Vaccines and Your Child

Separating Fact from Fiction

Paul A. Offit, Charlotte A. Moser

• Publisher: Columbia University Press
• Year: 2011
• eBook ISBN:
  9780231526715
• Topic: Medicine
• Subtopic: Health Care Delivery

Paul A. Offit and Charlotte A. Moser answer questions about the science and safety of modern vaccines. In straightforward prose, they explain how vaccines work, how they are made, and how they are tested. Most important, they separate the real risks of vaccines from feared but unfounded risks.

Offit and Moser address parental fears that children may receive too many vaccines too early, that the HPV vaccine may cause chronic fatigue or other dangerous side effects, that additives and preservatives in vaccines cause autism, and that vaccines might do more harm than good. There couldn't be a better moment or more pressing need for this book, which offers honesty—instead of hype—in the quest to protect children's health.

INDIVIDUAL VACCINES

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VACCINES IN THE FIRST YEAR OF LIFE

HEPATITIS B

HEPATITIS B: THE DISEASE

Newborns and sexually transmitted diseases aren’t typically discussed in the same conversation, so many parents wonder why their baby needs a hepatitis B vaccine before leaving the nursery.

What is hepatitis B?

Hepatitis B is a virus that is transmitted most commonly from one person to another by blood. Because as many as a billion infectious viruses can be found in a milliliter (a fifth of a teaspoon) of blood, the amount of blood necessary to transmit the infection is minuscule. Indeed, invisible amounts of blood from an infected person can be found in unusual places, such as toothbrushes, and can be infectious for up to a week.

Before the hepatitis B vaccine was routinely recommended for infants in 1991, about 16,000 children less than 10 years old were infected with the virus every year. Many of these children got hepatitis B while passing through the birth canal of an infected mother, but some caught it from someone else who was infected. That’s why it’s so important to be immunized early.

ONE PERSON’S STORY

“When Helen Kane and her husband adopted their daughter in China, they knew nothing about hepatitis B. They certainly never imagined that their beautiful new baby could have hepatitis B. And they had no idea that their future would be filled with hospital visits, blood tests, and a paralyzing fear of losing their child to this unknown liver infection. ... Among the most difficult challenges they would ultimately face was whether to treat their child with a potent drug called interferon that required three painful injections each week and promised a lackluster 30 percent chance of success.”

MORGAN’S STORY, from the Hepatitis B Foundation: http://www.hepb.org/patients/personal_stories_morgan.htm

What are the symptoms of hepatitis B?

Hepatitis B infections occur in four different forms:

• Infection with symptoms—Symptoms include fever, vomiting, nausea, aversion to food, abdominal pain, headache, muscle and joint pain, rash, and dark urine, followed a few days later by jaundice (yellowing of the skin and eyes). Jaundice can last for a few weeks and is often accompanied by discoloration of feces (light or gray color) and an enlargement and tenderness of the liver. Fatigue and general feelings of discomfort usually last for several weeks after other symptoms have resolved. Symptoms first appear one to two months after exposure to hepatitis B virus. About 40 of 100 people in the United States with symptomatic hepatitis B infection will be hospitalized.

• Infection without symptoms—Occurs in most children and about half of adults who are infected. Because there are no symptoms, these people usually aren’t aware they’ve been infected with hepatitis B virus—but they’re still contagious.

• Infection with complications—Occurs in 2 of 100 people infected with hepatitis B virus. Complications include confusion, jerking movements (particularly of the hands), disorientation, extreme sleepiness, semiconsciousness, and coma: all symptoms of severe liver damage. About 25 of 100 people with severe liver damage will die unless they receive a liver transplant.

• Long-lasting or chronic infection—Occurs in 5 of 100 people infected with hepatitis B virus; infants and young children are much more likely to suffer chronic infections. Although people with chronic infection are highly contagious, they often don’t exhibit any symptoms. People with chronic infection typically develop severe liver damage (cirrhosis) leading to liver failure or liver cancer.

DID YOU KNOW?

People with chronic infections are called carriers. Hepatitis B virus reproduces itself in carriers for at least six months and often for years. However, because many carriers don’t have symptoms, they don’t know they’re infected and therefore contagious to others. That’s why hepatitis B virus is called the silent epidemic. About a million people in the United States are chronic carriers.

DID YOU KNOW?

Every year between 1,000 and 1,500 people in the United States die from liver cancer caused by hepatitis B virus. For this reason, hepatitis B vaccine was actually the first vaccine to prevent a known cause of cancer. The human papillomavirus (HPV) vaccine, which prevents the only known cause of cervical cancer, was the second (see the section titled “Human Papillomavirus”).

HEPATITIS B: THE VACCINE

What is the hepatitis B vaccine?

The hepatitis B vaccine uses only a single protein from the surface of the virus (see “How are vaccines made?”). The protein is produced in yeast cells and purified. As a result, the vaccine only contains the hepatitis B protein, small amounts of residual yeast proteins, and some aluminum hydroxide as an adjuvant. The aluminum hydroxide is used to enhance the immune response and allow for less viral protein to be contained in the vaccine (see “Do vaccines contain harmful adjuvants like aluminum?”).

Who should get the hepatitis B vaccine?

The American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) recommend three doses of the hepatitis B vaccine for all children, to be given at birth, one to two months, and six to eighteen months of age. The first dose is usually given before the newborn leaves the hospital.

Does the hepatitis B vaccine work?

After a single dose of vaccine, more than half of infants will be protected from hepatitis B; after all three doses, at least 98 of 100 will be protected. In the United States, hepatitis B vaccine has virtually eliminated the disease in children.

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Who should avoid or delay getting hepatitis B vaccine?

People who had a severe allergic reaction to previous doses of hepatitis B vaccine should not get additional doses, and those who have moderate or severe illness should delay getting the vaccine.

What are the side effects of the vaccine?

Local reactions to hepatitis B vaccine such as pain at the site of injection, mild fever, headache, fatigue, and irritability have been reported. However, these symptoms do not occur at a frequency greater than in those injected with a placebo. The vaccine can rarely cause a severe allergic reaction in about 1 of 1,000,000 recipients.

WHY GIVE MY CHILD HEPATITIS B VACCINE?

1. Hepatitis B virus is around. About 78,000 hepatitis B infections causing 5,000 deaths occur every year in the United States.

2. Not everyone with hepatitis B infection knows they’re infected. Almost all children and more than half of adults infected with hepatitis B virus will not have symptoms—but they’re still contagious. About a million people in the United States are chronically infected with hepatitis B virus, and about 5,000 to 8,000 more will become chronically infected every year. All of these people can transmit the infection to others.

3. Outcomes tend to be worse in younger people. Younger people are more likely to have a long-term infection, liver damage, and liver cancer.

4. The vaccine is safe. Severe allergic reactions to the vaccine are extraordinarily rare.

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HEPATITIS B: OTHER THINGS YOU MIGHT HAVE WONDERED ABOUT

Newborns and Sexually Transmitted Diseases

When hepatitis B vaccine first became available in 1981, the AAP and CDC recommended it for high-risk groups such as health care providers, men who had sex with men, injection drug users, and babies born to infected mothers. Unfortunately, this strategy didn’t protect thousands of children under the age of ten who were infected with hepatitis B virus every year from sources other than their mothers, often a family member or family friend who didn’t know they were infected. Because children are at higher risk of long-term infections and subsequent liver damage and because those with chronic infections are more likely to transmit the disease, the AAP and CDC recommended in 1991 that all newborns receive the hepatitis B vaccine. Since that time, the disease has been almost completely eliminated in children less than eighteen years of age.

Different Types of Hepatitis

Hepatitis B is one of several viruses that cause hepatitis. Four other hepatitis viruses can also cause disease: hepatitis A, hepatitis C, hepatitis D, and hepatitis E. These viruses differ in their size, structure, and type of genetic material. In some cases they also differ in how they’re spread. Hepatitis C is spread similarly to hepatitis B, through blood or body fluids; hepatitis A and E are spread through feces or contaminated food or water. Because hepatitis B virus is spread primarily through blood, it used to be called serum hepatitis; hepatitis A virus, spread more casually, was called infectious hepatitis. Hepatitis A and B are the only hepatitis viruses preventable by vaccine.

Extra Dose of Vaccine

Because of combination vaccines, young children sometimes inadvertently get a fourth dose of hepatitis B vaccine. The extra dose does not increase the rate of occurrence of side effects; instead, it boosts the immune response (see “What if my child inadvertently gets an extra dose of vaccine?”).

HEPATITIS B: ADDITIONAL RESOURCES

Online Information

http://www.chop.edu/service/vaccine-education-center/a-look-ateach-vaccine/hepatitis-b-vaccine.html

http://www.chop.edu/video/vaccines-and-your-baby/home.html?item=5 (video clip)

http://www.nnii.org/vaccineInfo/vaccine_detail.cfv?id=4

http://www.vaccineinformation.org/video/hepb.asp (video clips)

Pictures of Hepatitis B

http://www.vaccineinformation.org/hepb/photos.asp

Personal Experiences

http://www.pkids.org/im_videos_hepatitisb.php (video clip)

http://www.immunize.org/reports/hepatitisb.asp

http://www.hepb.org/patients/personal_stories.htm

Support Groups

Parents of Kids with Infectious Diseases (PKIDS): provi...

Table of contents

• Title Page
• Dedication
• QUESTIONS PARENTS HAVE ABOUT VACCINES
• INDIVIDUAL VACCINES
• APPENDICES
• SELECTED READING
• ABOUT THE AUTHORS
• INDEX
• Copyright Page