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#41
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"Beware of Vaccine Bullies"--Malkin column
"PF Riley" wrote in message
... On Tue, 10 Feb 2004 05:23:07 GMT, "Roger Schlafly" wrote: "Jeff" wrote Yet, how often do think that: 1) A parent knows that another kid in class is Hep B+? 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? |
#42
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"Beware of Vaccine Bullies"--Malkin column
"Jonathan Smith" wrote in message
m... "Roger Schlafly" wrote in message .net... "Jonathan Smith" wrote [quoting CDC article] We investigated two situations involving hepatitis B virus exposure among children in day care. In the first a 4-year-old boy who attended a day care center developed acute hepatitis B; another child at the center, who had a history of aggressive behavior (biting/scratching), was subsequently found to be a hepatitis B carrier. No other source of infection among family and other contacts was identified and no other persons at the center became infected. Possible, but not very convincing. The question was - are there any documented cases of horizontal transmission in children. The answer is - YES. For heaven's sake, Jonathan, the proof/evidence in the day care case is strictly circumstantial. Don't you find it somewhat odd that the "documentation" doesn't show that the case patient was ever bitten or scratched by the HBV+ "aggressive" child? Gee, you'd think *someone* (parents, day care staff) would have made note of a blood-drawing assault. Aren't you even curious as to why the investigation into the source of the case patient's infection settled on the "aggressive" child? Could it be, perhaps, that this child's carrier status came to light only incidentally (i.e., not as a direct result of looking for the source of the case subject's infection), and that once a person in the case subject's sphere of contacts was known/found to be HBV+, the search was halted and that person was presumed to be the source? I'd bet that if a household member of the subject patient was found to be HBV+, before knowledge that a day care-mate was also HBV+ came to light, the search would have been halted then and there. (Shades of the OJ defense...) Did the boy bite or scratch the kid who got infected? Did he draw blood? If others were bitten or scratched, why weren't they infected? Could the family have been concealing other contacts because it was suing the day care center? Look - I don't know. The data are reported in a medical journal. Whether or not you believe it is of no consequence. WHAT data? Based on the abstract, it appears that it's merely *suspected* that the HBV+ ("aggressive") child was the source! We have no idea about the scope of the investigation; was it immediately halted upon the discovery of an HBV+ individual among the child's contacts? In the second situation a 4-year-old boy with frequently bleeding eczematous lesions was discovered to be a hepatitis B carrier after having attended a day care center for 17 months. Testing of contacts at the center revealed no transmission to other children or staff (representing 887 person months of exposure). So transmission is unlikely, I guess. Unlikely? Hey - I'm not putting any OR stats to it. It can happen and it has happened. Can? Sure. Has? Still no irrefutable proof, only suspicion. Nationwide surveillance data showed that for the period 1983 to 1987, 161 children 1 to 4 years of age were reported with acute hepatitis B. After children with known hepatitis B risk factors were excluded, 25% (7 of 28) of children with known day care status were reported as day care attendees, a percentage comparable to national estimates of day care attendance by this age group. If HBV was being transmitted in day care, then we would expect that the set of kids with HBV would have a higher percentage of day care attendees. Instead, these figures suggest that HBV infection in uncorrelated with day care status. Huh? Your statistical acumen is a legend on this NG - thanks for reinforcing it. Notice how small the numbers are. This was before the universal HBV vaccination program was started, so the numbers are even smaller now. But it has happened - horizontal transmission, Roger, between children on the playground. That's what JG asked and that's what I provided. A *suspected* case, nothing more. This is the first reported case of hepatitis B virus transmission between children in day care in the United States. Although it appears that day care transmission of hepatitis B is infrequent, further studies are needed to define the risk more accurately. IOW, the risk is too small and hypothetical to measure. IOW - it can happen, Roger. It did happen, Roger. It will happen again. *One* reported *possible* case. *Yawn*. That's supposed to justify mandatory vaccination? Get real! Want stats - here's something from a Japanaese university's American footbaqll team: http://www.cchi.com.hk/abs_reviews/h...bstract005.htm The authors conclude that, "All players with acute hepatitis B belonged to the same training group, which also included the HB(e)Ag carrier. Our analysis suggests that horizontal transmission of HBV can occur even in a sports team, probably due to contact with open wounds during training." In that same series of papers there is a case of student to teacher transmission, intrafamilial transmission, the presence of virus in fluids other then seminal. Enough evidence to show that it can and does happen. The Japanese experience is particularly enlightening. 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. The epidemiology suggests that the relative risk is proportional to the underlying population character of the infection - the risk is higher in populations with higher carrier status. Isn't that remarkable. That does not suggest that lack of endemic infection is in and by itself protective. Go ahead - argue the race card. I really don't care. The point is clear - horizontal transmission can and does occur between children and it happens even in the good neighborhoods. You've cited *one* *suspected* case. Hardly convincing. If it's a widespread occurrence, surely more (and better) documentation is available. |
#43
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"Beware of Vaccine Bullies"--Malkin column
"Jonathan Smith" wrote in message
m... "JG" wrote in message ... [...] Just what goes takes place on your schools' playgrounds, PF? Orgies? Group piercings? Tattooing? Biting? A child who bites isn't ready for kindergarten. Oh please. There are a lot of kids not ready for kidergarten and some of them are in third grade. So biting is common in your kid's school? Tsk. It's not around my "impoverished little rock"! g 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. http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract [...article excerpt snipped...] Close; day care isn't exactly school. ;-) Day care is a lot like recess. I wouldn't know; my kids were never in day care. I was under the impression that day care attendees, for the most part (I understand some kids go to day care centers after school, in lieu of being "latch-key" kids), are younger, pre-kindergarten kids. (It would be interesting to know why the staff of the day care center in the first instance cited didn't control the behavior of a known-to-be-"aggressive" attendee, though.) Nevertheless, there's no proof that the "passive" child contracted HBV from the "aggressive" child; heck, the article doesn't even state whether the passive child was even bitten or scratched! (I'd hope a wound serious enough to break the skin--esp. a bite, which would have left a distinctive mark--would be noticed by his parents, at least. Even if not contemporaneously investigated, you'd think they'd recall it when questioned by doctors/health officials about possible sources of their kid's infection.) The second instance cited--the fact that no one with whom an HBV+ kid had regular contact became infected--just highlights how (relatively) difficult it is to transmit HBV. You got what you asked for. No; I'm looking for evidence of transmission (e.g., via playground activities) among school-aged kids. Now you want to discount it because you think it's (relatively) difficult. With 30% or more of cases without a reasonable chain of evidence as to the source, HBV infectivity is hardly a well enough described for you to make such a conclusion. Others have suggested that it seems to be difficult and likely to be of low Care to re-write the above (using complete, grammatical sentences)? I grant you, it's not easy but it's far from impossible. You wanted evidence, I gave it - here's another documented case. Horizontal transmission of hepatitis B in a children's day-care cent a preventable event. McIntosh ED, Bek MD, Cardona M, Goldston K, Isaacs D, Burgess MA, Cossart YE. Department of Paediatrics and Child Health, University of Sydney. Using molecular finger-printing, we provided evidence that, in a children's day-care centre, a known hepatitis B virus (HBV) hepatitis B e antigen (HBeAg) carrier transmitted HBV to another child (the index case). The chronic HBV carrier had an exudative skin lesion and a history of biting. We sought to identify other at-risk children and prevent further transmission. Blood samples were collected and tested serologically for HBV. Of the 90 other children, 78 (87 per cent) were tested and none had serological evidence of HBV infection; 73 (81 per cent) were of Caucasian background; 38 (49 per cent) had a history of HBV immunisation with serological confirmation. Therefore, 1 (2.4 per cent, 95 per cent confidence interval 1.0 to 12.8 per cent) of the 41 known susceptible contacts became infected. The risk of horizontal HBV transmission in a children's day-care centre is low but not negligible. Staff and children should be vaccinated when a child in a day-care centre is a known HBV carrier. Another *day care* report. Look, many toddlers bite and scratch. If you find a case of "playground," horizontal transmission among *school-aged* kids, please post it. I was particularly struck by the results from the Japanese university football team. Not exactly schoolchildren now, are they? Do you know how many kids between 5 and 16 participate in organized after school athletics? Millions. (Pity even more don't, given the ever-increasing obesity rate among kids.) Have you ever observed a group of 10 year olds on the playground? Of course. Do you have children? Yes (including a daughter who was a first-team All-America athlete, in a contact sport, while in college). Have you ever seen a skinned knee or a bloody lip? Hundreds. How about a nose bleed? Of course. There are plenty of opportunities and plenty of evidence that it can and does happen. Not from day-to-day non-athletic interaction among schoolkids... |
#44
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"Beware of Vaccine Bullies"--Malkin column
"JG" wrote in message ...
"Jonathan Smith" wrote in message m... "JG" wrote in message ... [...] Just what goes takes place on your schools' playgrounds, PF? Orgies? Group piercings? Tattooing? Biting? A child who bites isn't ready for kindergarten. Oh please. There are a lot of kids not ready for kidergarten and some of them are in third grade. So biting is common in your kid's school? Tsk. It's not around my "impoverished little rock"! g You just aren't looking out from under it. 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. http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract [...article excerpt snipped...] Close; day care isn't exactly school. ;-) Day care is a lot like recess. I wouldn't know; my kids were never in day care. Goody for you, super mom. I was under the impression that day care attendees, for the most part (I understand some kids go to day care centers after school, in lieu of being "latch-key" kids), are younger, pre-kindergarten kids. so all of a sudden between 4 and 6 kids grow up and stop rough housing? Not in my school, but then again, we let kids be kids in my high class nannyhood. (It would be interesting to know why the staff of the day care center in the first instance cited didn't control the behavior of a known-to-be-"aggressive" attendee, though.) Nevertheless, there's no proof that the "passive" child contracted HBV from the "aggressive" child; heck, the article doesn't even state whether the passive child was even bitten or scratched! (I'd hope a wound serious enough to break the skin--esp. a bite, which would have left a distinctive mark--would be noticed by his parents, at least. Even if not contemporaneously investigated, you'd think they'd recall it when questioned by doctors/health officials about possible sources of their kid's infection.) The second instance cited--the fact that no one with whom an HBV+ kid had regular contact became infected--just highlights how (relatively) difficult it is to transmit HBV. You got what you asked for. 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. Now you want to discount it because you think it's (relatively) difficult. With 30% or more of cases without a reasonable chain of evidence as to the source, HBV infectivity is hardly a well enough described for you to make such a conclusion. Others have suggested that it seems to be difficult and likely to be of low Care to re-write the above (using complete, grammatical sentences)? I don't take responsibility for my newsreader hickups. I also don't criticize others - but I can make an exception in your case. I grant you, it's not easy but it's far from impossible. You wanted evidence, I gave it - here's another documented case. Horizontal transmission of hepatitis B in a children's day-care cent a preventable event. McIntosh ED, Bek MD, Cardona M, Goldston K, Isaacs D, Burgess MA, Cossart YE. Department of Paediatrics and Child Health, University of Sydney. Using molecular finger-printing, we provided evidence that, in a children's day-care centre, a known hepatitis B virus (HBV) hepatitis B e antigen (HBeAg) carrier transmitted HBV to another child (the index case). The chronic HBV carrier had an exudative skin lesion and a history of biting. We sought to identify other at-risk children and prevent further transmission. Blood samples were collected and tested serologically for HBV. Of the 90 other children, 78 (87 per cent) were tested and none had serological evidence of HBV infection; 73 (81 per cent) were of Caucasian background; 38 (49 per cent) had a history of HBV immunisation with serological confirmation. Therefore, 1 (2.4 per cent, 95 per cent confidence interval 1.0 to 12.8 per cent) of the 41 known susceptible contacts became infected. The risk of horizontal HBV transmission in a children's day-care centre is low but not negligible. Staff and children should be vaccinated when a child in a day-care centre is a known HBV carrier. Another *day care* report. Look, many toddlers bite and scratch. If you find a case of "playground," horizontal transmission among *school-aged* kids, please post it. What makes these kids any less susceptible? I've seen more bloody noses, skinned knees, and exchange of spit on the playground than in day care. I was particularly struck by the results from the Japanese university football team. Not exactly schoolchildren now, are they? No - university students. So we bounded the upper and lower and you argue U-shaped curve with zero probability in the formative years? Do you know how many kids between 5 and 16 participate in organized after school athletics? Millions. (Pity even more don't, given the ever-increasing obesity rate among kids.) OK - so, somehow this isn't enough to have a non-zero risk? Have you ever observed a group of 10 year olds on the playground? Of course. Do you have children? Yes (including a daughter who was a first-team All-America athlete, in a contact sport, while in college). Have you ever seen a skinned knee or a bloody lip? Hundreds. How about a nose bleed? Of course. There are plenty of opportunities and plenty of evidence that it can and does happen. Not from day-to-day non-athletic interaction among schoolkids... Millions of student athletes? OK - I give up. I'm not wasting my time arguing semantics and conjecture. My time is much more valuable than that. You got what you asked for and your denial that it isn't exactly what you meant is much to much like a Schlafly. And more of that level crap is not needed in this world. js |
#45
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"Beware of Vaccine Bullies"--Malkin column
"JG" wrote in message ...
"Jonathan Smith" wrote in message m... "Roger Schlafly" wrote in message .net... "Jonathan Smith" wrote [quoting CDC article] We investigated two situations involving hepatitis B virus exposure among children in day care. In the first a 4-year-old boy who attended a day care center developed acute hepatitis B; another child at the center, who had a history of aggressive behavior (biting/scratching), was subsequently found to be a hepatitis B carrier. No other source of infection among family and other contacts was identified and no other persons at the center became infected. Possible, but not very convincing. The question was - are there any documented cases of horizontal transmission in children. The answer is - YES. For heaven's sake, Jonathan, the proof/evidence in the day care case is strictly circumstantial. Don't you find it somewhat odd that the "documentation" doesn't show that the case patient was ever bitten or scratched by the HBV+ "aggressive" child? Gee, you'd think *someone* (parents, day care staff) would have made note of a blood-drawing assault. Aren't you even curious as to why the investigation into the source of the case patient's infection settled on the "aggressive" child? Could it be, perhaps, that this child's carrier status came to light only incidentally (i.e., not as a direct result of looking for the source of the case subject's infection), and that once a person in the case subject's sphere of contacts was known/found to be HBV+, the search was halted and that person was presumed to be the source? I'd bet that if a household member of the subject patient was found to be HBV+, before knowledge that a day care-mate was also HBV+ came to light, the search would have been halted then and there. (Shades of the OJ defense...) Did the boy bite or scratch the kid who got infected? Did he draw blood? If others were bitten or scratched, why weren't they infected? Could the family have been concealing other contacts because it was suing the day care center? Look - I don't know. The data are reported in a medical journal. Whether or not you believe it is of no consequence. WHAT data? Based on the abstract, it appears that it's merely *suspected* that the HBV+ ("aggressive") child was the source! We have no idea about the scope of the investigation; was it immediately halted upon the discovery of an HBV+ individual among the child's contacts? In the second situation a 4-year-old boy with frequently bleeding eczematous lesions was discovered to be a hepatitis B carrier after having attended a day care center for 17 months. Testing of contacts at the center revealed no transmission to other children or staff (representing 887 person months of exposure). So transmission is unlikely, I guess. Unlikely? Hey - I'm not putting any OR stats to it. It can happen and it has happened. Can? Sure. Has? Still no irrefutable proof, only suspicion. Nationwide surveillance data showed that for the period 1983 to 1987, 161 children 1 to 4 years of age were reported with acute hepatitis B. After children with known hepatitis B risk factors were excluded, 25% (7 of 28) of children with known day care status were reported as day care attendees, a percentage comparable to national estimates of day care attendance by this age group. If HBV was being transmitted in day care, then we would expect that the set of kids with HBV would have a higher percentage of day care attendees. Instead, these figures suggest that HBV infection in uncorrelated with day care status. Huh? Your statistical acumen is a legend on this NG - thanks for reinforcing it. Notice how small the numbers are. This was before the universal HBV vaccination program was started, so the numbers are even smaller now. But it has happened - horizontal transmission, Roger, between children on the playground. That's what JG asked and that's what I provided. A *suspected* case, nothing more. This is the first reported case of hepatitis B virus transmission between children in day care in the United States. Although it appears that day care transmission of hepatitis B is infrequent, further studies are needed to define the risk more accurately. IOW, the risk is too small and hypothetical to measure. IOW - it can happen, Roger. It did happen, Roger. It will happen again. *One* reported *possible* case. *Yawn*. That's supposed to justify mandatory vaccination? Get real! Want stats - here's something from a Japanaese university's American footbaqll team: http://www.cchi.com.hk/abs_reviews/h...bstract005.htm The authors conclude that, "All players with acute hepatitis B belonged to the same training group, which also included the HB(e)Ag carrier. Our analysis suggests that horizontal transmission of HBV can occur even in a sports team, probably due to contact with open wounds during training." In that same series of papers there is a case of student to teacher transmission, intrafamilial transmission, the presence of virus in fluids other then seminal. Enough evidence to show that it can and does happen. The Japanese experience is particularly enlightening. 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. The epidemiology suggests that the relative risk is proportional to the underlying population character of the infection - the risk is higher in populations with higher carrier status. Isn't that remarkable. That does not suggest that lack of endemic infection is in and by itself protective. Go ahead - argue the race card. I really don't care. The point is clear - horizontal transmission can and does occur between children and it happens even in the good neighborhoods. You've cited *one* *suspected* case. Hardly convincing. If it's a widespread occurrence, surely more (and better) documentation is available. I gave you a list of references. Horizontal child to child transmission is possible and has occured. I really don't care if the handful of examples are insufficient to meet your data threshhold. You got what you asked for - or do you insist that it is impossible? Gees - what will you think of next. |
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"Beware of Vaccine Bullies"--Malkin column
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: "Jeff" wrote Yet, how often do think that: 1) A parent knows that another kid in class is Hep B+? 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. PF |
#47
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"Beware of Vaccine Bullies"--Malkin column
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...? PF |
#48
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"Beware of Vaccine Bullies"--Malkin column
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#49
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"Beware of Vaccine Bullies"--Malkin column
"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. 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? Which kid was it? When was it? 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? Bet you're just a hit in your neighborhood. 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? Put him in solitary? ...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? 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. 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. js |
#50
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"Beware of Vaccine Bullies"--Malkin column
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