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Excerpted from "Immunization and Infectious Disease News"
Wisconsin Whisper
March 2001

Tom Saari, MD, FAAP

Hepatitis B Birthdosing: 201 infants were born to hepatitis B surface antigen (+) mothers in Wisconsin in 2000. Eighty-five of them were born in the Milwaukee-Racine-Kenosha area, 52 in the Northeast health district (Appleton, Green Bay), 27 in the South health district (Madison, Janesville), 21 in the North district (Superior, Rice Lake) and 15 in the West district (LaCrosse). There is no area in Wisconsin that is not represented by a threat of a perinatally spread virus that would eventually kill 30 to 40 of those infants if they fail to receive hepatitis B vaccine at birth. Receiving hepatitis B vaccine at 2 weeks or 2 months of life is simply too late. 15 % of pregnant Wisconsin women are not tested for their hepatitis B status prior to their delivery putting their infants at increase risk if the birthdose is not given.

Remember, the DHFS will provide hepatitis B vaccine FREE to any Wisconsin birthing hospital that signs up through the VFC program to give hepatitis B vaccine to all their infants before discharge. Every Wisconsin infant, regardless of their insurance or HMO status, can receive hepatitis B vaccine prior to discharge at no cost Current combination vaccine use should not deter you from giving hep B at birth.

Vaccine Safety, The Search for Truth:

Falsehood flies and the Truth comes Limping after;
so that when men come to be undeceived it is too late:
the Jest is over and the Tale has had Its effect.

Jonathan Swift, The Examiner Nov. 9, 1710

The war of words waged by those opposed to vaccines and those who see immunization as the greatest achievement in public health in the 20th century continues. The small but vocal groups who work against immunization activity in this country are motivated by a spectrum of beliefs that include 1) zero risk during times of low disease activity , 2) holistic and naturopathic philosophies that are against the instillation of material that mimics disease in otherwise healthy bodies, 3) the product of a blame-centered and litigious society, 4) adherents to anti-authority tenets that stress personal freedoms take precedence over the welfare of the community; i.e.: "government can’t tell me what to do" and 5) conspiracy buffs who believe any health activity that involves capitalist drug companies automatically creates conflicts of interest for anyone , including policy makers. Speculation about vaccine side effects fuels the anti-vaccine movement to create fear in the public and to gain an audience for their respective cause. Wisconsinites have a special appreciation for the devastation the fear monger can wreak based on events that occurred 45 years ago.

The truth is that no one has ever claimed vaccines are perfect. No vaccine is 100% effective. No vaccine is 100% safe. Never have been and never will. The risk of encephalitis from contracting wild measles and "natural " chicken pox is 1 in 1000 and 4 in a 1000 respectively. The risk of developing encephalitis following rubeola and varicella vaccine is 1 in a million doses. This also happens to be less than the background rate of encephalitis from all etiologies in the USA. The risk of dying from tetanus is one chance in 10 and from the tetanus shot one chance in a million. One in every 200 children who were infected with wild polio in 1952 developed acute flaccid paralysis ( AFP ). VAPP occurs in one in 750,000 first doses of OPV. Some of us are still around who grew up in a world before immunization became a way of life and would never want to return to the "good old days". I fear the return of vaccine preventable disease far, far more than the vaccines themselves but in some parts of today’s society, the vaccines are scrutinized more than the diseases they are meant to prevent.

Speculation that vaccines cause autism, ADD, diabetes, asthma, inflammatory bowel disease, SIDS, multiple sclerosis, chronic fatigue and any and all diseases without a recognized etiology is purely that, speculation. Cold fusion proved to be speculation when subjected to scientific scrutiny but still garnered front page status in Time magazine. Nearly all anti-vaccine messages your patients see on "60 Minutes" and "20/20" is the result of speculation fed by interest groups to an eager and undiscerning media. Anti-vaccine groups are interested only in the uncertainty their speculation creates in the public trust, not in the science. They will always find a whipping boy for their cause, be it DTP, MMR or hepatitis B.

So far, the impact of anti-vaccine efforts on immunization rates in the United States and Wisconsin has been small. This is a testimony to the effectiveness of nurses and practitioners working in clinics who have remained strong immunization advocates throughout this trying period. Wisconsin is one of 13 states with a personal exemption provision in the immunization rules for school entry. The personal exemption rate in our state has only increased from 0.3% to 0.8% over the past 10 years.

Searching for The Truth: There have now been at least 5 large studies conducted in England, Sweden and the United States that have refuted Dr. Wakefield’s speculation that MMR vaccine is connected to autism. How many more studies will it take to undo the damage that has been done by the " speculation published as fact " campaign promoted by groups that oppose immunization. Example: Recent claims published in Wisconsin newspapers identified the thimerosal in MMR as the cause of childhood autism. MMR has never had thimerosal in it.

Two articles in the Feb 1st, 2001 edition of the NEJM provide further proof that vaccines in general and hepatitis B in particular have no bearing on either the induction or reactivation of multiple sclerosis. This supplements a number of other studies from around the world that have debunked the alarm anti-vaccine groups raised in public forums that claimed hepatitis B vaccine produced numerous neurologic adverse events.

Claims that Hib and hepatitis B vaccines cause diabetes have been refuted by large population and case control studies. Speculation that DTP and hepatitis B vaccine use led to SIDS is unfounded. In fact, SIDS deaths have dropped dramatically with the advent of our universal infant hepatitis B immunization program. This has more likely been the result of the simultaneous practice of sleeping babies on their backs than any beneficial effects of giving hepatitis B vaccine. It is tempting to play the anti-vaccination game in reverse, but we won’t.

Despite the concern raised about the presence of thimerosal in some vaccines, there has never been an indication that ethyl mercury, in the amounts found in vaccines, has ever had ill effects on the development of infants receiving them. Two large studies conducted through the Vaccine Data Link system for vaccine adverse events surveillance involving over 100,000 children failed to find any relative-risk association between thimerosal and autism, ADD or other neurologic or renal impairments This study included painstaking record reviews and standardized diagnostic criteria and was scrutinized by an expert panel convened last summer to look for "signals" that might indicate such associations. There were none.

Be wary of 1) claims against vaccines that suggest they are the cause of diseases without readily identifiable etiologies, 2) claims made by a single investigator or one group of investigators, 3) work that raises the specter of causality without confirmation by peers using strict study design, 4) unconfirmed work that is promoted to the media without regard for the harm done to a frightened public, 5) investigators who ride the parent advocacy lecture circuit before their work has been properly scrutinized, and 6) information from groups who continue to promote "research" long after it has been discredited.

Reputable Immunization Resources:

Have questions? Look it up on the web. Give these sites to your web savvy parents with your blessing:

Order the Immunization Information Resource Kit from the National Network for Immunization Information (NN ii)on their web site. It contains a wealth of information for parents and your practice that I have found invaluable.

You can always contact me by calling Tom Saari, 1-608-263-9733 or by e-mail at tsaari@facstaff.wisc.edu

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