"Beware of Vaccine Bullies"--Malkin column

"Jonathan Smith" wrote
In the case cited, the HBV+ kid *was known* to be "aggressive."
OK - so should we exclude this child from day care?

Yes. An HBV+ kid who goes around aggressively biting other
kids should *not* be in day care with others.

"PF Riley" wrote in message
...
On 10 Feb 2004 20:04:16 -0800, (Jonathan
Smith) wrote:

"JG" wrote in message
...

No; I'm looking for evidence of transmission (e.g., via playground
activities) among school-aged kids.

Give me a break - you asked for horizontal - you got it. Every one
of
the citations referenced back that in that age group (kids before sex
and drugs) can be exposed and can become infected. The US model is a
poor one because the background prevalence is pretty low. That
doesn't change the vector or the existance albeit small of a
transmission risk. You said it doesn't happen - the literature says
it does.

Where did I say it doesn't happen? I simply asked for evidence that it
has/does--big difference.

I think she got stuck arbitrarily on grade-school age when I mentioned
"recess." I am surprised that JG is engaging in Schlaflyesque
weaselling -- claiming first that horizontal transmission is not a
concern among "infants/children" and then narrowing this proclamation
to grade-school children only once evidence of horizontal transmission
among preschool-age and high school-age children is presented, in
order to continue to be "right." I agree with you on your decision to
give up on this one.

No, PF; my focus on school-aged kids goes back to Michelle Malkin's
column. Her kids aren't in day care; they're home with their parents.
School attendance is compulsory, however, so the Malkins will have to
revisit the issue when their daughter reaches school age (5, if they're
still in MD).

Apparently, for JG, the "best" plan to avoid hepatitis B in childhood
it:

1. Don't put your child in daycare.

I don't recommend it (for both medical and non-medical reasons).

2. If your child gets bitten or scratched by another child, demand to
know his or her hepatitis B status, then try to prevent infection with
post-exposure prophylaxis if necessary.

And just what is your objection to this? If your kid is bitten or
scratched--assaulted--by another, you might have a cause of action
against whoever should have been supervising the kids. I think most
parents would divulge their kid's HBV (and HIV) status, or acquiesce to
testing, if you stipulated that you wouldn't pursue legal action if they
agreed to do so.

3. And, most importantly, never let your child play with Asian kids.

Low blow, PF; shame on you.

My plan:

1. Get the hepatitis B vaccine series.

Hey, whatever works for you.

"PF Riley" wrote in message
...

On Tue, 10 Feb 2004 16:10:15 -0700, "JG"
wrote:

"Jonathan Smith" wrote in message
om...

There are dozens of articles that show horizontal transmission is a
risk and does happen. Just because you don't want to believe it
doesn't change the facts.

No one's denied that transmission between/among athletes has occurred
(I've read of suspected transmission between wrestlers). This is not
the school ("playground") transmission scenario/incidence being
questioned.

So you speculate that rough-housing by elementary-school students is
so substantially different in terms of transmission risk from contact
by athletes because...?

This is the 21st century, PF. Playground "rough housing" is forbidden
(at least around here!).

Why don't you do the math: Find out the (approximate) number of
school-aged kids who are HBV+, then, taking demographics such as
geographic distribution into account (no doubt there are many more
"carrier kids" in urban areas, especially along the west and east
coasts), calculate the chance of a given kid even being in contact with
a (kid) carrier, let alone engaging in behavior(s) with him/her that
could result in HBV transmission.

"PF Riley" wrote in message
...

On Tue, 10 Feb 2004 16:10:10 -0700, "JG"
wrote:

"PF Riley" wrote in message
...

On Tue, 10 Feb 2004 05:23:07 GMT, "Roger Schlafly"
wrote:


Very rare. There are only a handful of hep B+ kids in the USA.

Gosh, and 4 of them happen to be my patients? Wow!

Asian immigrants/adoptees?

Only one of them. You and Roger seem not to understand that white
people get hepatitis B, too, you know.

Sure, but Asian American kids have *20 times* more risk for infection
from HBV than other American children. (Watson, B. "Hepatitis B
Immunization of Asian Pacific Islanders in the United States"; The
Pediatric Infectious Disease Journal; Volume 17(7) supplement,
pp.S38-S42; 1998)

"While the incidence of chronic hepatitis B in the majority of the U.S.
population is less than one in 200, its incidence is one in 10 among
Asian Americans."
(http://www.stanfordhospital.com/news...52001/jadeRibb
onCampaign.html)

"Jonathan Smith" wrote in message
m...
"JG" wrote in message
...
"PF Riley" wrote in message
...

On Sun, 8 Feb 2004 21:38:46 -0700, "JG"
wrote:

"PF Riley" wrote in message
...

So they'll just go to the library instead the playground at
recess?

If you can find a verified, documented case of "recess
transmission,"
please point me to it.

Well, a possible case of "daycare transmission" is cited elsewhere
on
this thread, at least.

Certainly if an instance of "blood swapping" did occur,
post-exposure
prophylaxis could be considered/initiated.

Except the chronic hepatitis B carriers who attend public school
that
I know keep it a secret, even from the school.

A diligent parent would undoubtedly notice a bite wound, even if the
kid
didn't tell him/her about it.

Isn't that a wonderful assumption - diligent parent. You don't have
any boys, do you.

No. Some of us are just lucky, I guess. (I thank God every day for my
good fortune. g) What difference would it make, anyway?

If a kid bit my kid, I'd certainly
request that the biter divulge/prove his/her HBV (and HIV, for that
matter) status. If the biter's parents refused, I'd take them to
court.

Now, who are you going to sue?

In a personal injury lawsuit, it would depend a lot on the age/capacity
of the kid. A court might determine that a very young child wasn't
capable of knowing that his/her "aggressiveness" (biting) was wrong
(even if repeatedly told so); an older child, otoh, might be deemed
capable of knowing/understanding this. If it could be proven that the
parents failed to supervise their child, *they* could be found liable
for any personal injury he/she caused. (CA even has laws addressing
this; see education code 48904.) In the case of a *known-to-be*
"aggressive" day care attendee, I'd think the center itself could be
held responsible for any injuries the kid inflicts. What rational
parent wouldn't agree to having his/her injury-inflicting kid tested if
doing so would avert a lawsuit?

Which kid was it? When was it?

You're being ridiculous now, Jonathan. "It" was whomever my kid said it
was, and "when" would have been that day. (Don't YOU talk to your kids
daily, asking them, for example, "How was school today? What'd you do?
Anything exciting happen?")

What
would your reaction be if a parent asked YOU for your daughters
medical records to PROVE she didn't have a disease? What would your
reaction be if your daughter denied having bitten the other child?
How would you react to a lawsuit?

LOL. I wouldn't submit my daughter's medical records to anyone unless
ordered to do so by a court. Given the option of submitting a blood
sample in lieu of a lawsuit, however, I'd give them the blood.

Bet you're just a hit in your neighborhood.

Why wouldn't I be? g

Hey, I have an idea! Instead of expecting daycare providers to
protect
your child from any physical conflict with other children, ...

In the case cited, the HBV+ kid *was known* to be "aggressive."

OK - so should we exclude this child from day care?

Sure; why not? Why should a private facility have to assume
responsibility for a potential "walking time bomb"? I'm sure kids
routinely get kicked out of day care centers (or denied admittance in
the first place) because of various "inappropriate" behaviors.

Put him in
solitary?

Hey, whatever works to keep him from injuring other kids (and leaving
the center open to lawsuits).

...and
expecting any hepatitis B carriers at school to wear a fluorescent
ID
bracelet so that you can run to the school nurse for an antibody
shot
should you contact his or her body fluids,

Huh? Why not just assume everyone's *not* a carrier until there's a
need to know (e.g., after a biting incident)?

Because it's silly? Because its impossible?

Huh? That's basically the way things are run now.

why not have everyone get
an easy three-dose vaccine series when they're babies and you can
relax a little about it! Or, better yet, let's use Roger's
"logic:"
Have everyone get the vaccine so that no one has to!

By the way, the Malkin article is crap, because both she and her
doctor are idiots. Reading the article is like watching two
retards
argue.

LOL. That's constructive criticism now, isn't it? g

I thought it was a pretty good description.

You would. (Now go play with PF in the sandbox. g)

I have no problem skipping hepatitis B and polio vaccines for
babies
of parents who really don't want them. (My families from India who
travel there frequently with their young infants would
theoretically
be an exception, although they know better.) Most of them end up
getting those shots later, anyway. To me, however, a parent
telling me
they don't want DTaP, Prevnar, or Hib is like telling me they
don't
use an infant car seat. ("Oh, I'll just make sure he's not around
anyone with any baaaaad diseases!" is like saying "Oh, I'll just
hold
him REAL TIGHT if we crash!")

Gee, a ped who actually discerns the epidemiological differences
among
various diseases. Way to go, PF! :-D

And a mom that finally got it - HBV horizontal transmission in
children is possible and does happen.

*Sigh* Possible? Sure. (It's also possible John Kerry will drop out
of the race tomorrow, the Nuggets will win the NBA championship, and
you'll admit you're a moron.) Has it happened? Maybe, perhaps even
probably. (I'm still waiting for irrefutable evidence that it has, let
alone that it's common among school-aged kids in the course of their
school day.)

What are the implications of something that is theoretically possible,
Jonathan? Does "theoretically possible" warrant the mandatory HBV
vaccination of all kids? (Had your smallpox vaccination yet? Installed
bullet-proof glass in your windows? g)

"abacus" wrote in message
om...
(Jonathan Smith) wrote in message
om...

HBV horizontal transmission in
children is possible and does happen.

Just curious. Been watching the thread. I don't dispute that
horizontal transmission in children is possible, but it does seem
quite rare. If no other risk factors are apparent, is the risk of the
disease (probability of contracting the disease multiplied by the
average *cost* of having the disease) worth the risk of vaccination
(probability of suffering an adverse reaction multiplied by the
average *cost* of the adverse reaction)?

I'd include the actual (direct) cost of the 3-vaccination series.

Just what 'facts' are being
used to make this determination? Isn't family history an appropriate
consideration to take into account in making that determination?

Family "lifestyle" certainly would/should be.

Thank you for trying to turn the focus of the discussion to the question
of whether it's necessary (from a risk/benefit perspective), or even
proper, to mandate hepatitis B vaccination.

"Roger Schlafly" wrote in message .net...
"Jonathan Smith" wrote
In the case cited, the HBV+ kid *was known* to be "aggressive."
OK - so should we exclude this child from day care?

Yes. An HBV+ kid who goes around aggressively biting other
kids should *not* be in day care with others.


So should testing for HBV carrier status be mandatory for all children
before they are admitted to daycare? How often should this be
performed? Who pays for it?

Mark, MD

Kathy Cole wrote:

Particular vaccination, maybe. All of them, no. If I
were a
pediatrician and I had patients that much at odds with
what I know to
be the current state of the research, I'd bet that I would
prefer not
to have the liability of that family and would discharge
the patient.
I believe that's what my youngest's pediatrician's office
does, and I
can't blame them a bit.

Well that is just it. The doc does not have to treat the
patient and if he feels there is no trust and it is not a
relationship he wants to be in there is no reason why he
shouldn't just say so.



Unless the doctor is bound by contract to serve all who
seek care, I
don't think the doctor owes the patient to keep him or her
in the
practice (absent a month or so to find another doctor),
any more than
I think a patient has an obligation to stay with a
particular doctor.

Exactly - it is a two way street.

--
CBI, MD

JG wrote:

The point is, about a third of childhood Hep B infections
have no
identifiable vector, therefore the author's assertion,
and yours,
that there is no need of protection is errant.

No *identified* vector; not "no *identifiable*" vector. I
think it's
highly probable that infected infants/children were
exposed, likely
on a regular basis, to an infected individual, and it's
entirely
possible *that* individual was unaware that he/she was a
carrier.

Whether something is unknowable or merely unknown has little
practical relevance for the present. Either way - right
now - we don;t know. If you don't know what you are guarding
against how can you be so sure that your precautions will be
effective?

--
CBI, MD

JG wrote:

If you can find a verified, documented case of "recess
transmission,"
please point me to it. Certainly if an instance of "blood
swapping"
did occur, post-exposure prophylaxis could be
considered/initiated.

This is the falacy that you keep repeating. We don't know
where the cases are comming from - so how can he document
the exposures?

Can you prove that any measure other than vacination
prevents the spreadof hep B amongst children? Clearly,
avoiding "blood swapping", at least recognized incidents of
it, is not enough.

--
CBI, MD