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

[Guest guest]

Sheri Nakken <snakken@n...> wrote:

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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******

" Just look at us. Everything is backwards; everything is upside down.

Doctors destroy health, lawyers destroy justice, universities destroy

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information

and religions destroy spirituality " .... Ellner

--- End forwarded message ---