Dr. Molly’s Weblog

Molly O’Shea starts a revolution in pediatric care

HIB infections on the rise January 27, 2009

Filed under: Uncategorized — Dr Molly OShea @ 11:03 pm

Hemophilus influenzae type b is a wicked bacterium.  It causes pneumonia, blood infections, meningitis, and a type of throat infection called epiglottitis all of which are life threatening. 

In the very early 1990s a vaccine became available to combat this bacterium, the HIB vaccine and it has been incredibly effective.  When I was a med student in the late 80s and a resident in 1990, I saw four children die of epiglottitis due to HIB and many more kids with pneumonia and meningitis.  Within just a year or two of the introduction of the vaccine the rates of illnesses caused by HIB plummeted. 

HIB is spread by actively sick children but also by children who carry the bacteria in their noses with no symptoms at all.  The beauty of the HIB vaccine is that it not only prevents a child from getting sick who gets exposed to the germ but eliminates the bacteria from the noses of the kids who are just carrying it.  That is how herd immunity works. 

It seems now that since fewer and fewer children are getting vaccinated our herd immunity is waning.  It used to be that even unvaccinated kids were relatively safe since most  kids were getting the vaccine and as a result there were virtually no ‘silent carriers’.  That is changing.  In 2008 Minnesota reported 5 cases of HIB disease and one death.  Three of the children had not received any vaccines at the parents request, one was so young he had only had two of the shots, and the one who died had all of the vaccines but had an immune compromising condition that prevented him from responding properly to the vaccine. 

I am not discussing this here to hit you over the head with a mallet if you are choosing not to vaccinate but rather to make sure that everyone has the data they need to make informed decisions.  It feels safer to opt not to vaccinate or delay vaccinations when the diseases the vaccines prevent are largely absent.  Now that safety net of herd immunity is fraying. 

More and more data support the safety of vaccines and over 20 studies have been published in the last couple of years refuting the association between vaccines and autism.  I also know that many parents remain skeptical and concerned about the risks of vaccinating their child on the AAP’s recommended schedule and my job is to make sure you have all the information you could need to decide about whether or not to vaccinate.  My job is not to bully you into doing it or chastize you for not, but rather to give you the information and allow you to make the decision for your child.  The tide though seems to be shifting.  The diseases vaccines prevent are resurfacing and as a result the decision whether or not vaccinate is more challenging and complex.  The risk of disease needs to be balanced against the risk of adverse outcomes from vaccinating.  We have good data about the risk of disease, and good data about the safety of vaccines and yet there is a common belief among many parents that they are taking a risk vaccinating.  But you are also taking an increasing risk by not vaccinating.  Food for thought.

Study the data, ask questions, and weigh the pros and cons and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center



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