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Risk-Benefit Analysis: Hep A, Hep B, Rotavirus

admin April 25, 2012

 

Welcome! This is the twelfth post in my vaccine series.  You may have missed  Getting Serious, 10 Bad Reasons Not to Vaccinate, Why “Science” Should Be Carefully Evaluated, What is Herd Immunity All About, How the Immune System Works, Ingredients in Vaccines Part 1, Ingredients in Vaccines, Part 2, Risk-Benefit Analysis: MMR, Risk-Benefit Analysis: DTaP, Risk-Benefit Analysis: Chicken Pox, Hib, Flu or Risk-Benefit Analysis: Pneumoccocal, Meningococcal and HPV.

Today we do the last in the risk-benefit analysis posts, concentrating on Hep A, Hep B, and rotavirus.

Hepatitis A

What is Hep A?

Hepatitis A is an infection of the liver.  It is spread infected feces, getting into the mouth.  (It would be spread through unwashed produce potentially, employees who don’t wash their hands after using the bathroom in restaurants, etc.)  Pre- vaccine, it caused about 100 deaths per year.  It is asymptomatic 70% of the time in children and 30% of the time in adults.

Interestingly, WHO has no position paper on Hep A.

Normal course of the illness

There is approximately a 28-day incubation.  Early symptoms are abrupt and include fever, fatigue, nausea, loss of appetite, stomach discomfort, dark urine, and jaundice.  This usually persists for about 2 months, but may last up to 6 months.

Complications

The greatest “complication” was loss of productivity, as adults lost an average of 27 days of work from hepatitis A infection.  No illness-related complications are mentioned by the CDC.

Case fatality rate is approximately 0.3%, but may as high as 2% in certain populations.

There is no treatment for Hep A, but the infection usually clears in a month or two with no lasting damage.

Vaccine Use

A 2-dose series is recommended starting at 12 months of age, with the second dose coming at 18 or 24 months.  Two doses are recommended for anyone over age 2 who has not yet had the vaccine series yet, especially those at high risk.

Side Effects

There were 1867 adverse reactions reported to VAERS in 2011.  132 of these were considered “serious,” or about 7%.  These include itching, rashes, localized pain, redness, fainting, fever, severe headaches, nausea, vomiting, fatigue, dizziness, seizures, death.

Bottom Line

Hepatitis A is not very common and often causes no symptoms.  When it does, symptoms are generally mild and resolve without lasting damage.  Those who are not at “high risk” should not consider this vaccine (strong words — but there is so little risk from this disease).  It is possible that with natural liver supports ( kombucha, dandelion root, etc.) that any potential Hep A infection could be cleared more easily (possible, I am not a medical professional).  The vaccine, on the other hand, presents a very real risk.

Hepatitis B

What is Hep B?

This is another strain of Hepatitis, and it has made news recently because the vaccine has been recommended for newborns for a few years now.  It is another form of liver infection, and it is one of the leading causes of both acute and chronic hepatitis and cirrhosis (liver failure).

Normal course of the illness

There is approximately a 90-day incubation period for this illness.  Early symptoms include fatigue, loss of appetite, nausea, vomiting, abdominal pain, fever, headache, joint pain, dark urine, etc.  3 – 10 days later, this is followed by jaundice (yellowing of the skin caused by bile, which indicates the liver isn’t functioning normally).  This lasts 1 – 3 weeks before resolving, typically without incident.

Most cases result in complete recovery and immunity to future infection.  Up to 50% of cases are asymptomatic.

Complications

1 – 2% of the time, hepatitis B becomes “fulminant” or serious.  This has a case fatality rate of 63 – 93% (only for the chronic cases, not all cases).

About 5% of Hep B infections become chronic.  Up to 90% of babies infected by their mothers become chronic, and 30 – 50% of children who are infected before age 5 also become chronic.

Most people with chronic infection are asymptomatic most of the time.  However, 25% die early from cirrhosis or cancer.  People with chronic infection are 12 to 300 times more likely to end up with liver cancer than those without Hep B infections.  4000 to 5500 people die each year from Hep B-related cancer or cirrhosis.

Interferon is used to treat chronic cases, and is successful 25 – 50% of the time.  Otherwise there is no treatment, only managing the symptoms.

Vaccine Use

Hep B vaccines are given to 12-hour old babies before they leave the hospital.  Doses are also recommended at 2 and 4 months, and occasionally again at 12 months.

According to the package insert, this vaccine shows antibodies for about 21 days and has an efficacy of 50 – 90%.  It has not been studied for use or safety in a pediatric population.  Another version has been studied in a pediatric population (which is the version used in babies).

Interestingly, the CDC’s chart on interpreting the serologic tests for Hep B shows that the results showing immunity from a vaccine and those showing immunity from natural infection are entirely different.

Side Effects

There were 1133 adverse events reported to VAERS in 2011.  152 were serious, or about 13% (this is on the high side).  Symptoms included severe pain, nausea, vomiting, fainting, redness, swelling, fever, inconsolable crying, dizziness, headache, diarrhea, seizures, death.

One study notes that Hep B vaccination in newborns “triples the risk of autism.”  Another study found that the full 3-shot series lead to a 9-fold increase in autism.

Bottom Line

Hep B can be serious, especially in at-risk populations (like newborns born to infected mothers).   Vaccination of all newborns, however, is clearly dangerous.  This is a vaccine where the child’s relative risk needs to be carefully considered vs. the risk of vaccination.  Most newborns probably would do better without it.

Risk-Benefit Analysis Hep A, B and Rotavirus pinterest

Rotavirus

What is Rotavirus?

Rotavirus is a common virus that causes diarrhea illness.  Most babies will have had it at some point before age 5.  It is usually not serious in developed countries with access to clean water and medical care.

The CDC says: “The immune correlates of protection from rotavirus are poorly understood. Serum and mucosal antibodies against VP7 and VP4 are probably important for protection from disease. Cell-mediated immunity probably plays a role in recovery from infection and in protection.”  Which means they are ‘not sure’ about any of these things (how immunity to rotavirus occurs).

One rotavirus infection is not usually considered to confer permanent immunity.  However, subsequent infections are milder and may be asymptomatic.

Normal Course of the Illness

Incubation is usually about two days.  This is followed by fatigue, nausea, mild fever (in some), and watery diarrhea for 3 – 7 days.  Other infections can cause the same symptoms, so rotavirus can only be diagnosed via laboratory test.

Infection is rare in infants under 3 months of age, and is most likely to be symptomatic in children 3 months to 3 years.  Older children and adults are often asymptomatic.

Complications

In young children (especially), rotavirus can lead to severe diarrhea, dehydration, electrolyte imbalance, and acidosis.  This is especially likely in those with compromised immune systems.

Rotavirus accounts for up to 70% of all hospitalizations due to diarrhea.  Rotavirus caused 20 – 60 deaths per year before the vaccine (in the U.S.).  Another “notable” complication is the up to $1 billion in lost productivity from parents having to miss work to care for sick children.

Vaccine Use

Rotavirus is a live-virus, oral vaccine that is recommended for use in children at 2, 4, and 6 months.  Infants 15 weeks or older who have not received a dose cannot be vaccinated, and the final dose must be completed before 8 months.  (The risk of intussusception increases with age, and the danger of rotavirus itself decreases).

In studies completed in third world countries, severe disease was prevented by the vaccine in roughly 2.5 out of 100 vaccinated babies.  The overall efficacy ranged from 49 to 77%.  “Efficacy” clearly increased in countries where the disease was not a great threat anyway (suggesting that, in fact, it was not the vaccine that was responsible).

About 25% of babies shed the live virus for a couple weeks following vaccination.

Side Effects

There were 905 adverse events reported to VAERS in 2011.  254 of these were considered serious, or about 28% (this is off the charts high!).  These included intussusception, fever, fatigue, inconsolable crying, vomiting, diarrhea, high-pitched crying, swelling, blood in stool, seizures, death.

All together, all vaccines (not just rotavirus) caused 94 deaths in 2011.

Bottom Line

This is an incredibly dangerous vaccine.  Average rate of “serious” effects is 3 – 7%.  “High” is 10 – 15%.  28% is simply unacceptable.  The vaccine also sheds the live virus in about 25% of cases.  The vaccine also doesn’t appear to work all that well; the “increase” in efficacy in areas where rotavirus is not much of a threat is clearly not due to the vaccine, but to the other environmental changes responsible for the lowered likelihood of infection.  The illness is not very dangerous if a child has access to breastmilk and medical care, and a relatively clean environment (such as in a developed country).  This is a vaccine that many “alternative” pediatricians don’t even offer.  I would never give this one, personally, even if I were doing others.

Final Thoughts

We’re done with the risk-benefit analyses!  That was quite a lot of work. 🙂  There is clearly a greater argument for some vaccines than others.  Always, always read the links provided within the text and always ask questions at the doctors’ office.  Ask for the package inserts.  Make sure you are making an informed choice!

Coming up we’ll be talking about ways to protect unvaccinated children, alternative schedules, and how to deal with those pesky vaccine pushers. 🙂

Are you concerned about Hep A, Hep B, Rotavirus and their corresponding vaccines?

Confused about vaccines?

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23 Comments

  1. I have to say that I love reading this series, and am always looking forward to reading the next one. I plan on giving this to my husband to read. He supports me with not vaccinating our son, but has his doubts sometimes. Also going to show my mom and MIL, as they both have gotten on my case. Thank you for all your hard work!!

    Reply

  2. One question I would have liked to see examined here with the hepatitis vaccines is the risk of spreading to others (especially later in life). You briefly touched on it with the Hep B as infants born to a mother with the disease are at risk, but didn’t mention whether these diseases are able to be spread later in life sexually (as in Hep C) and could be problematic that way.

    As for the rotavirus vaccine, that’s just scary!

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  3. I failed to see where you stated how Hep B is spread. Can you clarify?

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    • Oh, sorry. It’s spread by contact with blood and bodily fluids — sexual contact, sharing needles, during birth, etc.

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  4. If a child gets 35-40 shots between birth and 18 years, has anyone calculated the amount of mercury that adds up to??

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  5. Thanks for all your hard work on this series. Will you be doing a post on Vitamin K – injections and/or oral? That’s what I’m currently researching for myself, so just curious.

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    • Kathryn, I wrote about that awhile ago in a post called “Newborn Procedures,” in my healthy pregnancy series. You can find it under the “Natural Pregnancy” category. 🙂

      Reply

  6. Thank you for taking the time to lay out all of this information for other parents and individuals interested about vaccines. I am definitely looking forward to the next in this series!

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  7. One of the other side effects of contracting Hepatitus is that you can never donate blood after that. My dad contracted Hepatitus A years ago (not sure from where). Do we know how long this vaccination has been around?

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    • It looks like about 10 years. It was created sometime between 1998 and 2000, and it was officially added to the mandated schedule in 2002. I can’t find exact approval dates at this moment. But…not that long.

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      • Well, that rules me out for getting the vaccine as well!! My son is 5 and he has been vaccinated, but I know he does have more coming up and I want to be more informed when that time comes. He was up for the flu shot at his last visit and my husband very emphatically said no.

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  8. Thank you so much for writing this, I was sitting down to do the exact same thing for my husband and his family, so you have saved me a LOT of work!

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  9. I was hoping that you’d do a risk-benefit analysis on Polio… it is a vaccine I am interested in giving to my daughter.

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  10. Thanks for this! I am wondering how you calculated the 28% AE rate from rotavirus OR if you quoted it from another reference source. If you calculated it, how did you obtain the numerator and denominator? In my experience using the VAERS search tool, you can either search for AEs that occurred when a child had only the rotavirus vaccine or AEs that occurred when the child had multiple vaccines including the rotavirus vaccine. In the latter search, this number would produce a numerator that may be attributable to other vaccines. Also, what data source did you use as your denominator? Thanks so much for this! I am doing some heavy research and am so appreciative of your contributions to these efforts.

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  11. My daughter reacted to the hep-B at birth with encephalitis and autism. I’d recommend parents read Judy Converse’s book When Your Doctor is Wrong: Autism and the Hepatitis-B Vaccine. The same thing happened to her son as to my daughter, but he nearly died from his reaction, and was ignored by his medical team. She has hundreds of horrifying statistics on the dangers of this vaccine. She testified before Congress in May 1999, a year before my daughter was born: Congress found it was a very dangerous vaccine and should definitely not be given with mercury, so they gave it to my daughter with mercury, without even asking permission. Michael Belkin, whose daughter was killed by the hep-B vaccine, also testified, and school nurse Patti White, who said her association of school nurses had reluctantly been convinced that this vaccine, given to newborns since 1991, was singlehandedly responsible for the deluge of autistic kindergartners suddenly hitting Missouri schools starting in 1996.

    Reply

  12. Robyn,
    The mercruy has been removed from most shots, but not from the flu vaccine that most people get. It still has a lot, and nurses often don’t shake up the vial before filling the syringe, so they often get a lot of mercury that has settled at the bottom. Not that’s it’s safe in any amount. You have to pay about three dollars more and ask for a single-use vial with no thimerosal if you don’t want mercury. But it’s still dangerous for many other reasons, aluminum being one important one.

    Reply

  13. Hi. Thanks for sharing all your hard work. II’m trying to wrap my mind around the whole picture, and I’m just curious if the stats you give on adverse reactions could be misleading. For example, the Rotavirus serious adverse reactions you report as being at 28%, but that is a percentage of the VAERS total adverse reaction events for the year. Obviously this doesn’t mean that 28% of children getting the vaccine will have serious reactions. It means that 28% of those who report reactions will fall into the serious category. It seems that a more helpful statistic, for me, would reflect the % of reported serious reactions (coincidental or real) among the vaccinated community as a whole. So can we figure what is the likelihood of having a serious complication from the illness and compare it to the likelihood of having a serious reaction to the vaccine?

    Reply

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I’m Kate, mama to 5 and wife to Ben.  I love meeting new people and hearing their stories.  I’m also a big fan of “fancy” drinks (anything but plain water counts as ‘fancy’ in my world!) and I can’t stop myself from DIY-ing everything.  I sure hope you’ll stick around so I can get to know you better!

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