Recently, I was contacted by a young woman about to complete her midwifery qualifications. She had delivered a baby whose young mother was a hepatitis B carrier. This young aspiring midwife had recently returned a negative blood test for Hepatitis B antibodies, Immediately, concerns had been raised that she may have been exposed to surface antigen from the baby's skin. I started asking questions, like, "Well, was this young mother vaccinated?" and... "Was she just surface antigen positive, or was she core antigen positive and therefore actively infectious?" then... "What information were you given to prove that hepatitis B surface antigen is littered all over this baby's skin?" and.. "Were you vaccinated with the Hepatitis B vaccine?"
Guess what? None of these questions could be conclusively answered.
And how times have changed. I have a 29 July 1988 Northland Base Hospital letter to staff about Hepatitis B infection, which states, "As the disease in hospital staff is acquired only from blood..."
This young woman knew that around 1988 there was an expanded pre-school catch-up campaign, and that some schools also initiated in-school vaccination programmes. Merck representatives had been welcomed into schools by many Boards of Trustees, consent forms sent out, and children duly vaccinated. There was a huge push amongst police, paramedics, midwives, dental nurses and auxiliary medical staff to complete the Hepatitis B vaccine schedule. Much media publicity was made of the financial field day to be had by Merck et al.
Such was the drive and pressure to get as many vaccinated as possible, that pretty much everyone who vaguely smelled of being at risk, was offered the opportunity to be gathered into the vaccinated "fold".
This young woman remembered being lined up at school, at the age of six, for a series of "something" but no-one appears to know what that "something" was. Her mother didn't, replying, "You got everything that was going, dear."
There were many questions going around in my head. The first related to the midwife.
In the early 90's in the Franklin area, I had many opportunities to talk to midwives and dental nurses. The head of the local dental nurses group came to me for advice, because they had all had the Hepatitis B shots, but on blood testing a year later, most of them had no detectable antibodies. Some had had a second series with the same result. I asked around at the time, and found the same was true in the Police; amongst hospital based midwives, and even people in the community who had bothered to have a blood test to see if they had immunity. Everyone was slightly nonplussed, but just laughed. A standout example were staff at the Auckland blood transfusion service, who had been tested, found non-immune, vaccinated, and a year later, only one of them had rising titres consistent with an evolving natural infection. I even raised these issue of vaccine non-responders, with an infectious disease specialist at Philson medical school, who said that after 9 vaccinations, if the person still didn't have antibodies you should assume they are immune.
Great.
However, what about the young mother who had just delivered a baby and who was a hepatitis B carrier?
Had she been immunised or not? Know one knew. That wasn't on her records. Only the blood test results could be seen in her obstetrics file.
Think on this.
Twenty three years ago, on 14th July,1988 at a meeting with Dr Michael Soljak, Dr John Stevenson and Dr Karen Poutasi, I asked them for a reporting system which would eventually:
- Take the up-coming National Immunisation Register (NIR), and make it more useful so that it could track both post-vaccine adverse events, and background “health events” in unvaccinated, simultaneously.
- Add all relevant pregnancy, birth, pre-existing, acute and on-going health issues of the people on the NIR, to allow both short and long term health outcomes, in both unvaccinated and vaccinated children to be monitored.
- That comparative results be available to the public, and published in medical journals.
If my 1988 request had been taken seriously, then we would not be in this situation today. The young mother who was a carrier, might be on the National Immunisation Register. If so, the NIR would have recorded not only that she had been vaccinated, but the fact that she is now a virus carrier. Wouldn't that raise a question or two?
This midwife might be on the National Immunisation Register, which would have details of her vaccinations, as well as her Hepatitis B-ve antibody status. Wouldn't that raise a question or two?
BUT there would be a problem with one of those questions.
I've had Hepatitis B twice. Supposedly different sub-groups. I had detectable antibodies for 13 years afterwards. Then about ten years after that, on changing doctors, my new doctor decided to test for a few things, and gleefully told me I should have a series of Hepatitis B shots, since I had no antibodies.
After a few moments, I said to him, "When you studied Immunology 101, did you not study memory immunity, or an amnestic response? Isn't the function of the body to retain memory, and in the absense of detectable antibodies, and rechallenge by the virus, to immediately start putting out antibodies again?"
The doctor blustered somewhat, along the lines of "quite right,.. so... um..." And not long before that, Sandor Milne, who did much of the original research on Hepatitis B infection and carriage in this country, had expounded on this in the Northland Advocate, assuring people that no boosters would be necessary, because of .... "memory Immunity"
If my request in 1988, had been implemented once the pilot Northland Immunisation Register had gone "national", and if all vaccine databases had been brought together on the NIR, with subsequent inclusion of health information, we would know all the answers to all the above questions.
We would certainly have the answers to the following questions:
Does Hepatitis B vaccination lead to long term immunity? (Easily proven by a blood test one month after a booster vaccination. If blood rises 40-fold in one month, the person had pre-existing memory immunity and didn't need to have the booster shot anyway)
Did the nationwide Hepatitis B vaccination programme started in babies in 1987, and expanded into other groups in 1988, stop young people from becoming carriers?
And maybe even some bright spark might want to look at whether or not natural infection with Hepatitis B leads to the same fall in detectable antibodies as appears to happen after vaccination.
But we can't know that, because the Ministry of Health decided in1988, that they wouldn't put the money, time and effort into designing a really useful long term database.
Result?
What we saw today. A Professor of Infectious diseases, Peter Collignon, lamenting the lack of workable databases, to answer really important questions, which most thinking parents want answers to.
