Starting Clinicals, Hepatitis B Vaccine question

Bshort73 · Dec 4, 2010

I'm pleased to find a recent thread on this topic, and hoping someone can answer my question. I start clinicals Jan '11 and at my school, Hep B vaccine is optional. After consulting my physician, I will start the 3 shot Hep B series next week. I find it concerning that students at my school attend clinicals without receiving this vaccine (a waiver is required if opting out). I questioned my physician as to why it would be optional given how easy it is to come into contact with body fluids, and she couldn't come up with a reason why it is optional as she sees the benefit of having the vaccine outweighs any risk of a side effect.
Does anyone know of any logical reason why Hepatitis B vaccine could be considered optional at any school? I see a few posts that state it is optional at their school, but I'm curious to know the reasoning when we are required to provide proof of immunization/blood titers for so many other diseases.

...any reason other than religious views....

Blackboot · May 5, 2011

...any reason other than religious views....

Well, you'll probably consider this a religious view, but I consider it a scientific view. My reason for not wanting it is the same as all the other vaccinations I don't want, nor do I want my children to have. It has to do with immunity. Sure, if EVERYONE in the world were to get the vaccine, and EVERYONE was receptive to the vaccine and was then immune to the disease, sure, it would make sense. However, that's no where near the case. So, rather than artificially introducing immunity to my body, I chose to allow my body to make itself stronger by building the immunities it needs. There is scientific proof that our current social norm of anti-bacterial everything, immunizing everything, and basically making our lives void of all bacteria and viruses is making our society weaker. A person who doesn't live in a germ free environment, who doesn't get all these immunizations, is more likely to have less severe reactions and symptoms to the real disease.

It's the same with the over use of antibiotics in kids today. It has also been researched and proven that children who have been given an undue amount of antibiotics (such as for every runny nose they have), are more likely to get sick more often throughout their life.

That's my reason.

Rob72, ASN, RN · May 5, 2011

Does anyone know of any logical reason why Hepatitis B vaccine could be considered optional at any school? I see a few posts that state it is optional at their school, but I'm curious to know the reasoning when we are required to provide proof of immunization/blood titers for so many other diseases.

The Hep vaccine has a slightly higher "fail" rate than other vaccines. 3% comes to mind, but I'm too lazy to search it. I'm another- took the series 3 times and never sero-converted. It happens.

BB, the logical fallacy of your position is that you are in some way benefitting from being susceptible to a communicable disease. Smallpox killed 80-90-odd percent of Amer. Indians who were exposed because they had no comparable environmental exposure. Level II/III pathogens don't strengthen societies, they wipe them out in waves. Whatever your "scientific" readings suggest, historical pathophys does not support that view. Take it as you will.

pockunit, ADN, RN · May 5, 2011

I would take into consideration how you might feel if you contracted a vaccine-preventable disease and passed it on to a patient or a family member.

I freely admit that I do delayed vaccinations for my kids. It doesn't mean they don't get done, however. And now that I'm in clinicals and around sick people, I'm fully up to date so I don't bring anything home and the kids are catching up.

You can only do the best that you can do, but with more knowledge, people generally tend to make better choices.

Blackboot · May 6, 2011

BB, the logical fallacy of your position is that you are in some way benefitting from being susceptible to a communicable disease. Smallpox killed 80-90-odd percent of Amer. Indians who were exposed because they had no comparable environmental exposure. Level II/III pathogens don't strengthen societies, they wipe them out in waves. Whatever your "scientific" readings suggest, historical pathophys does not support that view. Take it as you will.

I understand your point of view. However, in my perspective, it has to do with seriousness of the disease. For instance, smallpox is deadly, chicken pox on the other hand has a negligible mortality rate. Therefore, I would rather undergo the inconveniences of the symptoms than have a vaccine prevent them. The same for the flu vaccine. While it may be deadly for certain groups, I am not in that group. Hepatitis B has less than a 5% mortality rate. That's acceptable for me. As for my patients, I always take the correct precautions to not contract something, and therefore take the same precautions not to give anything. If I happened to work on a floor where I contracted Hep B, the likely hood of me giving it to another patient is about the same as that patient contracting it from the same patient I got it from. It's transmission is one that should be completely halted by proper hygiene. Therefore, I choose to abstain, though admittedly I'm having trouble doing so in my current applications.

Again, regardless of the actual rationale, personal choice does have an affect. I have no problem with anyone and everyone getting all the vaccines. However, in return, I expect to be left alone when I chose not to receive them.

JROregon, ASN, BSN, RN · May 6, 2011

So Blackboot, tell me what type of symptoms would you have if you caught pertussis (whooping cough)? Maybe you would only have symptoms of a cold and cough and it would be pretty mild for you. Imagine if you or your children passed on that bacterial infection to a newborn who doesn't have the ability to produce antibodies - in other words, he can't be vaccinated until about 2 months of age. What then? Or maybe you passed it on to one of your cancer patients or aged patients. So you are worried about an acellular form of pertussis causing YOUR body to make antibodies against an attack by the full-on live virus. It's not artificial immunity. It's called acquired immunity. Your body makes antibodies that will protect you and your patients for several years... then you get a new shot. As a hospital patient, I would hope you would do me the favor and get the shot. How will you be educating your older patients that they need pneumovaccine? How about a flu shot?

JROregon, ASN, BSN, RN · May 6, 2011

I'm just using pertussis as an example because this disease is making a big comeback and school age children and adults have symptom that resemble a bad cold. In a baby or toddler the symptoms are scary to witness.

Blackboot · May 6, 2011

So Blackboot, tell me what type of symptoms would you have if you caught pertussis (whooping cough)? Maybe you would only have symptoms of a cold and cough and it would be pretty mild for you. Imagine if you or your children passed on that bacterial infection to a newborn who doesn't have the ability to produce antibodies - in other words, he can't be vaccinated until about 2 months of age. What then? Or maybe you passed it on to one of your cancer patients or aged patients. So you are worried about an acellular form of pertussis causing YOUR body to make antibodies against an attack by the full-on live virus. It's not artificial immunity. It's called acquired immunity. Your body makes antibodies that will protect you and your patients for several years... then you get a new shot. As a hospital patient, I would hope you would do me the favor and get the shot. How will you be educating your older patients that they need pneumovaccine? How about a flu shot?

Acquired immunity is what I have been trying to promote. Immunity acquired from an infection. What I call artificial immunity, vaccine given immunity, is also known as active immunity. The later is a choice, and should be. A two month old should under most circumstances be using the transferred immunity from its mother.

There are many ways to look at it, and one of those that both you and I are concerned with is in passing pertussis to another person. However, your route requires me to have a vaccine that I don't need or want so that I may protect someone else. That other person has been given the choice to protect themselves, and if they choose not to, it should not be my responsibility to protect them. If I pass on a disease to another, it is because I didn't want the vaccine, and neither did they, and it is as it should be. I know you're going to bring up children, and for those circumstances, it is the choice of the parent to protect the child. I'll agree that I'm selfish, and I'll agree that not everyone will remain safe. But again, I make my decision on the severity of the illness. Pertussis is only linked to about 30 deaths per year, as far as disease related deaths, that's pretty low. Those statistics don't take into account for other factors, however. Therefore, as a hospital patient, I would hope you do yourself the favor and get the shot.

As for education, that has nothing to do with my beliefs. I don't encourage or discourage anyone from receiving any treatment or vaccine. I simply explain the facts and let them make the decision. My personal opinion is not important to the patient, if they want that, they can receive that from their physician.

As a side note, I find it funny that many hospitals are now requiring people who don't get the flu vaccine to wear masks. But as you said, pertussis is re-emerging. Yet, not having a pertussis vaccine doesn't require wearing a mask. The pertussis vaccine works, while the flu vaccine only has about a 20% chance of working.

Southern Magnolia · May 6, 2011

Let us not forget that 200 years ago (in the western world) a mother could expect one quarter of her children to die by the age of five and around 50% of the population was expected to live to the age of 30. We live in a time that affords us the luxury of personal choice regarding vaccinations. (I get that these statistics aren't specific to preventable illnesses.)

If you are a person that chooses not to vaccinate yourself or your children please exercise extreme caution. Think twice before visiting a sick relative or a newborn baby. Your chances of dying from an illness preventable by vaccine is slim but others don't have your odds of a positive outcome. Unfortunately, incubation times won't allow you to always know that you're sick before you expose someone else. It isn't about you.

Rob72, ASN, RN · May 6, 2011

Pertussis is only linked to about 30 deaths per year, as far as disease related deaths, that's pretty low.(1) Those statistics don't take into account for other factors, however. Therefore, as a hospital patient, I would hope you do yourself the favor and get the shot.
The pertussis vaccine works, while the flu vaccine only has about a 20% chance of working(2).

(1) That's the "modern" stat with >85% of the population immunized. I think it was a tad higher than that, circa 1880.

(2) 20% efficacy against the "flu", or against the strain against which an individual is being vaccinated? I know that the 2009 H1N1 achieved >85% efficacy as demonstrated by serum antibodies at 21 days. Sorry, I work in research. Yeah, there is squirrelly stuff out there, but this ain't it.

JROregon, ASN, BSN, RN · May 6, 2011

Yes indeed, we live in a time and place that allows for great luxury of choice. Try living in India or parts of Sub-Saharan Africa. They have polio and diphtheria there. Living in the US, where most are vaccinated against such diseases affords the minority of "natural immunity lovers" to go without vaccines. Someone needs a history lesson. It wasn't that long ago that mothers were willing to allow someone to test a "new" polio vaccine on their children. I'm thankful that 95% or more of parents immunize their kids. Yes, it's very unlikely that you'll get Hep B from your hospital work. The flu, on the other hand, is a little more likely and actually does kill a number of people every year. Same with pneumonia. The ones who don't die, may have a long stay at the hospital.

Despareux · May 7, 2011

How do you plan on "natural immunity" when most of the population is vaccinated against those diseases for which exposure is required for an immune response?