What is Hib disease?--Greg Beattie

From: Greg Beattie <g.beattie@uq.net.au>

Is it meningitis? No. Is it epiglottitis? No. Is it septicemia, or pneumonia, or cellulitis, arthritis, middle ear infection, osteomyelitis, conjunctivitis, or respiratory infections? Well, no. But sometimes it presents as these diseases.

Then what is it? And what does the vaccine aim to protect our children from? Hib is not a disease. It's a type of bacteria - Haemophilus influenzae type b. The term Hib disease applies to any disease where Hib is found in laboratory tests. It can be any of a great variety of diseases including those mentioned above. But that doesn't mean that all cases of meningitis, or epiglottitis, or middle ear infection etc, are Hib disease. Only some of them. Only when a specimen is sent to a laboratory and Hib is found in it. If some other bacteria are found the disease is given a different name. If no bacteria are found it gets another name again.

So, Hib disease is not like measles, or whooping cough, or polio, or any of the other diseases we vaccinate for, because it is not defined by symptoms. Hib disease can basically be any disease with any symptoms. Whereas whooping cough, measles etc. have traditionally been defined by the symptoms they present, Hib disease is defined entirely by laboratory tests. There is no clinical definition for it. You may be asking, what does that matter? It matters when we introduce a vaccine for it, because we must be able to see how well the vaccine is working - i.e., how much disease it's preventing. Measles vaccine was introduced to combat the illness we call measles (fever, skin rash etc), and its associated complications and deaths. Whooping cough vaccine was introduced to combat a different illness, with a different set of symptoms. Rubella vaccine was introduced to combat birth defects. Polio vaccine, to prevent paralysis.

What is Hib vaccine supposed to prevent? Which illness was chosen for monitoring to see if the vaccine was beneficial? The truth is, none. No illness is being monitored. Basically, we don't know if Hib vaccination is reducing illness at all. The only thing being monitored is the frequency of Hib bacteria found in sick children. There are fewer laboratory tests detecting Hib nowadays so the vaccine is considered to be effective. The primary motive for introducing the vaccine was to combat what are known as invasive bacterial infections. But there is no evidence this has been achieved. In fact, it has not even been looked at.

There are three major types of invasive bacterial infections - Hib, pneumococcal, and meningococcal. Interestingly, the decrease in invasive Hib infections appears to have been accompanied by an increase in the other two. There appears to be no evidence of a decrease in invasive bacterial disease overall. In Australia, the notifications of meningococcal disease in 1995 were the highest since 1979, the year the health department started counting them again.106 More recently, the Sydney Morning Herald (April 24, 1997) warned that the rise was so significant that doctors have been advised to shift their policy, and administer broad spectrum antibiotics in the event of suspected cases. The article reported: About 400 cases and 40 deaths are reported in Australia each year, and the incidence has been rising gradually in many developed countries, although experts are not sure why. The number of cases in NSW jumped from 18 in 1988 to 154 in 1993. This rise occurred in parallel with the fall in Hib disease, so what savings in illness have there been? A research team in Finland reported an increase in invasive pneumococcal disease since 1993, suggesting its relationship to the disappearance of Hib disease as follows:107

"...our results suggest that following the disappearance of invasive Hib disease in children bacteraemic pneumococcal infections have increased. A similar, although less striking increase has been reported in Philadelphia... It is tempting to speculate that the increase in invasive pneumococcal infections is causally related to the disappearance of Hib disease."

A follow up report108 mentioned an outbreak of invasive pneumococcal disease in Iceland which, "... also arose in the context of Hib elimination by a vaccine programme, and so provides another possible example of upsurge in pneumococcal disease after Hib control."

The World Health Organisation reports109 that cases of meningococcal meningitis (serogroup B) have increased markedly in North America in recent years. So, there seems to be no demonstrated savings in illness in children. On top of all this there seems to be an association between DPT vaccination and invasive Hib disease. Dr Viera Scheibner comments on the reported 399% increase in Hib disease since the early 1940s and asks,110 "Why have developed countries experienced such an increase of invasive infections in the last 40 years?... The best demonstrable common factor in this period is a documented push for mass vaccination."

In summary, Hib vaccination was introduced to prevent the diseases mentioned earlier (meningitis etc). But its success is not measured by how much disease it prevents. It is only measured by how much Hib bacteria are found in laboratory tests. It was primarily introduced to combat meningitis, but we are yet to see any reports of a reduction in meningitis. Haemophilus influenzae is a group of bacteria regarded as normal inhabitants of the upper respiratory tract. They are considered 'typable' if they contain a polysaccharide capsule.

There are six 'typable' varieties named 'a' through to 'f'. The 'b' type (Hib) is considered to be one of the causes of the diseases mentioned earlier (meningitis etc). It is, however, also found in up to 5% of normal healthy children. The question is, has disease itself been reduced? Are meningitis, arthritis etc still occurring at the same rate as before, but with different organisms found in association? We are yet to see a report of reduced disease due to Hib vaccination. Actually, this raises a broader question in relation to vaccination in general. Shouldn't vaccination be measured by its success in reducing disease in the community and its success in promoting wellness? Shouldn't we be looking at the big picture?

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