HAEMOPHILUS INFLUENZA B -THE DISEASE AND THE VACCINE by DR JAYNE DONEGAN

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HAEMOPHILUS INFLUENZA B -THE DISEASE AND THE VACCINE by DR JAYNE DONEGAN

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HAEMOPHILUS INFLUENZA B -THE DISEASE AND THE VACCINE

YOUR QUESTIONS ANSWERED BY DR JAYNE DONEGAN

Informed Parent Summer 1997

1. Are the symptoms the same as those from other forms of meningitis?

The symptoms of Haemophilus Influenza B (Hib)

meningitis are similar to those of other forms of

meningitis in children. Hib meningitis occurs

more often after colds, coughs and ear infections

in young children. Seizures are more common. The

disease tends to have a slower onset than

Neisseria meningitidis type B meningitis and is

less likely to cause a rash. It also occurs less commonly in epidemics.

2. What other diseases does the vaccine prevent

and how does it cover more than one?

Haemophilus influenzae is a bacterium that

infects humans only. It comes in an

unencapsulated form which causes mostly coughs,

colds. sinusitis and ear infections. There is an

encapsulated form that has six types (A-F). Type

B is the commonest type and can cause’ invasive’

disease. It may spread directly and inflame the

skin of the face or cause epiglottitis or it may

invade the blood stream and cause infections

further away - meningitis, joint infection,

pneumonia. 90% of healthy individuals carry

Haemophilus influenzae in their noses. 5% of these organisms will be type B.

The vaccine is only against type B so it will

only affect infections caused by Haemophilus

influenzae type B (Hib). It is also likely that,

as infections by type B are suppressed, the other

types A, C-F will eventually take over and produce them instead.

3. Is my child less likely to get Hib meningitis

because other children are vaccinated or more

likely to because the other children are carrying Hib without signs of illness?

Invasive Haemophilus influenzae disease is more

likely in children aged 3-48 months. The peak age

is ten to eleven months. Antibodies form against

the encapsulated form (of which type B is one)

and may be the result of carrying the organism,

without symptoms, in the nose or the pharynx.

Antibodies may also be formed as a result of

infections with other organisms that have similar

capsules (such as E. coli k100, found in the gut).

The vaccine will presumably cause less children

to meet the organism and less children to carry

it in their nose. This means that less children

will gain natural immunity to Haemophilus

influenzae and this will increase the likelihood

of their contracting severe forms of the disease at a later age.

The incidence of disease caused by invasive forms

of Haemophilus influenzae (encapsulated forms

A-F) has been rising since the introduction of

mass vaccination in the 1950s and excessive use of antibiotics.

In answer to the question, your child may be less

likely to get natural immunity from meeting the

infection in other children but, hopefully,

should still meet it in healthy adult carriers.

As this latter group disappears with the

vaccination of sucessive generations, the chance

of gaining natural immunity at an early age will

also disappear with all the consequent complications that this causes.

4. What studies have been done on reactions and

long term effects? How long has the vaccine been available?

Studies have been carried out on reactions but

none of them are long term. The original vaccines

were ‘unconjugated’ and did not produce an immune

response in children less than 18 months of age.

The current ‘conjugated’ vaccines are made of a

purified part of the capsule of Hib and are

joined (conjugated) to another material with the

aim of provoking an immune response at a younger age.

The conjugated vaccines have been around for less

than ten years and were not licensed for use in

two month old children until 1990 (in the USA).

There are many different types, depending on the

material to which they are conjugated:

PRP-D Conjugated to Diphtheria Toxoid

PRP-T Conjugated to Tetanus Toxoid (Pasteur Merieux - ActHib and ActHibDPT)

(Kline Beecham-Hiberix)

PRP-CRM Conjugated to Cross Reacting Mutant

Diphtheria Toxoid (Lederle Praxis CRM 197 HibTITER)

PRP-OMP Conjugated to Outer Membrane Protein of Group B Neisseria meningitidis

HbOC Conjugated to Oligosaccharide

The Handbook of Immunisation against infectious

diseases 1996 mentions large field trials in

Finland, the USA and the UK. The trials showing

the highest efficacy and given as references in

the Handbook are for the vaccines PRPOMP and

HbOC, neither of which are used in this country.

The trials were all over a one to two year period

so no data as to long term efficacy are

available. As for reactions, studies on reactions

and incidence of Hib disease post vaccination

have been mainly in children who were given Hib

vaccine and DPT and Polio compared with children

given DPT and Polio alone. This is not a very

good control group, bearing in mind the high

incidence of adverse effects that these vaccines

have on immunity, particularly in young babies.

Some studies suggest that the Hib vaccine may

reduce the ability of a child to fight infection

in the two to three weeks after administration.

The Handbook on Immunisation mentions swelling

and redness at the injection site in 10% of

doses. The British National Formulary lists:

fever, headache, malaise. irritability, prolonged

crying, loss of appetite, vomiting, diarrhoea,

rash, allergic urticaria, convulsions, erythema

multiforme, and transient cyanosis (blueness) of

the lower limbs. Other reactions which have been

reported through the Vaccine Adverse Event

Reporting System (VAERS) of the USA are:

Guillain-Barré Syndrome (a neurological disease

which may eventually cause paralysis of the

muscles needed for breathing and necessitates

artificial ventilation in intensive care. .The

symptoms may gradually improve), Transverse

Myelitis (a paralysing disease that mainly

involves the legs), Death (which may have been

caused by the Hib vaccine or by other vaccines

that were given at the same time).

5. At what age is one less likely to contract a

Hib disease? Is this because of a more developed immune system?

Hib disease is unlikely to occur after the age of

five years because by this age the organism will

have been encountered and symptomatic or

asymptomatic disease with subsequent immunity

will have occured, but this age will rise as

vaccination becomes more prevalent. 70% of all

cases of Hib and menigococcal type B meningitis

currently occur in children less than five years

of age. Boys are more likely to be affected than

girls. The highest seasonal incidence is between

autumn and spring. The incidence is much higher in daycare institutions.

6. What can I do to boost my child’s immune

system? I want to give them vitamins but can only

find inadequate synthetic ones.

To boost your child’s immune system you need to

give them love, time (ordinary time not just

‘quality’ time), fresh air, fresh fruit and

vegetables, home cooked, unprocessed food, water

(uncontaminated by sewage, heavy metals and

agrochemicals), exercise and the space to

assimilate all that is going on around them in

this increasingly hectic, unchildlike world.

VITAMINS. Because of intensive farming methods

and pollution, it is probable that even a

healthy, well balanced diet is lacking in

nutrients. Vitamin supplementation is, therefore,

probably advisable. Nature’s Own (Tel 01684

310022) make what they call ‘food state’ vitamins

which are supposed to be more bioavailable.

Unfortunately, they charge more for their

children’s multivitamin/mineral supplements than

they do for their adult ones (even though there

is less in them!) because of their odd package

sizes. If you do wish to order something from

them, ask to speak to the managing director,

Wallace, and insist that you get 100

childrens vitamins for the same price as 100 adult ones.

Jayne L M Donegan,July 1997

References:

•Handbook of Immunisation against Infectious Disease -1996 HMSO

•British National Formulary, Number 33 - March

1997 BMA and Royal Pharmaceutical Society of Gt Britain

• on’s Principles of Internal Medicine, 11th Edition -1987 McGraw Hill

•Vaccination, Viera Scheibner -1993 Australian Print Group, , Australia

•The Vaccination Guide, Randall Neustaedter -

1996 North Atlantic Books, Homeopathic

Educational Services, Berkley, California, USA