extra Hib vaccine

[Katherine]

Just got a letter through from my HV reequesting I take DD (3.5) in for an extra Hib booster saying that the incidence is on the rise in our area.

Have to admit not really sure what Hib is anyway but although I've been happy to go for the "normal" vaccinations for babies and MMR that I really don't agree with vaccinations willy nilly.

Wondered if anyone else had expereinced this and what peoples thoughts were or whether its a trivial thing and I should just do it or whether I'm right to question the necessity of it.

Thanks

Hi Katherine
There was a discussion on this earlier this month. It's called 'hib booster' in the health topic area. It was quite comprehensive so that might help.

Hib is Haemophilus influenzae type b.

As well as meningitis, it can cause infection in joints, pneumonia and epiglottitis (causing swelling of part of the windpipe causing noisy, painful breathing and even blockage of the airway).

There has been a small but significant rise in cases since 1998. The DOH are running the booster programme to control the disease way before it reaches epidemic proportions.

Thanks lalaa - found it and read up. Seems to me that DD is at low risk and she's only scraed into the bracket by a few weeks. I've decided the jab is unecessary unless I'm suddenly provided with compelling evidence to the contrary.

Hib disease has never been an epidemic. Before introduction of the vaccine precise records were not kept, but around 20 children a year died from hib meningitis.

hmb (or someone else) can you answer a question for me? The rationale behind boosters being offered to those 4 and under seems to be that children naturally acquire immunity by the time they are 5. But if they've been vaccinated and the vaccine immunity wears off (something the d of h have suggested maybe happening) won't they just be susceptible at an older age? I've never managed to get my head round this piece of logic.

I never said that it was an epidemic or that it ever has been.

Should I chase this up or leave it be?

4 weeks or so ago there was something in the local paper about this saying that all babies over 6 months old needed a top-up. I remember thinking at the time that we would have a recall as DD was 6 and 1/2 months at the time but so far we haven't heard.

Thoughts?

We had the letter recently (DD is nearly 12 months) and I have yet to action it (time contraints rather than issues with the vaccine itself). My friend who has a DD of nearly 8 months was not sent the letter as her DD should still be covered from her last scheduled vaccine.

err no but you said the d of h were controlling it before it reached epidemic proportions? Why would it if it hadn't ever been in the past?

There is a first time for everything. Surely there was first time for all epidemics ?!

I accept and apologise that I may have over-exaggerated the risk with regards to the magnitude of the problem (although I said 'way before it reaches epidemic proportions - meaning that it should hopefully, never get that far due to this new immunisation programme). If I frightened anyone unneccessarily then I apologise.

Perhaps it would be helpful to read what the DOH has to say on it's own policy here... DoH on HIB

Jimjam, your faith in me is touching, and sadly misplaced I don't realy know if it would just push up the age or not. I do know that some age groups are more suseptable to some forms of meningitis. Other viruses have odd patterns of 'attack'. I'm thinking of the influenza virus that hit just after WW1. It mostly killed people in their 20's and 30's, quite unlike the 'normal' pattern for 'flu deaths. Similarly other viruses like chicken pox are more dangerous to adults. So it could be that only the younger children are at greatest risk. But this is just supposition on my part. Haven't a scooby doo realy!

hmb- Well your stuff on tetanus helped- especially the bit about the slow release of the toxoid- makes perfect sense now. Still haven't decided when/if to give it to him, but at least I have more idea of the risk/benefit ratio.

I know meningitis c likes teenagers - so could be something like that with hib I suppose but everything I've read (including from the D of H) say that the disease has been practically unknown in the over 5's as by then they have come into contact with hib by then and developed their own immunity (same argument used when they say all people born before 1950 soemthing will be naturally immune to measles, as it would have been impossible to avoid coming into contact with it). They've also said that the reason the numbers may be going up is becuase the vaccine is wearing off. Well won't the same thing happen when the vaccine wears off again? Or am I totally missing something? Measles is now being found in adults becuase of vaccine immunity wearing off, surely hib will be the same?

I just really really don't understand the logic behind this- I'm quite keen to!

Just remembered a friend rang into radio 4 and spoke to a d of h bigwig about MMR. He pointed out that becuase immunity from vaccinations wears off once you start vaccinating you have to continue given boosters over and over again. The D of H man agreed with him! So maybe I've answered my own question. Unless someone knows otherwise.......

I'm assuming you've discussed it with your GP/Health Visitor/Practice Nurse, who should be able to explain the logic behind it ?

Glad the tetanus stuff was a help. I'm not much use at remembering anything anymore, but I'm reasonably good at finding things!

I honestly don't know about the hib. I could argue it either way, but with no data to back myself up. (benefits of a university education bull with confidence )

My GP has been unable to answer my vaccination questions as he doesn't know the answers. He does however understand my reasons for not vaccinating DS2 as does my HV (who said she would do the same in my situation). I'm not worried as I'm not giving DS2 Hib vaccination, and ds1 isn't having any boosters of anything - I'm just interested. hmb answered a question I'd had for ages the other night regarding tetanus so I wondered if she could answer this one.

well practiced in tutorials hmb Actually I think most of this stuff can be argued either way depending on which stats you use. Thanks though. I'll carry on scratching my head on this one. Years ago some science guy policy maker in the dept of health gave me his phone number to discuss any questions I had with him. I may dig his letter out and send him a list (this was in the innocent pre-autism days so believe me I have many more questions for him now )

You could try asking the medical information department of the company that makes the vaccination, they might be able to help. I used to do this job years ago. They are limited in what they can tell you (ie they can be seen to come between a patient and their medical practitioner, and can's say anything to a member of the public that would be seen as advertising). Don't tell them about your worries following on from ds's problems (or they will clam up) and flash your academic qualifications (which should help them loosen up a bit). If I have time I may have a google later. But we have just been given a piano.....so the house is a hellish mass of noise and overexcited kids at the moment!

Now there's an idea- curious retired academic/come ex A level Biology teacher- I can play that one. Better not ring though- they might hear ds1 in the background and guess.... Might write to them though. Thanks hmb!

Ds had this yesterday and, thankfully, seems fine. However was a bit surprised when nurse said "Oh, he's due for his mmr booster, we can give it at the same time". Like bloody hell you will I replied, or words to that effect. Find it incredible that, given the fear surrounding mmr, they try and push it down your throats (well, in to your child's arm actually) at the same time as another jab.

Had a quick look (in between arpegios) and found this

'Natural immunity: Natural immunity to Hib involves many factors and components of the immune system, e.g., immunity of mucous membranes, humoral immunity, activation of inflammatory responses, phagocytosis, and cellular immunity. It is difficult to determine which of these mechanisms is the most important in protecting the individual. Most people acquire a natural immunity to Hib in the first years of life without having developed disease. This immunity arises from pharyngeal colonization and/or asymptomatic enteric colonization of microorganisms that have an antigenic cross-reactivity with H. influenzae type b. The importance of antibodies as one of the elements that provide protection is demonstrated by a gradual increase in their concentration in blood with age and by a concomitant reduction in the risk of contracting disease. It is also observed that in newborns, as the maternal antibodies acquired through the placenta decline, the risk of contracting invasive diseases from Hib increase. Functional analyses of the specific antibodies to the capsular polysaccharide of Hib demonstrate their bactericidal and opsonophagocytic capacity. Other surface antigens also stimulate the production of protective antibodies. Antibody levels above 0.15m g/ml, specifically IgG, are considered to protect against Hib; to ensure long-term protection, a value of 1.0m g/ml is necessary.'

From www.paho.org/English/HVP/HVI/hvp_hib_epidprev.htm

From this it would seem that there is sufficient cross reactivity from similar viruses to stimulate the immunity, but that it takes a while to build up (poss explaining why it is mostly under 5s that get it) If it is cross reactive then cutting out the Hib wouldn't necessarily push up the age group that get the illness. I read on one web site that getting hib doesn't give you 100% cover, not sure why not, poss antigenic drift???

I've also had a quick glance at the epidemiological data and there doesn't appear to be a peak in the over 5 incidence following the innoculations (5 years or so down the line). But I'd put in the caveat that this is way outside my field, and I wouldn't bet the farm on this.

Regards
HMB

aha- cheers hmb - that makes sense. You superstar- see my faith if you was well placed! Now I need ot think of another tricky question...... Hope the piano sounds good.

willow- incredible I know!

It is so nice to think on occasion. I'll be watching the autism program with great interest. I'm going to be working with at least 1 pupil with ASD next term, so I'm hoping to get some useful insights.

Jacqui is wonderful. She has such a great attitude and was a real help when we were going through the acceptance stage. Leading by example I can't wait to see it either. I think she's on BBC breakfast time tomorrow as well with Luke at 8.15am