----- Original Message -----
Sent: Sunday, March 09, 2003 6:30
PM
Subject: [ozmidwifery] Hep B
Vaccine at Birth
I have previously expressed concerns related to the
administration of Hep B Vaccine (HBV) to all babes at birth ie 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 hispractice have missedthe 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 there 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)
- adaptation to extrauterine life – profound physical changes in all
systems respiratory, circulatory, neurological, sensory,
digestive/alimentary
- organisation of suck to enable feed
- overcome effects of pharmacological substances used in labour,
birth an 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 effectective 3 dose
targetted program for many years). Certain occupational groups, eg
health workers, have a higher than average risk and are generally
vaccinated witha 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 Austalian 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.
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
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
judgement. 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. Drs in US and UK have similar deals with
gov't or employers.
Sandra
It would be nice if there were a few more blips
showing up on the "Early Warning
System"
