|
|
| |
|
Hep B Vaccine at Birth
by Sandra ( Midwife)
|
|
|
| |
I have previously expressed concerns related to the administration of Hep B Vaccine
(HBV) to all babes at birth - that the midwives in my unit had become aware
of marked increase in numbers of irritable babes and many more with breastfeeding
difficulties in the first few days, since May 2000 when the new schedule
was introduced.
Since then we have done some investigation and as we became convinced of
the connection we have been much more conscientious about gaining "informed
consent" prior to administration of birth dose of Hep B ie "full disclosure
of risks/benefits without coercion or fraud". As a result, parents are not
consenting and the rate of uptake of the birth dose in our unit has dropped off
dramatically. (It is generally much nicer to come to work these days too with
fewer screaming babies, distraught mothers and frantic fathers!)
We (the midwives) are now copping flak because we show up very large on the
radar in the 'Early Warning System' of the authorities pushing the universal
immunisation issue. The pressure to conform has come from Public Health Unit,
District Manager, Medical Superintendent as well as letters of complaint
from a local GP (who may be fearful that he will lose his incentive payments
if the children who return to his practice have missed the birth dose!).
We have been told that we must "actively
encourage" our clients to accept the vaccination, that "it is frequently
reported that the unit works well because of the high degree of trust and respect.
Herein lies the opportunity to disseminate the positive effect of early Hepatitis
vaccination" We have been told that we must "act in line with the Code
of Conduct" to actively promote this policy.
I do believe this is a terribly important ethical issue and will not persuade
my clients to act against their best interests and instincts.
We use the materials and information provided by Qld Health and "Immunise
Australia" when we discuss the issue with the parents. It is acknowledged
in the "Understanding infant hepatitis B immunisation" pamphlet put
out by the "Immunise Australia Program" that among the common side
effects are mild fever, joint pain, irritability and baby going "off its
food for a short time" - discuss how this might affect their newborn in
the first few days of life.
Whilst these common and perhaps transient side effects may be of little concern
in an older child they are liable to be of much greater significance in a newborn
child who is already facing many challenges at this deeply important point in
its life. Challenges to the newborn (physiological and iatrogenic pathology)
-
1. adaptation to extrauterine life – profound physical changes in all
systems respiratory, circulatory, neurological, sensory, digestive/alimentary
2. organisation of suck to enable feed
3. overcome effects of pharmacological substances used in labour, birth and
4. postnatally recovery from the traumatic effect of birth eg head moulding and
other birth injury
We also give them the Qld Health Hep B Information which has this advice "give
extra fluids e.g more breast feeds or water" - we discuss the implication
of this at initiation of breastfeeding.
We also discuss the risk factors for contracting the disease both in infancy
and throught the lifespan.
All women are screened for HBsAg antenatally so that babes of HB positive mothers
can receive both Immunoglobulin and vaccination at birth. This has been shown
to be extremely effective in managing the risk of vertical (mother to baby) transmission.The
risk factors (for contracting the disease) are IV drug use, unsafe sexual practices
and certain ethnic groups have high endemnicity so may have a slightly elevated
risk of transmission (e.g aboriginal, TSI, particular asian groups for whom we
have had an effective 3 dose targeted program for many years). Certain occupational
groups, eg health workers, have a higher than average risk and are generally
vaccinated with a 3 dose progam.
World Health Organisation classifies Australia as a "low" risk for
Hep B with low endemnicity of <2%, transmission rates in infancy are "rare" and "infrequent" in
childhood. Qld Health Notifiable. Diseases Annual Report 1997 -2001 did not count
any in the age group of < 13 years. The majority of notifications in the 15
-39 yr age range.
WHO recommendation is for universal Hep B immunisation in childhood for those
countries with "high" endemnicity and the recommended program is for
3 doses.
Immunisation success (90% sero-conversion which is as high as it gets) occurs
after the 2nd dose, so a child will become immunised at 4.5 rather than 2.5 months
if they choose not to have the birth dose but elect to have the 2,4 & 6 month
doses.
Breastfeeding rates are not monitored after discharge from hospital even
though there are mountains of scientific evidence on the economic value and
health benefits to be gained from increasing breastfeeding rates. I wonder
if there were pocketable profits to be made from introduction of universal
breastfeeding – would
the "breastfeeding Nazis" be men in suits with stock options as part
of their salary package rather than the mothers at the Australian Breastfeeding
Association coffee mornings? This is a very interesting document which I found
in my research. Just go to it to have a look at the last few pages - the attendance
list and the Summary of recommendations are truly enlightening.
www.vhpb.org/stpetersburg/backgrounddoc/behaviouralissues.pdf
It is the report from a 3 day conference in Antwerp which was heavily
loaded with members and "invited guests" with addresses and
job titles which include the following names - Pasteur Merieux MSD,
Smithkline Beecham, Merck, Aventis Pasteur MSD -
These people were "junketted" from all around the world to
meet and came up with strategic plan on how to push and persuade health
professionals, parents, general public and gov't.
I see the language and strategies that came out of this meeting now being
employed on me, my colleagues and clients. Eg Early Warning System - to show
trouble spots, resistence or "crisis in confidence" Vaccination rates
used as "quality issue" Parents being conditioned into belief that
any and all vaccination is black and white "Good Parental Practice".
Issues
What constitutes informed consent?
Coersive and/or fraudulant means for increasing immunisation rates. The gagging
of midwives and doctors expressing reservations. Pressures being brought to bear
on health practitioners to conform despite genuine concern and objective assessment.
Many health professionals have deep concerns about universal Hep B vaccination
in childhood and the birth dose in particular.
A 1995 survey of Californian doctors showed that 43% of family physicians and
17% of paediatricians disagreed with the guidelines -that there is no need for
it and that it may in fact cause harm. It is also suggested that many of these
doctors are giving the vaccine whilst they remain unconvinced that it is in the
best interests of their patient because of pressure applied by the HMO that they
worked for.
The dynamics of the health system are such that health professionals are
coerced or bullied into acting against their better judgment. In Australia
doctors receive payments from the federal gov’t for each completed course of vaccination
as well as a tiered payment for rate targets eg >85% , >90% of vaccinated
kids registered in the practice. Doctors in US and UK have similar deals with
gov't or employers.
Sandra
PS. It would be nice if there were a few more blips showing up on the "Early
Warning System" |
|
| |
|
|
|
|
|
