Monday, May 26, 2008

Let the discussion begin

So, I've been hesitant to post about vaccines for a few reasons:
1- because I know what a controversial topic they are, and both sides of the debate can get quite heated.
2- because I have so much information about vaccines that it is hard for me to organize it in my head, much less in a blog post.
3- I'm not sure that the few of you reading my blog have much desire to learn about vaccines.

That said, I do feel passionately about the importance of making educated vaccine decisions, and I wish I'd had more information when Amira was a baby. Let's start the discussion with the first vaccine babies are given: hepatitis B.

Hepatitis B is a serious disease, I am certainly not going to argue against that. It is a disease that affects the liver, and according to the CDC website is more likely to lead to an acute infection in adults and a chronic infection in infants and children. Children who develop chronic Hepatitis B can eventually die as a result of liver failure.

After listing the dangerous symptoms of HepB, the CDC lists the means of infection for the disease. Not surprisingly, they are not as thorough, or explicit, when they discuss the means of transmission:

A person can become infected by:
- contact with a mother’s blood and body fluids at
the time of birth; (this should read: contact with a HepB carrying mother)
- contact with blood and body fluids through
breaks in the skin such as bites, cuts, or sores; (translation: for your child to get HepB in this manner the blood or semen of a person with HepB would have to come in contact with an open sore on your child)
- contact with objects that could have blood or bodyfluids on them such as toothbrushes or razors; (don't let your baby brush their teeth with a HepB infected toothbrush. No shaving, either)

and, we vaccinate babies against these other frightening possiblities:
- having unprotected sex with an infected person;
- sharing needles when injecting drugs;
- being stuck with a used needle on the job.

Obviously,the italics were added by me, but the bullet points are all courtesy of the CDC's HepB vaccine sheet.
Just to be clear, HepB is a sexually transmitted disease, and is passed along by the same means as HIV. To be fair, HepB is viable outside of the body for longer periods than HIV, making it a bit more likely to contract (if a pool of HIV infected blood is sitting on your kid's toothbrush the virus will die more quickly than HepB, which can live outside of the body for a long time).

So, has the CDC lost their mind? Is that the point I'm trying to make here? Not at all. Although most of the ways to become infected by HepB are clearly not relevant to newborn babies, it is true that babies born to mothers with HepB can contract the disease during the birth process. If a baby is exposed to HepB during birth and is vaccinated for the disease immediately after, it can keep the newborn from contracting the disease. Clearly this a great idea and well worth the risks of the vaccine.

I imagine the large picture for the CDC employees in charge of immunizations looks something like this: a mother with hepatitis B can pass it on to her baby during childbirth. Vaccinating the at-risk newborn is an effective way to prevent the spread of this serious disease. It is not feasible to give the vaccine to only the babies of at-risk women (you can't very well say to a pregnant woman, "you look like you may be a promiscuous drug-user, we would like to vaccinate your child") so in the interest of protecting the at-risk babies, it is advisable to vaccinate all newborns against hepatitis B. This is where the problem lies, for me. (as a side note, I don't know why they can't test pregnant women for hepatitis B and only vaccinate the babies at-risk? They already test for HIV during pregnancy. Just a thought.)

I do not have hepatitis B. As a monogamous, drug-free, non health-care worker I know I am not at risk for getting hepatitis B anytime soon. Because of that I would like to make the argument that is not only unnecessary, but ludicrous(and even dangerous), to suggest that I should have vaccinated my just hours-old infant against a sexually transmitted disease.

At Norah's 2-month appointment I discussed this issue with her pediatrician:
me: I really don't understand why someone as low-risk for getting the disease as my 2-month old should have to get a vaccine.
Doctor: There are other many ways Norah could get HepB.
Me: What kind of things should I be worried about?
Doctor: She could be infected by needles or by other bodily fluids in a daycare setting.
Me: (not believing the conversation has gone on this long) My daughter doesn't go to daycare. She just doesn't have any contact with needles or infected bodily fluids (read:semen). Are there other things I should worry about.
Doctor: mumbles a few things, starts to discuss other vaccines.

I would like to say that I actually really like my pediatrician, and appreciate her openness to some of the information I have. I know she is under a large amount of pressure to encourage vaccines.

One final point, and then I should probably go back to taking care of my kids :) I recognize that vaccines are not only about protecting the individual child, but protecting the community, at large. I appreciate that need, and consider "herd immunity" very strongly when making my vaccination choices. Due to the fact that hepB is an STD (have I beaten that point to death) concerns about un-vaccinated Norah infecting someone else are minimal.

I haven't mentioned any of the possible side effects for the hepB vaccine (of which, sadly, there are many) because I think the arguments against the vaccine are strong enough, on their own. Any risks of the vaccine are too many, in my mind, since the vaccine is not at all necessary for low-risk children, in the first place.

I can't help but post one last section from the CDC's website that illuminates, once more, the risk factors for hepB:

All unvaccinated adults at risk for HBV infection
should be vaccinated. This includes:
- sex partners of people infected with HBV,
- men who have sex with men,
- people who inject street drugs,
- people with more than one sex partner,
- people with chronic liver or kidney disease,
- people with jobs that expose them to human
blood,
- household contacts of people infected with HBV,
- residents and staff in institutions for the
developmentally disabled,
- kidney dialysis patients

According to Dr. Robert Sears (from his book called The Vaccine Book, in which he actually recommends the importance of most of the vaccines) Dr. Sears advises against giving your baby the hepB series unless you have "one risky baby." My point, exactly.

ps- I am constantly learning in this aspect of parenting, as in all others, and am very much open and grateful for additional information. If you have information to refute or support my assertions, I would greatly appreciate your input.

10 comments:

Caroline said...

Thanks for the post, Jami! I don't have any kids yet and so this is some good food for thought. I think you bring up a wonderful point how we need to become more knowledgeable about the vaccinations and medications that are given to our families.

What do you think about the new HPV vaccine? Is this something you would like your daughters to be vaccinated for when they are older? Justin and I have both agreed that we want our future daughters to have it. (Although we still need to read about possible side effects and such.) One of my best friends from high school was exposed to this virus and I think of her whenever I see those Garasil commercials...

I'm interested to hear your thoughts since this has become quite a hot topic too.

Jami said...

I have not researched the guardasil vaccine very thoroughly, yet. That said, my initial thinking is that I will not have my daughters vaccinated. Since HPV is a STD I believe teaching my girls abstinence is the best protection against HPV. Even for those who don't teach abstinence, safe sex practices are also sufficient in protecting against HPV (in my understanding, at least) and since safe sex practices are important for myriad reasons, I vote for that over vaccinations. Also, the commercials for guardasil are misleading in their wording. The vaccine only protects against HPV which can (and not often, at that) lead to cervical cancer. The vaccine is not a protection against cervical cancer. Oh, and my preliminary research turned up 11 deaths attributed to the vaccine.

amy said...

i have heard some scary stuff about gardasil, too, caroline, so my guess is you have lots of research ahead of you--don't we all!

jami, thanks so much for sharing some of yours. it is hard to come by someone so thorough in both reasoning and research. it is refreshing to see a mother confident enough to make sound decisions on her kids behalf and to be willing to recognize the possibility that not every doctor knows everything. those who come to terms with this reality stand in a better position, i think, to make the best choices.

kudos for the hard work. your kids will thank you!

Jana said...

Wow, Jami, I appreciate all the research you’ve done before making this important decision. I have spoken with too many mothers who don’t immunize because their mothers didn’t, or because they heard on Oprah that immunizing “causes” autism. I am so glad you’re making an educated decision even though I disagree with it.

I have not done near as much delving as you, but have spoken with several doctors and my old child/infant development professors, read the CDC, AAP, IOM and National Network for Immunization Information websites. I have also just started looking up information in research journals. This debate fascinates me as there are so many heated participants and it directly affects those we love.

I believe in vaccinating. I know you know this, and we’ve always sort of skirted around the topic on the phone, but I truly do believe vaccinating is positive. As you’ve stated, I don’t think all vaccinations are “necessary,” Norah (and Addie for that matter) are not likely to contract Hepatitis B, and so when neither of them are ever exposed to HepB that will “prove” the vaccination wasn’t necessary. However, not likely is not quite good enough for me. I just read a startling statistic on the NNii website. It stated “approximately 30% of those who become infected with HBV have no known risk factors.” That’s Norah, that’s Addie. That statistic may include mothers with an unknown HBV status, but it may also include those whose mothers are not carriers as well.

Sure, Addie is primarily in my care and I am positive Jason and I are not carriers, but I can’t control every situation she’s in. I will leave her with babysitters whom I trust, but I can’t be certain everyone they allow into their home is not a carrier (however unlikely it is). There will be other situations as well that may (although unlikely) place her in a compromised position. I can’t be sure. Babies explore the world by sticking things into their mouths, they crawl on the ground (sometimes around the toilet and bed where semen or other bodily fluids may be found), they sometimes HAVE to be changed in a public bathroom, they get into things they shouldn’t, and those things they touch may sometimes (although unlikely) be handled by people who are carriers. And, even though it’s unlikely as well, some of their fluid may be left behind. For me “unlikely” is enough to vaccinate--especially because half of those infected show no symptoms but may get liver cancer later in life. How would you know? And that’s just HepB. (As for the claim that HepB is linked to MS, I couldn’t find any peer-reviewed information to substantially back it up, yet I found many credible sources denying.)

What about measles? Our church leaders even think those immunizations are important, the church has contributed over three million dollars to the cause worldwide (according to lds.org). And while the US at large has eradicated the disease here, we are still at risk from those entering our country who may be carriers. The CDC website sites an outbreak in 2005 in Indiana. An unvaccinated person caught measles in Romania and transmitted the disease to 34 people, 32 of which were never vaccinated. That man could have lived in Memphis, went to our church, and worked in our nursery.

I know I have more research to do to back up what I’m saying, but I feel comfortable with vaccines. I was vaccinated and, although I’m not completely normal (we all would agree), I believe the vaccinations I received successfully increased my resistance to communicable diseases. I want this for my children, especially as more and more parents are choosing not to vaccinate, as the world gets smaller with more international traveling (I hope to do some myself some day), and now that Jason is going into a health profession. Anyhow, as I become more educated and feel more comfortable backing up my claims, I will look forward to discussing them with you. It will be nice to respectfully talk about it with an opposing point of view.

Caroline said...

Jami,

I'm curious... Do you oppose all vaccinations or just the one against Hepatitis B? I'm new to this whole vaccinate/don't vaccinate discussion so I'd love to hear your thoughts.

I haven't given much thought to vaccinations, but I always assumed I would vaccinate my kids. Not because this is something everyone does but because I'm a real worry wort and I have unrealistic ideas about my children catching measles, mumps, or even that African sleeping sickness. There was even an article in the Washington Post yesterday about a Louisiana teenager who has leprosy! And she's never even been out of the country! (Curiously enough, there are several hundred new cases of leprosy reported in the US every year.)

What are some good unbiased resources to learn about vaccinations? Sheesh. This parenthood thing is sounding harder and harder the longer I wait... :o)

And Jana, I really liked your comment. It was very well thought-out.

Jami said...

Jana, I really appreciate your comments and how well-researched your position is. I think vaccines are a particularly hard issue because well-informed parents fall on both sides of the debate. I mean, look at the arguments on both sides of the debate for just this ONE vaccine. Ugh. Your comment made me think. I am so committed to getting this decision right, and your statistic about 30% of HBV from people with no known risk factors freaks me out. I will have to look into that as I had not heard that statistic before. The thing that makes the debate so hard for me is that I feel like both sides try to create fear in order to garner support. My mom was saying that she saw a poster in the public health office, the other day, showing a child infected with "deadly" chicken pocks. We all know chicken pocks is rarely a serious disease. Then, the people on the opposite side of the debate scream about some crazy conspiracy theories (none of which I belive, by-the-way). I guess the thing that worries me is what a lucrative bussiness pharmaceuticals are, I just have a hard time believing we get all the truth about vaccines.

The measles vaccine, in my opinion, is a completely seperate issue. The measles vaccine has a very real public health component, which is why I will likely vaccinate Norah (as a seperate vaccine rather than part of the MMR). I am not actually afraid of Norah getting terribly sick even if she did get the measels (David had it as a child an was quite sick, but ultimately just fine) but I do worry about Norah getting it on passing it on to very young babies and/or pregnant women. I also think that vaccinating populations in developing countries where there are true measels outbreaks is a very, very good idea. Those populations are both more likely to get measels, and more likely to have decrased abilities to fight the infection.

Caroline- I am not against all vaccinations, just against the "one size fits all" approach. Also, in my mind, the burden of proof rests with the vaccine. By this I mean: Norah's body and immune system are working beautifully. It is the responsibility of the vaccine companies/CDC to prove that vaccines are worth the risk. So, I will take each vaccine seperately and consider all factors such as: prevalence of the disease in my area (Hawaii has some unique public health issues), the means of tranmission of the disease, the seriousness of the disease, the seriousness of vaccine reactions, the frequency of reactions (some vaccines are much more reactive than others) and the ingredients in the vaccine. The short answer to your question? I plan on vaccinating Norah in a very selective and delayed manner.

Jami said...

"This parenthood thing is sounding harder and harder the longer I wait... :o)"


PS- Caroline, just stop waiting :)Although, if you wait long enough, I'll come be your midwife!

Lisa (Espanish for "Lisa") said...

Jami, ladies, I have had mixed feelings about the HepB. As Jami pointed out, it really is most crucial for children that are at-risk, yet my philosophy up until lately has been "when in doubt do what the doctor says."

Now I am dealing with a new issue. Nicole is allergic, and very violently so to at least one of the (5) vaccinations she got at her 12 month appointment. I still, in a lot of ways think that vaccines can be a great thing, but I feel a little jilted at not having more easy access to in-depth information on risks, side effects, pros and cons, etc. I am beginning to do my own research but have a long way to go. My biggest concern is protecting my girls against the greatest harm they might be in danger, and as a side to that, helping to protect other children in the community as well. Vaccines still seem worth it to me for the most part, but if the risks outway the benefit I'm going to choose another route. I would love any information/websites you guys come in contact with, let me know!

(By the way, I did see on the CDC website that they mentioned the autism concern, and briefly discussed the studies that have been done and claim no connection. I don't get the impression the CDC isn't being truthful, but I'd really like access to those studies. Studies are never totally conclusive, but if they look fairly thorough and reasonable, I am more likely to side with them than with talk shows, even one as reputable as Oprah.)

Lisa (Espanish for "Lisa") said...

Whoa, Sorry! I should have proof-read my comment. I hope it makes sense!

Jami said...

Lisa,

That is SO scary about Nicole and her reaction. I went and read the story on your blog, too. I don't know if you will come back to read these comments, so I'll probably just e-mail you.

Anyway, do they now which vaccine Nicole reacted to? Did the doctors tell you that she should not recieve that vaccine, again? You can get a doctor's waiver for any vaccinations she had a reaction to, since next time it would most likely be worse. I'm sure you already know that. I will send you a few links of studies I've read (although Autism isn't my biggest concern).

I am SO glad Nicole is okay. That must have been so terrifying.