From: doyle+@pitt.edu (Howard R Doyle)
Newsgroups: sci.med,misc.kids
Subject: Re: Hepatitis vaccine
Date: 17 Aug 92 21:36:08 GMT
Followup-To: sci.med
Organization: Pittsburgh Transplant Institute

In article <1992Aug17.093610.13815@umiami.ir.miami.edu> ahelmers@umiami.ir.miami.edu writes:
>
>Well, my own followup, and final comment...first I do apologize if the tone of
>my remarks sounded "offensively ignorant" and smug.  Posting an immediate
>response to a nasty post (i.e. Steve's attack on Nanette) is probably not always
>wise!  
>
>However, the truth of my position was best stated, more diplomatically perhaps,
>by Paula Burch.  She wrote (as I interpreted it) that although a parent can and
>must make decisions on vaccination to protect a child, in this situation
>the risk factors for her [my] infant are NOT such that they are likely to be
>vulnerable to developing Hepatitis B.  And as a parent, I have chosen not to
>give my child a vaccine that does not seem necessary for his health--a decision
>backed up and supported by my pediatrician.  Of course when he is older
>it is possible, perhaps likely, that he will be vaccinated.  This was one of
>my immediate questions: whether the vaccine was equally effective when
>administered to an older child or adolescent.
>
>As for judgements about "clean" groups, middle-class lifestyles, etc. that is
>truly not the issue that I wish to or plan to debate on the net.  As a mother
>the phrase "the personal is political" rings true to me.  And actually, given
>a limited amount of both funding and medical access--is it better for me to
>take a dose of this vaccine for my child or promote it being provided to a
>child that may be in immediate need of protection?  As for my child being
>in that situation, at 3 1/2 years old and 10 months old I can reasonably be
>sure that they are not at risk FOR THE MOMENT.  But who can know the future? 
>
>Ann Helmers

Not that I want to take advantage of your offer regarding this being your
last post on this subject, but I get the feeling you (with the help of your
pediatrician) are missing some important points.

Worldwide, hepatitis B is the leading cause of death due to liver failure.
It is also the single most important etiologic factor in the development
of hepatocellular carcinoma. In some countries hepatocellular carcinoma is
the most common cancer, and cure rates are still dismal. The only treatment
we have for cirrhosis due to the B virus is liver transplantation. And most
patients will develop recurrent hepatitis in the transplanted organ, which
goes on to cirrhosis in a short period of time. We are actually sending
hepatitis B patients home to die (those who are DNA positive) without 
offering them the possibility of a transplant, because it means throwing a
scarce organ away. Many other patients, who may have a slightly better
outlook, simply just die waiting.

So we are talking about a real killer disease, one that, once you get it,
it's too late to do much about it. And the real sad part is that it is a
PREVENTABLE disease. Children being born today shouldn't have to worry 
about dying of this any more than they should worry about diphteria. And 
those who look after children (medical personnel and otherwise) need to
understand that one of the reasons the B virus doesn't seem such a terrible
health hazard then is because by the time you reach end-stage you're 
usually already an adult.

People who wonder whether their children (or their patients) should get
the vaccine should come work with me for a couple of weeks. 

You say that your 3 1/2 year old child is safe for the time being, and
therefore you have elected to postpone immunization. Statistically, in
our country, it is probably a correct statement. So when, may I ask, is the
right time to do it? Two years ago I had to take care of a 14 year old
girl who almost died of fulminant liver failure. She contracted the 
disease from heterosexual sex. She survived a liver transplant with
many complications, and has so far done well. Should we immunize them
before they become sexually active then? And when is that? And let's not
even go into when are they likely to be first exposed to dirty needles,
because we seem to get pretty uptight about that.

Theoretically, we have the means to eradicate hepatitis B. And we should.
And the issue is not really whether it is better to give the vaccine to
middle-class children, as opposed to inner city kids, on epidemiological
grounds. Anyone can get this disease, at any age. And if you dig through
the literature you will find documented cases of transmission through
toothbrushes, baby bottles, toys, eating utensils, razors, respirators,
endoscopes, etc etc. That because the virus is enviromentally stable.
It may be uncommon, but it happens. Now you decide.
-------------------
Howard Doyle
doyle+@pitt.edu



Newsgroups: sci.med