Hepatitis B Vaccines: A Response
Saturday, August 07, 1999

From J. Thomas Megerian, MD, Ph.D. Child Neurology, Neuropharmacology and Behavioral Neurology Children's Hospital in Boston.

As a pediatrician and child neurologist specializing in pervasive developmental disorder and other disorders of behavior and cognition, I enjoy reading your newsletter, mostly for the insight it gives me about what concerns parents have and what information they are reading about in the lay and professional presses. Normally, I do not respond to things I read, even when they are grossly inaccurate, partly because I don't think anyone will listen and partly because I don't have time to debunk misinformation when there are children to see.

However, your article from one bereaved parent regarding the dangers of Hep B is filled with so many fallacies, that I cannot help but say something, lest thousands of readers go on thinking what they've read here even remotely resembles the truth. Here are the facts. I will let the readers rather than propagandize them with 'counter' opinions. "An estimated 300,000 new cases of HBV infection occur in the US each year, with the 20- to 39-yr age group at greatest risk. The number of new cases in children is low but is difficult to estimate because the majority of infections in children are asymptomatic. The risk of chronic infection is related inversely to age; although less than 10% of infections occur in children, these infections account for 20-30% of all chronic cases." (Snyder and Pickering, Behrman: Nelson Textbook of Pediatrics, 15th ed., Copyright © 1996 W. B. Saunders Company, pp 911).

Counter to what your article stated, the highest prevalence in the US is not in 'drug abusers' or 'promiscuous people' but in the Eskimo Population in Alaska (not a group known for promiscuity or drug abuse). 70-90% of infants of actively infected mothers become chronically infected if untreated. The risk that our adolescent children will become chronically infected if they contract HBV is 50%.

What does that mean? Snyder and Pickering write that "Chronic HBV infection, which is defined as being HBsAg positive for 6 or more, is associated with chronic liver disease and with primary hepatocellular carcinoma, the most important cause of cancer-related death in the Orient." What has fooled many into thinking this disease is not or never has been a threat is the fact that children show little if any signs when they get infected. It's actually not the IV drug users or sexually promiscuous that are at risk for the sequelae of HBV infection...they usually get over the acute infection without becoming chronically infected...it's the kids and infants that carry the disease with them the rest of their lives (lives drastically shortened by the almost inevitable occurrence of end-stage hepatitis or liver cancer in the chronically infected). In older children and young adults, acute, fulminant hepatitis, treated only by liver transplantation, occurs much more frequently in HBV infection than with any other hepatitis virus. The Death rate is 30% in those who get fulminant hepatitis with HBV.

As for the notion that we are unnecessarily vaccinating children who are not really at risk, by virtue of their birth to law abiding, non-drug using, non-promiscuous middle Americans, readers should know the real list of who gets HBV besides the minority of cases from IV drug use....."Others at increased risk include those with occupational exposure to blood or body fluids, staff of institutions and nonresidential child care programs for the developmentally disabled, patients receiving hemodialysis, and sexual or household contacts of persons with an acute or chronic infection.

However, more than one third of infected persons do not have a readily identifiable risk factor." ( AAP 1997 Red Book: Report of the Committee on Infectious Diseases, 24th ed., Copyright © 1997 ). Remember that when we count adverse events in statistics for vaccines, the overwhelming majority of those refer to red arms, slight fever, pain in the injection site, or rash. Death as an adverse event of vaccination is extremely rare. Death and real suffering at an early age because an infant was unwittingly infected by a parent or caretaker is not rare...it just doesn't happen while the child is still a child.

I hope you will see fit to publish these facts, so that people know how much their children were (and still are) at risk prior to the advent of this vaccine. There is a tendency now-a-days to feel that good health is a G-d given birth right. It's not. Left to our birth rights, multitudes of infants would die before they saw the age of 1 year of life. They don't because of vaccines, antibiotics, sanitation, nutrition, and the ever growing ability of medicine to intercede and repel nature's desire to have only the fittest survive.

Sincerely,
J. Thomas Megerian, MD, Ph.D.
Child Neurology, Neuropharmacology and Behavioral Neurology
Children's Hospital
Boston, MA 02115
tmeg@massmed.org