----- Original Message -----
Sent: Monday, March 10, 2003 10:30
AM
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"