Saturday, January 24, 2009

Hib infection: what you need to know

I haven't seen a lot of haemophilus type b infection. That's one of those diseases that the old-timers (and not even that old; this was around like 15 years ago) talk about, and tell the young docs they should be relieved not to have to worry about. When you suspect a child has epiglottis, which I've never seen, you don't even touch their mouth or throat until you are in the operating room. If you so much as put a popsicle stick on their tongue, their throat could spasm and they will choke to death right in front of you.

Like I said, horror stories.

Well, guess what? Five children have Hib infections in Minnesota, one has died. There is a shortage of vaccine right now, and young babies are given priority.

From CNN:

Three of the children had not received any vaccination because of their parents' decisions, not because of a vaccine shortage, officials said.

One of the infected children, a 5-month old, had not completed the three-dose series of the vaccination, and a 15-month old child had received all doses but had an immune deficiency.

The cases are not related and were in different counties, said Dr. Ruth Lynfield, Minnesota state epidemiologist.

But the shortage may be having an effect in the community.

"When there are high immunization rates, there is herd immunity," Lynfield said. "It may be that because of the shortage, that herd immunity has dropped. That first manifests in unimmunized children."

One in 20 children infected with Hib dies, according to the CDC. And survivors of the disease can become deaf; 10 to 30 percent have permanent brain damage.

"Parents may not realize the importance of this vaccine," Schuchat said. "The disease is still around."

People tend to "think it's gone because it has not been seen for a while. Clearly, the bacteria is in the community in Minnesota, and babies that haven't gotten their vaccines are at risk," she said.

From the CDC:

Hib disease is caused by bacteria called Haemophilus influenzae type b. Hib bacteria are spread through contact with mucus or droplets from the nose and throat of an infected person when they cough or sneeze. Hib can be spread by people who are ill with the disease. More commonly, however, Hib is spread by people who have the bacteria in their noses and throats but who are not ill.

Before Hib vaccines, there were about 20,000 cases of invasive Hib each year in the U.S. Invasive disease means that germs invade parts of the body that are normally free from germs. When this happens, disease is usually very severe, causing hospitalization or even death. Before a Hib vaccine was available, Hib was the most common cause of bacterial meningitis in the U.S. About 12,000 children each year—most of them younger than 5 years of age—got Hib meningitis. Meningitis is just one of the invasive diseases that can be caused by Hib. Hib can also cause life-threatening infections that make it difficult to breathe, including epiglottitis (infection in the throat) and pneumonia (infection in the lungs). Other forms of invasive Hib disease include blood, bone, or joint infections.

Despite the success of Hib vaccine, parents need to remember the disease is still out there. Hib can be carried in the noses and throats of people who are not sick from the disease. These people can spread Hib bacteria to infants and children who are not protected by Hib vaccine. Vaccinating infants protects them at a time when they are most vulnerable to disease. If vaccination levels get too low in the U.S., Hib disease could make a comeback.

I respect the right of parents to make their own decisions about vaccines. I understand the concerns. But it's easy to decide against vaccines when you've never seen or heard of the diseases they protect against. A lot of people depend on herd immunity to protect their unimmunized children, and that layer of protection is bound to wear thin as more people take that option. In this case a temporary vaccine shortage was sufficient to completely remove the herd immunity effect. Parents must decide for themselves, and there is a lot of confusing information out there. Part of an informed decision about vaccines must involve information about these outbreaks, and their consequences.


mandi said...

wow- that is scary. thanks for the post.
it is frustrating when people choose not to vaccinate, yet do nothing to encourage good health. crappy diets, little exercise, no outside time.
both sides of the vaccine debate are scary to me. and confusing, yes. we are the most overly vaccinated country, but our children tend to be less healthy than in some european nations. it's hard to weigh out the 'political vaccines' from the truly important ones when they are all presented as necessary and mandatory.
oh to live in a perfect world, where we could truly believe what we are being fed.
anyway- this is good information that you have presented-so thanks for passing it on.

Erin said...

Terrific post!! Thanks!!

Anonymous said...

Hi Brandi...this isn't so much about vaccines, but I was reading your profile and it said your interests were about peds HIV...can you email me and tell me more? Kthanks!

Mommy, M.D. said...

you're right that our children are less healthy. we have enormous problems of premature birth and infant mortality, especially for African American babies and children with low socioeconomic status. obesity and even Type II ("adult onset") diabetes are rampant in children. asthma and food allergies are exploding.

but our vaccines are very effective against the specific diseases for which they are designed, both for individual children and at the level of public health. we have far lower rates of measles, rubella, and Hib than european nations. europe experiences frequent outbreaks of these illnesses. they have lower immunization rates, higher infection rates, and comparable rates of autism. but yes, much less obesity and infant mortality.

you are right that good nutrition, a healthy lifestyle, and spending time at home with mom rather than in daycare are all extremely beneficial. you are to be strongly commended for your hard work in these ways. these protect against all the conditions i mentioned above, and also provide some defense against infection.

i mourn the actions of the FDA, AAP, drug companies and bad apple physicians that have cost a good deal of public trust. that is not an easy thing to earn back. but i would not describe any of the recommended vaccines as political. many prescription medications, yes. but i don't see the vaccines that way.

i'm glad we can air this out a little. there are many people i love and respect who believe differently from me on this issue. mandi, you're one of them. my goal is mutual understanding. so thanks for your help in that.