Letter from a Pathologist on Mandatory Hepatitis B Vaccines
Dear Sir or Madam:
Virginia joined the ranks of those states mandating hepatitis B vaccination of infants a few years ago (before I moved here). The Division of Immunization of the Department of Health next added the requirement that children entering kindergarden or first grade must be vaccinated against hepatitis B. They now added a requirement that beginning this September, all students entering sixth grade must be vaccinated. Please note that none of these mandates required legislative action or public hearings. Our state legislature gave the Department of Public Health extensive powers to amend vaccination recommendations without any oversight.
I recently sent the letter below to two newspapers, the Virginia Pilot and the Richmond Times/Dispatch. Neither one published my letter or contacted me. I sent a similar letter to my two state legislators without results. I also contacted the Division of Immunization and was told to read the information (propaganda and lies) provided on the CDC's web site! (This was doubly stupid because I cited the CDC's misleading information in my letter to the Division of Immunization.)
Virginia allows only religious and medical exemptions to mandatory vaccination of children. I am willing to supply nearly any child a medical exemption to hepatitis B vaccination, but I cannot reach the public if the media and legislature refuse to publish or discuss my letters. Therefore, I am appealing to your organization for help. If Virginia-based members would all write to their legislators and newspapers, perhaps someone would take notice.
As an aside, I am appalled at the widespread physician complicity on this matter. The medical dictum of "first, do no harm" is being ignored when it comes to hepatitis B vaccinations of children at negligible risk to acquiring the disease.
Gregory Tetrault, M. D
The letter I sent to two major newspapers in Virginia on 4/1/01:
To the Editor:
The state of Virginia has followed the misguided recommendations from the Centers for Disease Control and Prevention (CDC) and mandated the vaccination of all children against hepatitis B. This policy was implemented by the Division of Immunology of the Office of Epidemiology of the Virginia Department of Health. Enforcement occurs at the school level. Children born after December 31, 1993 must have complete immunizations, including hepatitis B, before entering school. Also, all children entering 6th grade in September 2001 must have been vaccinated against hepatitis B. Only medical and religious exemptions are allowed. Well-reasoned parental objections carry no weight. Children who do not receive all required immunizations will be barred from school.
What reasons can the Department of Health use to justify the mandatory immunization of children against hepatitis B? Is hepatitis B contagious like measles or mumps? No. Hepatitis B can only be transmitted by coming into contact with the blood of an infected person or (with less likelihood) by having sex with an infected person. Since sharing contaminated needles and engaging in sexual intercourse with intravenous drug abusers are not school-related activities, there is no public health reason for immunizing our infants and children against hepatitis B. Are we experiencing an epidemic of hepatitis B? No. The average number of new cases in the entire state of Virginia has been 97 per year for the past five years. Nearly all cases occurred in adults or in babies born to infected mothers. Is hepatitis B a devastating disease with severe health consequences? No. The death rate from hepatitis B infections is less than 1 per 1000 patients. The serious illness rate is 1 per 80 patients. What does that mean for Virginia? Vaccinating EVERYONE in the state would prevent fewer than 100 hepatitis B cases per year, prevent 1 hepatitis B-related hospitalization per year, and save 1 life every 10 years. Vaccinating all children in the state would have no significant impact on the already low hepatitis B rates for TWENTY years, because most victims of hepatitis B are adults from 20-40 years old.
Why should we not have our children vaccinated against hepatitis B? The first rule of medicine is to do no harm. Yet, we know that immunizing children against hepatitis B confers almost no benefit and subjects our children to harm. Hepatitis B immunization requires three intramuscular injections over a 4-6 month period. Approximately 20% of children experience soreness, swelling, and pain at the injection site. Approximately 5% of children experience fever, muscle aches, and flu-like symptoms for 3-7 days after each injection. Serious acute adverse reactions requiring hospitalization occur in 4-40 (estimates vary) children per 100,000. With 100,000 Virginia children (our current birth rate) receiving three injections per year, we would expect to see 12-120 children hospitalized each year due to hepatitis B vaccination. Many physicians believe that hepatitis B vaccination is associated with medium-term and long-term complications such as arthritis, type 1 diabetes mellitus, and neurologic diseases such as Guillain-Barre syndrome and multiple sclerosis. Since the mandated vaccinations would prevent only about 1 childhood hepatitis B infection per year (with usually only mild symptoms), obviously vaccinating our children against hepatitis B will cause more harm than good. That is why the Association of American Physicians and Surgeons issued a strong statement to the United States Congress protesting mandatory hepatitis B immunization programs.*
What makes this program even less valuable is the fact that hepatitis B immunization is not lifelong. Only about 85% of people acquire immunity after all three vaccinations, and immunity may fail after 7-15 years (a phenomenon seen with other vaccines such as tetanus). Will Virginia soon mandate that children who received hepatitis B immunization during infancy get reimmunized at age 10? How much harm must our children endure at the whims of state health officials?
What can we do about this dangerous program? Parents should show this letter to their pediatricians and ask about the risks and benefits of hepatitis B vaccination. I encourage pediatricians and family practice physicians to issue medical waivers because the likely harm to infants and children from hepatitis B vaccination far outweighs any benefits. I urge all Virginians to contact their State Delegates and State Senators to protest this vaccination policy and sponsor legislation that will rein-in the Division of Immunology and overturn the hepatitis B immunization mandate
Gregory Tetrault, M. D.
*STATEMENT of the ASSOCIATION OF AMERICAN PHYSICIANS & SURGEONS to the Subcommittee on Criminal Justice, Drug Policy, and Human Resources of the Committee on Government Reform U.S. House of Representatives. RE: HEPATITIS B VACCINE, Submitted by Jane Orient, M.D. June 14, 1999.
More information is available from the National Vaccine Information Center:
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