CDC Updates Guidelines for Immunization Against hepatitis B virus (HBV) Infection

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And the 'free' US (not) becomes even less free................and

children's brains and lives will continue to be destroyed. Can't have you

achieving your potential, now can we, or you might rise up!

See my webpages for the dangers of these vaccines

http://www.nccn.net/~wwithin/hepatitisb.htm

Sheri

Terrible and it continues

" Administering a birth dose to infants even without HBIG testing serves as

a " safety net " to prevent perinatal infection of infants born to

HBsAg-positive mothers who are not correctly identified. The birth dose

also affords early protection to infants at risk for infection after the

perinatal period. "

http://www.medscape.com/viewarticle/520762

CDC Updates Guidelines for

>Immunization Against Hepatitis B Virus Infection CME *News Author:

>Laurie Barclay, MD CME Author: Vega, MD, FAAFP* Disclosures To

>earn CME credit, read the news brief along with the CME information that

>follows and answer the test questions. *Release Date: January 3, 2006*;

>*Valid for credit through January 3, 2007 * Credits Available

>*Physicians* - up to 0.25 AMA PRA Category 1 continuing medical education

>credits for physicians ; *Family Physicians* - up to 0.25 AAFP Prescribed

>continuing medical education credits for physicians

Jan. 3, 2006 The Advisory Committee on Immunization Practices (ACIP) of

the US Centers for Disease Control and Prevention (CDC) has updated

comprehensive guidelines and issued a strategy for the eradication of

hepatitis B virus (HBV) in the United States. The first report, published

in the December 23, 2005, issue of Morbidity and Mortality Weekly Report,

Recommendations and Reports, focuses on infants, children and adolescents.

The second part of the ACIP statement will be published separately and will

include updated recommendations and strategies to increase HBV vaccination

in adults.

" The report provides updated recommendations to improve prevention of

perinatal and early childhood HBV transmission, including implementation of

universal infant vaccination beginning at birth, and to increase vaccine

coverage among previously unvaccinated children and adolescents, " write

E. Mast, MD, from the National Center for Infectious Diseases, and

colleagues. " Strategies to enhance implementation of the recommendations

include 1) establishing standing orders for administration of hepatitis B

vaccination beginning at birth; 2) instituting delivery hospital policies

and procedures and case management programs to improve identification of

and administration of immunoprophylaxis to infants born to mothers who are

hepatitis B surface antigen (HBsAg) positive and to mothers with unknown

HBsAg status at the time of delivery; and 3) implementing vaccination

record reviews for all children aged 11 - 12 years and children and

adolescents aged <19 years who were born in countries with intermediate and

high levels of HBV endemicity, adopting hepatitis B vaccine requirements

for school entry, and integrating hepatitis B vaccination services into

settings that serve adolescents. "

Updated recommendations to address challenges in implementing the strategy

to eliminate HBV transmission in the United States include improving

prevention of perinatal and early childhood HBV transmission; administering

a birth dose of HBV vaccine to medically stable infants who weigh more than

2,000 g and who are born to HBsAg-negative mothers; improving vaccine

coverage of children and adolescents who were not previously vaccinated;

and vaccination of all unvaccinated adolescents in settings that provide

healthcare services to adolescents.

Specific recommendations are as follows:

All pregnant women should be tested routinely for HBsAg, and infants born

to mothers who are HBsAg positive should receive HBV vaccine and hepatitis

B immune globulin (HBIG) within 12 hours of birth. If HBsAg status of the

mother is unknown, the infant should receive HBV vaccine within 12 hours of

birth, followed by HBIG as soon as possible (no later than age 1 week) if

the mother is found to be HBsAg positive.

Administration of a birth dose of HBV vaccine is required for effective

postexposure immunoprophylaxis to prevent perinatal HBV infection in

infants identified by maternal HBsAg testing. Compared with vaccination at

older ages, a birth dose of HBV vaccine has only minimal decrease in

immunogenicity and no decrease in protective efficacy.

Administering a birth dose to infants even without HBIG testing serves as a

" safety net " to prevent perinatal infection of infants born to

HBsAg-positive mothers who are not correctly identified. The birth dose

also affords early protection to infants at risk for infection after the

perinatal period.

Full-term infants who are medically stable, weigh more than 2,000 g, and

are born to HBsAg-negative mothers should receive single-antigen HBV

vaccine before hospital discharge. Preterm infants weighing less than 2,000

g who are born to HBsAg-negative mothers should receive the first dose of

vaccine 1 month after birth or at hospital discharge.

After the birth dose, all infants should complete the HBV vaccine series

with either single-antigen vaccine or combination vaccine, according to a

recommended vaccination schedule. After completion of the HBV vaccine

series at age 9 to 18 months, infants born to HBsAg-positive mothers should

be tested for HBsAg and antibody to HBsAg.

All unvaccinated children and adolescents younger than 19 years should

receive the HBV vaccine series. In adolescents, the recommended vaccination

schedules balance available immunogenicity data with the need to achieve

compliance with vaccination.

Intramuscular administration of both licensed single-antigen HBV vaccines

at 0, 1, and 6 months produces greater than 95% seroprotection in

adolescents. Rates of seroprotection are equivalent for adolescents

vaccinated at 0, 1 to 2, and 4 months and 0, 12, and 24 months.

In children and adolescents aged 11 to 15 years, the adult (10 ¼g) dose of

Recombivax-HB (Merck & Co, Whitehouse Station, NJ) administered in a 2-dose

schedule at 0 and 4 to 6 months produces antibody levels equivalent to

those obtained with the 5-¼g dose administered on a 3-dose schedule, but

there are no data on long-term antibody persistence or protection for

2-dose schedules. No combination vaccines containing HBV antigen are

approved for use in adolescents aged 11 to 17 years.

Nonstandard vaccination schedules, in which minimum spacing of doses is not

achieved precisely, do not appear to have significant effects on

immunogenicity. Increasing the interval between the first 2 doses has

little effect on immunogenicity or final antibody concentration. Although

the third dose confers the maximum level of seroprotection, it acts

primarily as a booster and appears to provide optimal long-term protection.

Longer intervals than recommended between the last 2 doses result in higher

final antibody levels. However, this might increase the risk for

acquisition of HBV infection in those who have a delayed response to

vaccination. When 1 or 2 doses of HBV vaccine produced by one manufacturer

are followed by doses from a different manufacturer, no differences in

immunogenicity have been observed.

Infants born to HBsAg-positive mothers who did not respond to a primary

vaccine series but who are not infected with HBV respond satisfactorily to

a repeat 3-dose revaccination series. However, no data suggest that

children with no detectable antibody after 6 doses of vaccine would benefit

from additional doses.

Groups requiring different vaccination doses or schedules include preterm

infants, hemodialysis patients, and other immunocompromised persons.

" Chronically infected persons are at high risk for chronic liver disease

and are a major reservoir of HBV infection, " the authors write. " During

delivery of recommended hepatitis B vaccination services (e.g., HBsAg

screening of pregnant women and serologic testing to assess

susceptibility), vaccination providers will identify persons who are HBsAg

positive. These persons require counseling and medical management for

chronic HBV infection to reduce their risk for chronic liver disease. "

MMWR Morb Mortal Wkly Rep. 2005;54(RR-16):1-31

--------------------------------------------------------

Sheri Nakken, R.N., MA, Hahnemannian Homeopath

Vaccination Information & Choice Network, Nevada City CA & Wales UK

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