib 94%, HepB 95%, Var 93%, Prev 86%, flu 46%, HepA 61%
Hennepin (MN) 1 in 42 DTaP 88%, IPV 93%, MMR 92%, Hib 88%, HepB 93%, Var 90%, Prev 82%, flu 42%, HepA 47%
Ramsey (MN) 1 in 42 DTaP 87%, IPV 96%, MMR 93%, Hib 91%, HepB 94%, Var 93%, Prev 79%, flu 42%, HepA 63%
Jefferson (MO) 1 in 71 DTaP 83%, IPV 95%, MMR 90%, Hib 92%, HepB 95%, Var 87%, Prev 82%, flu -%, HepA 51%
Essex (NJ) 1 in 34 DTaP 81%, IPV 91%, MMR 91%, Hib 93%, HepB 91%, Var 91%, Prev 69%, flu -%, HepA -%
Hudson (NJ) 1 in 34 DTaP 78%, IPV 91%, MMR 91%, Hib 92%, HepB 91%, Var 91%, Prev 70%, flu -%, HepA -%
Ocean (NJ) 1 in 34 DTaP 84%, IPV 91%, MMR 91%, Hib 92%, HepB 91%, Var 83%, Prev 74%, flu -%, HepA -%
Union (NJ) 1 in 34 DTaP 89%, IPV 92%, MMR 92%, Hib 91%, HepB 94%, Var 91%, Prev 79%, flu -%, HepA -%
Davidson (TN) 1 in 64 DTaP 89%, IPV 95%, MMR 95%, Hib 93%, HepB 94%, Var 94%, Prev 84%, flu 50%, HepA 35%
Dane (WI)
 1 in 71 DTaP 87%, IPV 93%, MMR 93%, Hib 88%, HepB 93%, Var 90%, Prev 82%, flu -%, HepA 45%

If vaccines were associated with autism, what should you see? Higher rates of autism in the areas with the highest immunization rates. You don’t see that in any of this data though, do you?

The counties in New Jersey, with the highest rates of autism, have good immunization rates, but they aren’t much different from the immunization rates in Colorado counties or Arizona counties with much lower autism rates.

Some other things we know about vaccines and the latest autism report?

  • in 2006, when those kids were born, New Jersey had one of the lowest rates for getting newborns a hepatitis B shot on their first day, as recommended, at just 23%. Arizona, with a much lower rate of autism, did much better, getting 65% of newborns their birth dose of hepatitis B vaccine on time. In fact, Maricopa County had one of the highest rates, at 71%.
  • fewer than half of their mothers likely received a flu shot during their pregnancy, even though they had been recommended since the 1990s
  • extremely few of their mothers received a Tdap vaccine during their pregnancy, as this didn’t become a routine recommendation until 2011

Does any of this surprise you?

How can vaccines be associated with autism, when counties that have higher immunization rates have lower rates of autism?

What to Know About Vaccines and the Latest Autism Prevalence Report

The latest Autism and Developmental Disabilities Monitoring (ADDM) Network report on autism prevalence from the CDC shows a rate that has increased to 1 in 59 children. And as county level trends in vaccination coverage show no correlation to those autism prevalence rates, folks will hopefully stop trying to associate vaccines with autism.

More on Vaccines and the Latest Autism Prevalence Report

What to Do If Your Child Is Exposed to Pertussis

Although things are much better than they were in the pre-vaccine era, we still have pertussis outbreaks in the United States.

How does that work?

Waning immunity and folks who are unvaccinated.

How Contagious is Pertussis?

Pertussis is very contagious, but not quite as contagious as other vaccine-preventable diseases, such as measles.

That’s why the focus on controlling pertussis outbreaks is usually looking at close contacts – those who were within about 3 feet for at least 10 hours a week or who had direct face-to-face contact with the person when they were contagious.

Have you gotten a letter from your child's school about pertussis yet?
Have you gotten a letter from your child’s school about pertussis yet?

So when you get a letter about a possible case of pertussis in your child’s school, it may be a a general warning and not that your child is at risk.

How do you get pertussis?

“Persons with pertussis are infectious from the beginning of the catarrhal stage through the third week after the onset of paroxysms or until 5 days after the start of effective antimicrobial treatment.”

Manual for the Surveillance of Vaccine-Preventable Diseases

Spread by respiratory droplets (coughing and sneezing), pertussis symptoms usually start about 5 to 10 days after being exposed to someone else who is in the early stage of their pertussis infection.

While pertussis symptoms can linger for up to 10 weeks, someone who has pertussis is most contagious during the first 2 or 3 weeks of symptoms.

Is Your Child Protected Against Pertussis?

Two pertussis vaccines, DTaP and Tdap, help protect us against pertussis.

In the Unites States, they are routinely given as a primary series (DTaP) at 2, 4, and 6, and 15 to 18 months, with a booster dose at age 4 years. And then a booster of Tdap at age 11 to 12 years. Later, Tdap is given again during each pregnancy, between 27 and 36 weeks gestation. Adults who have never had a dose of Tdap should get caught up, especially if they will be around a baby.

Protection from the pertussis vaccines wanes or wears off, so even fully vaccinated children and adults can still get pertussis. Of course, you are much more likely to get pertussis if you are unvaccinated and you will likely have more severe illness if you are unvaccinated.

Postexposure Antimicrobial Prophylaxis for Pertussis

Fortunately, as with meningitis was caused by Neisseria meningitidis and Haemophilus influenzae type b (Hib), taking antibiotics after being exposed to someone with pertussis can help prevent you from getting sick.

There are only specific situations for which this type of postexposure antimicrobial prophylaxis is recommended though, so for example, you wouldn’t usually give everyone in a school antibiotics because a few kids had pertussis.

Why not give antibiotics to everyone who might have been exposed to someone with pertussis?

“…there are no data to indicate that widespread use of PEP among contacts effectively controls or limits the scope of pertussis outbreaks.”

Postexposure Antimicrobial Prophylaxis

In addition to the fact that it likely wouldn’t stop our pertussis outbreaks, overuse of antibiotics can have consequences.

Situations in which postexposure antibiotics (azithromycin, clarithromycin, and erythromycin, or Bactrim) likely would be a good idea include:

  • household contacts of a known pertussis case
  • to help control an outbreak in a limited closed setting, like a daycare
  • contacts of a pertussis cases who are at high risk for severe pertussis, including pregnant women, infants, especially infants less than 4 months old, and people with chronic medical problems
  • contacts of a pertussis cases who are also contacts of someone who is at high risk for severe pertussis

What if you were exposed to someone with pertussis and have already gotten sick?

If your child was exposed to pertussis and is now coughing, then in addition to antibiotics, pertussis PCR testing and/or culture will also likely be done to confirm that they have pertussis. And remember that their contacts might need postexposure antibiotics.

Kids who have been exposed to pertussis and who have been coughing for more than 3 weeks won’t need antibiotics or testing, as it is too late for the antibiotics to be helpful and likely too late for testing to be accurate. Fortunately, after 3 weeks, they should no longer be contagious.

What to Do If Your Unvaccinated Child Is Exposed to Pertussis

Unvaccinated kids who are exposed to pertussis should follow the postexposure antimicrobial prophylaxis guidelines.

They should also get caught up on their immunizations, including DTaP if they are between 2 months and 6 years, or Tdap if they are older.

What to Do If Your Vaccinated Child Is Exposed to Pertussis

Since protection from the pertussis vaccines wanes, even kids who are fully vaccinated should follow the postexposure antimicrobial prophylaxis guidelines if they are exposed to pertussis.

Then why get vaccinated?

Again, being vaccinated, your child will be much less likely to get pertussis than someone who is unvaccinated. Even though the pertussis vaccine isn’t perfect, it has been shown that children who had never received any doses of DTaP (unvaccinated children) faced odds of having pertussis at least eight times higher than children who received all five doses.

What to Know About Getting Exposed to Pertussis

Talk to your pediatrician if your child gets exposed to pertussis to make sure he doesn’t need post-exposure prophylaxis to keep him from getting sick, even if you think he is up-to-date on his vaccines.

More on Getting Exposed to Pertussis

How Can the Unvaccinated Spread Diseases They Don’t Have?

Folks who are intentionally unvaccinated often have a hard time understanding why the rest of us might be a little leery of being around them.

That’s especially true if we have a new baby in the house, younger kids who aren’t fully vaccinated and protected, or anyone with a chronic medical condition who can’t be vaccinated.

Why? Of course, it is because we don’t want them to catch measles, pertussis, or other vaccine-preventable diseases.

“How can you spread a disease that you don’t even have?”

It’s true, you can’t spread a disease that you don’t have.

But infectious diseases don’t magically appear inside our bodies – we catch them from other people. And if you have skipped or delayed a vaccine, then you have a much higher chance of getting a vaccine-preventable disease than someone who is vaccinated and protected.

So, just avoid other people when you are sick, right?

“…the increased risk of disease in the pediatric population, in part because of increasing rates of vaccine refusal and in some circumstances more rapid loss of immunity, increases potential exposure of immunodeficient children.”

Medical Advisory Committee of the Immune Deficiency Foundation

That works great in theory, but since you are often contagious before you show signs and symptoms and know that you are sick, you can very easily spread a disease that you don’t even know that you have.

An infant hospitalized during a measles outbreak in the Philippines in which 110 people died.
Children with measles are contagious 4 days before through 4 days after their rash appears, but you often don’t recognize that it is measles until they get the rash! Photo by Jim Goodson, M.P.H.

There’s the trouble:

  1. being unvaccinated, you or your child are at higher risk to get sick
  2. when you get sick, you can be contagious several days before you have obvious symptoms
  3. you can spread the disease to others before you ever know that you are sick, or at least before you know that you have a vaccine preventable disease

This makes intentionally unvaccinated folks a risk to those who are too young to be vaccinated, are too young to be fully vaccinated, have a true medical exemption to getting vaccinated, or when their vaccine simply didn’t work.

measles-santa-clara-county
Folks with measles often expose a lot of other people because they don’t yet know that they have measles and aren’t showing signs and symptoms yet.

In fact, this is how most outbreaks start. Tragically, kids too young to be vaccinated get caught up in these outbreaks.

Keep in mind that these parents didn’t have a choice about getting them protected yet. Someone who decided to skip their own vaccines made that choice for them.

And remember that while you can’t spread a disease that you don’t even have, you can certainly spread a disease that you don’t realize that you have.

What to Know About The Unvaccinated Spreading Disease

If you aren’t going to get vaccinated or vaccinate your kids, understand the risks and responsibilities, so that you don’t spread a vaccine-preventable diseases to others that you might not even know that you have yet.

More on the Unvaccinated Spreading Disease

What Shots Do You Need to Be Around a Newborn?

We often focus on what vaccines a baby will need once they are born, but it is also important that folks around your new baby get vaccinated too.

What Shots Do You Need to Be Around a Newborn?

To protect their new baby, many parents institute a no visit policy for friends and family members who don't get vaccinated.
To protect their new baby, many parents institute a no visit policy for friends and family members who don’t get vaccinated.

Of course, all of your vaccines should be up-to-date, especially if you plan to be around young kids. That’s how we maintain herd immunity levels of protection for those who can’t be vaccinated and protected, including newborns who are too young to be vaccinated.

In addition to routine vaccines, it is especially important that teens and adults who are going to be around a newborn or younger infant have:

  • a dose of Tdap – now routinely given to kids when they are 11 to 12 years old and to women during each pregnancy (to protect newborns against pertussis), others should get a dose if they have never had one. There are currently no recommendations for a booster dose.
  • a flu shot – is it flu season? Then anyone who is going to be around your baby should have had a flu shot. And for the purposes of keeping a newborn safe from the flu, you can assume that flu season extends from September through May, or anytime that flu shots are still available.

That’s it?

Only two shots?

Yes, only two shots assuming you are either immune or are up-to-date on your other vaccines. If you have been delaying or skipping any vaccines, then you might need an MMR, the chicken pox vaccine, and whatever else you are missing.

Other Precautions Around a New Baby

Unfortunately, there are many risks to a new baby that aren’t vaccine preventable.

Just because everyone is vaccinated and protected, that doesn’t mean that you should have a party welcoming your baby home and invite everyone in the neighborhood. Besides the flu, we get concerned about other cold and flu-like viruses, especially RSV.

That means to protect them, you should keep your baby away from:

  • large crowds, or even small crowds for that matter – in general, the more people that your baby is exposed to, the higher the chance that they will catch something
  • people who are sick
  • cigarette smoke – second hand smoke increases the risk of infections, like RSV

And make sure everyone, even if they don’t seem sick, washes their hands well before handling your baby.

“Parents or relatives with cold sores should be especially careful not to kiss babies—their immune systems are not well developed until after about 6 months old.”

AAP on Cold Sores in Children: About the Herpes Simplex Virus

Because you can sometimes be contagious even if you don’t have an active cold sore (fever blister), some parents don’t let anyone kiss their baby. Most of this fear comes after news reports of babies getting severe or life-threatening herpes infections after a probable kiss from a family member or friend.

When Can I Take My Newborn Out in Public?

When can you take your baby out in public? Most people try to wait until they are at least two months old.

Is that because that’s when they are protected with their two month shots?

Not really, as your baby won’t really be protected until they complete the primary series of infant vaccinations at six months.

Two months is a good general rule though, because by that age, if your baby gets a cold virus and a fever, it won’t necessarily mean a big work-up and a lot of testing. Before about six weeks, babies routinely get a lot of testing to figure out why they have a fever (the septic workup), even if it might be caused by a virus. That’s because younger infants are at risk for sepsis, UTI’s, and meningitis and they often have few signs when they are sick.

Keep in mind that going out in public is much different from going out. You can go for a walk with your baby at almost any time, as long as they are protected from the sun, bugs, and wind, etc., as long as there aren’t people around.

What to Know About Protecting Newborn Babies

Protect your baby by making sure everyone around them is vaccinated and protected, especially with a dose of Tdap and the flu vaccine.

More on Protecting Newborn Babies

Are Vaccinated Children Dying from the Flu?

We know that kids die from the flu, not just this year, but every year.

In fact, on average, just over 100 kids die of the flu each year!

The flu is a terrible disease.

How Many Kids Die from the Flu?

The CDC started to track pediatric flu deaths in the fall of 2004, when it became nationally reportable. This followed a particularly bad 2003-04 flu season (H3N2-predominant), during which the CDC got reports of 153 pediatric deaths from only 40 states.

Since then, the number of pediatric flu deaths has ranged from a low of 37, during the 2011-12 flu season, to a high of 289 deaths during the swine flu pandemic.

  • 2004-05 flu season – 47 pediatric flu deaths
  • 2005-06 flu season – 46 pediatric flu deaths
  • 2006-07 flu season – 77 pediatric flu deaths
  • 2007-08 flu season – 88 pediatric flu deaths (H3N2-predominant)
  • 2008-09 flu season – 137 pediatric flu deaths
  • 2009-10 flu season – 289 pediatric flu deaths (swine flu pandemic)
  • 2010-11 flu season – 123 pediatric flu deaths
  • 2011-12 flu season – 37 pediatric flu deaths
  • 2012-13 flu season – 171 pediatric flu deaths (H3N2-predominant)
  • 2013-14 flu season – 111 pediatric flu deaths
  • 2014-15 flu season – 148 pediatric flu deaths (H3N2-predominant)
  • 2015-16 flu season – 93 pediatric flu deaths
  • 2016-17 flu season – 110 pediatric flu deaths (H3N2-predominant)

So far, this year, there have been 165 flu deaths in children.

Are Vaccinated Children Dying from the Flu?

The anti-vaccine movement is obviously the one in PANIC MODE as they continue putting out anti-vaccine propaganda.
The anti-vaccine movement is obviously the one in PANIC MODE as they continue putting out anti-vaccine propaganda, even as unvaccinated kids continue to die.

Although this year’s flu season, in which an H3N2 flu strain got off to an early start, certainly has the potential to be a lot worse than your average flu season, it seems similar to other H3N2 flu seasons.

Tragically, that means a lot of kids will likely die with the flu this season. H3N2-predominant flu seasons tend to be much worse than when other flu virus strains

And like previous flu seasons, we know that:

  • many of them will be otherwise healthy, without an underlying high risk medical condition
  • half will be between 5 to 17 years old

And most of them will be unvaccinated.

“During past seasons, approximately 80% of flu-associated deaths in children have occurred in children who were not vaccinated. Based on available data, this remains true for the 2017-2018 season, as well.”

CDC on How many flu-associated deaths occur in people who have been vaccinated?

And we also know that it isn’t too late to get a flu shot to get protected for the rest of this year’s flu season.

What to Know About Pediatric Flu Deaths

The flu vaccine isn’t perfect, but there is no denying the fact that year after year, most pediatric flu deaths are in kids who weren’t vaccinated.

More on Pediatric Flu Deaths

Updated May 13, 2018

Did Your Hepatitis B Antibody Test Come Back Negative?

Hepatitis B can be prevented.Three doses of the hepatitis B vaccines have been shown to provide long lasting protection in most people.

Do you need to get your titers checked to make sure you are immune?

Usually not. Simply being fully vaccinated with the  vaccine is  good enough evidence that you are immune in most, but not all circumstances.

A few circumstances in which you might need to be tested can include:

  • a baby who was born to a HBsAg (hepatitis B surface antigen) mother
  • being a healthcare worker who has a job and who is in a work setting that puts them at higher risk for exposure to blood or body fluids from patients who are positive for HBsAg
  • being immunocompromised, so you are not sure if the vaccine is going to work, or patients requiring chronic dialysis
  • someone who has sex or shares needles with a person who has a chronic hepatitis B infection

The screening test for vaccine immunity that is done checks the persons level of anti-HBs (antibody to the hepatitis B surface antigen). It should be done one to two months after your last dose of hepatitis B vaccine, but not later.

“Persons determined to have anti-HBs concentrations of ≥10 mIU/mL after receipt of the primary vaccine series are considered immune, and the result should be documented. Immunocompetent persons have long-term protection and do not need further periodic testing to assess anti-HBs levels.”

CDC on Immunization of Health-Care Personnel

The alternative to screening healthcare workers after they complete their vaccination series is to do postexposure management. In this method, in the case of a needlestick or other blood or body fluid exposure, both the source patient and the health care worker are tested and postexposure prophylaxis is given as necessary.

Don’t pregnant women get tested for hepatitis B? They do, but not to see if they are immune from immunization. They routinely have a HBsAg test to see if they have a chronic hepatitis B infection, which can be passed on to their baby.

Other screening tests that can be done include anti-HBc (antibody to hepatitis B core antigen) and IgM anti-HBc (IgM subclass to hepatitis B core antigen). These two tests can help you figure out if a person has an acute infection or is immune from a past infection.

Non-Immune Hepatitis B Titer Levels

Why check the anti-HBs level?

Because of the devastating effects of chronic hepatitis B infections, it is good to have all of the information you can get to help prevent a possible infection if you are exposed to blood or body fluids while working.

Having a positive anti-HBs level, typically defined as a level of ≥10 IU/mL, means that you are immune and protected.

But what if your level is negative? What if your level is <10 IU/mL after you have already gotten three doses of hepatitis B vaccine?

Then you get another dose of hepatitis B vaccine and the level is checked again in one to two months. If it is still <10 IU/mL, then you get two more doses of hepatitis B vaccine and the level is checked again in one to two months.

If you are still negative after six or more doses of hepatitis B vaccine, then you are considered a non-responder. You would then require postexposure testing and possible prophylaxis if you are exposed to a patient’s blood or body fluids.

What If You Lost Your Hepatitis B Immunity?

There is a reason that they don’t recommend testing more than one to two months after your last dose of hepatitis B vaccine.

“Studies indicate that immunologic memory remains intact for at least 20 years and confers protection against clinical illness and chronic HBV infection, even though anti-HBs levels that once measured adequate might become low or decline below detectable levels. If one is challenged with HBV, people whose immune systems are competent will mount an anamnestic response and develop protective anti-HBs.”

Immunization Action Coalition on Hepatitis B Questions

It is known that anti-HBs levels can decrease over time.

Fortunately, this does not lead to waning immunity in typical circumstances. Because of an anamnestic response, the hepatitis B vaccine provides long lasting protection, even if your antibody levels appear to have dropped.

Avoiding Hepatitis B

Since health care workers should practice universal precautions whether or not they are immune to hepatitis B, being a non-responder isn’t going to change how you do things too much.

Plus, there are other diseases that are not yet vaccine preventable that you could get if you are stuck with a needle, so you are hopefully still very careful, no matter how immune you are to hepatitis B.

Still, it is very nice to have one less thing to worry about in this situation.

“Unvaccinated or incompletely vaccinated persons who experience a workplace exposure from persons known to be HBsAg-positive should receive 1 dose of hepatitis B immune globulin HBIG (i.e., passive vaccination) as soon as possible after exposure (preferably within 24 hours).”

CDC on Immunization of Health-Care Personnel

If you are a non-responder and and are exposed to hepatitis B, then one thing that is different is that you will likely require two doses of HBIG (hepatitis B immune globulin) for protection. Others can get one dose of HBIG and can repeat the hepatitis B vaccine. Those who are fully vaccinated and known to be immune likely won’t have to do anything to protect themselves from hepatitis B, although each incident should be investigated to make sure.

But it is not just healthcare workers who are at risk for accidental needlesticks. What if a healthcare worker sticks themselves and then you or your child? Or what if your child gets stuck with a discarded needle at the park?

What to Know About Hepatitis B Titers

Get vaccinated and follow the latest guidelines if you are exposed to hepatitis B, especially if you are a non-responder to the vaccine with low titer levels.

More on Hepatitis B Titers and Immunity

Did Your Rubella Titer Come Back Negative?

Two doses of the MMR vaccines give the great majority of people long lasting immunity to measles, mumps, and rubella. Well, measles and rubella anyway. Unfortunately, the mumps part of the vaccine has some issues with waning immunity.

Do you need to get your titers checked to make sure you are immune?

Usually not. Simply being fully vaccinated with the MMR vaccine is  good enough evidence that you are immune in most, but not all circumstances

Getting or being pregnant is one of those circumstances in which it is important to know for sure. It is really one of the only circumstances. Health care works are no longer routinely tested after they are vaccinated, as proof of vaccination is good evidence of immunity for the MMR vaccine.

The American College of Obstetricians and Gynecologists recommends that all pregnant women be screened for rubella.
The American College of Obstetricians and Gynecologists recommends that all pregnant women be screened for rubella.

That screening test is a rubella serum IgG levels or as it is more commonly known as, a titer level.

Non-Immune Rubella Titers

Why check it?

Because of the devastating effects of congenital rubella syndrome, all pregnant women are screened early in their pregnancy.

Babies with congenital rubella syndrome may have cataracts and many other birth defects.
Babies with congenital rubella syndrome may have cataracts and many other birth defects. Photo courtesy PHIL

Having a positive rubella titer, typically defined as a IgG level of ≥10 IU/mL, means that you are immune and protected.

But what if your rubella titer is negative? What if your level is <10 IU/mL?

We know that levels of vaccine-induced rubella antibodies can decrease over time, but unlike mumps and pertussis, this does not seem lead to waning immunity with rubella.

Still, the current recommendations from the Advisory Committee on Immunization Practices (ACIP) are that:

  1. Vaccinated women of childbearing age who have received one or two doses of rubella-containing vaccine and have a rubella serum IgG levels that is not clearly positive should be administered one additional dose of MMR vaccine, with a maximum of three doses.
  2. After this additional dose, they do not need to be retested for serologic evidence of rubella immunity.
  3. Since MMR is a live vaccine, the additional dose should not be given during pregnancy or within a month of when you plan to get pregnant. You can get it while you are breastfeeding though.

How much should you be concerned about a negative rubella titer?

Although congenital rubella syndrome is not uncommon in other countries that don’t routinely vaccinate for rubella, there has not been a case of congenital rubella syndrome in the United States since – 2017.

That’s right, we have actually had two cases of congenital rubella syndrome in the US this year! In past years, these cases have all been linked to pregnant women becoming infected outside the US though, as there are thought to be very few rubella infections locally.

And two cases is a far cry from when rubella caused 2,100 neonatal deaths and 20,000 infants to be born with congenital rubella syndrome during an epidemic in the mid-1960s, before the first rubella vaccine was available.

That’s because vaccines work.

Wait, then why do some of these folks have a negative titer when they are tested?

While the easy answer is to say that they aren’t immune, it is more complicated than that. For example, some of the negative results could be false negatives (a negative test result that really should be positive). Others could possibly have low antibody levels, but they are still immune. Still, since one dose of a rubella containing vaccine is only about 97% effective, some of them could be non-responders.

Will a second or third booster dose of vaccine help increase your antibody levels? Yes, but in this situation, they will likely just rise temporarily. The second or third dose of MMR isn’t technically a booster dose, but rather a dose for those who didn’t respond to the previous doses, particularly for the measles component.

Avoiding Rubella

With a negative rubella titer, especially if you have not been previously vaccinated with one or more rubella-containing vaccines, you should likely try to avoid anyone who might have rubella.

There aren’t a lot of guidelines on how to avoid rubella though.

If you want to avoid rubella, avoid folks who aren't vaccinated against rubella.
If you want to avoid rubella, avoid folks who aren’t vaccinated against rubella. Photo courtesy of PHIL

That probably surprises you, especially with all of the information out there on how to avoid the flu, measles, mumps, and other infectious diseases, but it shouldn’t.

Symptoms of a rubella infection can include swollen lymph glands, low grade fever, a mild case of pink eye, and a red rash that can be hard to see, unless the person is overheated, like after a bath. Most importantly, people with rubella can be contagious for another few weeks, even as all of the symptoms have gone away. Also, like most viral infections, they were contagious for a few days even before they developed their first symptoms. And, believe it or not, some people with rubella might have no symptoms at all and still be contagious.

So how do you avoid someone who doesn’t even know that they are sick and are still contagious?

You basically want to try and away from anyone who might become sick and contagious…

While that sounds impossible, avoiding kids and adults who are intentionally unvaccinated, especially those who are intentionally unvaccinated and have recently traveled out of the country, can be a good start.

And like someone with a medical exemptions to getting vaccinated, if you have been vaccinated and lost your immunity to rubella, feel free to hide in the herd. This is one of the reasons everyone gets vaccinated!

What to Know About Rubella Titers

Get vaccinated and follow the latest guidelines if you are pregnant and your rubella titer is negative.

More on Rubella Titers and Immunity