Sunday, December 29, 2013

Dec 29, 2013 - China and Hep B

It's been reported that there have been 8 infant deaths (not sure if they were infants, meaning <1 year of age or neonates, meaning <28 days old) in the last 2 months following vaccination for Hepatitis B; The vaccine had been made by Shenzhen Kangtai (#1). China is an area of the world where the incidence and prevalence of Hep B is much higher than other areas. Hepatitis B can be a transitory infection or it can become chronic. Those who have chronic Hep B are at greater risk for liver cancer and other liver problems, and they can also transmit the disease to others with whom they have sex or share needles. Generally newborns who are born to mothers who are chronic carriers are given Hep B immune globulin and are vaccinated against Hep B (which requires a series of 3 shots - initial injection, 2 months, 6 months). 

The second link (#2) is the testimony before Congress of Dr. Orient (1999) regarding the practice of universal Hep B vaccination of infants and why it might be prudent to re-consider. She makes some excellent points. While her testimony was given 14+ years ago, it remains relevant today, as Hep B is still not so prevalent that universal vaccination makes sense. 

For those who are at high risk (multiple sex partners, injection drug user, infants born to mother who is a chronic carrier, healthcare workers) it would make sense for them to discuss with their healthcare provider if the benefit/risk ratio of vaccination falls in favor of vaccination. But to vaccinate an infant because they MIGHT fall into a high risk group at some point in their life does not make sense. Especially since the risk reduction (of contracting Hep B if exposed) is unlikely to last their entire life (#3). Better to start vaccinating if/when the risk reduction is greater than the risk of the intervention. 

Hep B vaccines have been associated with adverse events/reactions following their use (#4), so a careful assessment of risk vs benefit must be done prior to vaccination. Some may think the risk/benefit ratio does not favor vaccination, even if they are at high risk due to personal lifestyle choices. 

Because vaccination is not risk free, the decision to vaccinate should be both personal, and private - between patient/client and health care provider. Vaccination should not be mandatory, nor compulsory. There needs to be better treatment options for those who do contract Hepatitis B, regardless of vaccination status. 



( 2013 Jan;57(1):37-45. doi: 10.1002/hep.25988. Epub 2012 Dec 28.) 


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