CA Vaccine Law - Pt 2 - Now W/arguments about everything!

[rosethorne]

I finally made it to the end of this thread!!!11!!!!1!!! :eleventy:

Nothing to add besides a link that is only semi-pertinent and made me lol (it's obviously a trollish, made up, story, but still amusing)

deadstate.org/teenager-defies-anti-vaxxer-parents-by-sneaking-out-and-getting-vaccinated/

I was randomly directed to said link by a snarky friend, and I immediately thought of this clusterfuck thread.

[Petrel]

Not to be all on-topic and stuff, but there's a new article on Science-Based Medicine about the rationale for infant vaccination for hepatitis B.

[Ali]

Not to be all on-topic and stuff, but there's a new article on Science-Based Medicine about the rationale for infant vaccination for hepatitis B.

Thanks for sharing this. My first child is fully vaccinated for her age. I am pregnant with my second and this is the one vaccination that I hesitate about giving to him or her. The part about it being able to survive for seven days is scary.

[notsocommon]

I like Puffins

[August]

Not to be all on-topic and stuff, but there's a new article on Science-Based Medicine about the rationale for infant vaccination for hepatitis B.

Interesting to see the another confirmation that it's good public health policy, but not necessarily necessary in each personal situation. Like prenatal rhogam, it's easier to just tell everyone to have it, but for an individual it might not be any advantage.

(rhogam is a pooled human blood product, so if you don't need it, best not to have it. But, because so many babies are not fathered by the putative father it's something caretakers insist on. You can get out if it, but it's a complicated judgement call by the care provider)

[CelticGoddess]

This is my meowbaby, Socks!

I used to be a dog person, but this little stray kitten showed up one day and never left :)

I love your baby. I have a soft spot for black or black and white kitties. I have a tuxedo names Bonkers. I just love black or black and white kitties. (poor babies tend to not be adopted, Same goes for black dogs)

[lawlifelgbt]

Up here in Minnesota, we love black dogs for some reason!

[Mama Mia]

Interesting to see the another confirmation that it's good public health policy, but not necessarily necessary in each personal situation. Like prenatal rhogam, it's easier to just tell everyone to have it, but for an individual it might not be any advantage.

(rhogam is a pooled human blood product, so if you don't need it, best not to have it. But, because so many babies are not fathered by the putative father it's something caretakers insist on. You can get out if it, but it's a complicated judgement call by the care provider)

Im confused. I thought the rhogam was given if the baby had rh+ positive blood and the mother had rh- blood, to prevent complications in future pregnancies. So why would it be given prenatally? I last had to deal with this a long time ago, so maybe I'm confused?

Off- topic I really wish someone had some insight to my previous question about being told I was " rh negative but showed up as positive" , I never figured it out and don't know what yo search for now that the Internet exists. To retell it quickly: I had one pregnancy that ended, was given the rhogam shot, told I'd need it for all future pregnancies. Later I had my blood typed to donate blood and it showed up as O+ . With the next several pregnancies I was not given the rhogam shot and I figured the first pregnancy they must have made a mistake on what my blood type was. My last pregnancy I was given the shot, and the Dr. was shocked that I hadn't received it the last several births and asked if I'd had my babies in Mexico. At one point one of the health providers told me that I had a weird thing where my blood was " negative but shows as positive" don't recall the exact phrasing. Any of you scientists or health care providers have any insight? Or search terms to use? I'm really curious.

[August]

Sometime around the early 2000s they realised that even with rhogam at birth about 1.5% of women were still getting sensitised. So they started giving rhogam prenatally and that cut the rate in half. The regimes varied when I looked into it, but it lasts around six weeks, so one had you get it at 28 and 34 weeks. I think I had just the one, but don't remember which week.

Before they give you the after birth rhogam they test the baby's blood, and you don't get it if the baby is rh-. (it's not only pooled blood, but difficult to make and expensive). Prenatally if the father is also rh- you wouldn't need it because you could guarantee the baby is rh-. But because parentage can be uncertain and it can be dangerous for a woman to admit to it, most care providers insist you have it anyway. Having it be policy means they don't endanger a woman by insisting that she have it even though her husband is rh-. IYKWIM.

I know what you mean with your blood. Give me a minute to look for a link for you. You'll be reassured that if you ever have a blood transfusion that error won't happen.

[August]

The search term you can use is "weak D" (or possibly partial D), but the explanations are a bit eye-crossing. I can't find a nice simple explanation, so I'll give it a go myself.

As you know, on your red blood cells you have a variety of proteins, which determine your type. You're familiar with A and B, the name of the rh (rhesus) factor is D. So an AB+ person has A,B and D on their red blood cells (rbc). An O- person has no A,B or D. There are also a ton of minor ones, which aren't relevant here, except as an illustration that blood typing is way more complicated than matching ABO groups.

Some people's D gene is defective in such a way that they end up with fewer D proteins on their rbc. They are called weak D. Others have other defects in the D protein and are called partial D.

When they're testing blood the weak D can not react strongly enough with quick crude tests (like you did in bio 101 lab). This will show up then as D- (rh-). They're supposed to take any blood which tests D- and do a further check to see if it's weak D. Now, here is where I'm speculating. Either that further check was only invented recently, or they don't do it for recently delivered women (am intrigued, am going to read more on this), with the reasoning that better to err on the side of caution (there's also something interesting about partial D and anti-D antibodies). But, for blood to be transfused they are testing six ways to Sunday, including just mixing donor and recipient together and seeing if they clot. A blood bank will spend the time and effort to look for weak D, so that's why they found it.

I wonder if your births were in a smaller hospital with smaller lab or onsite testing kits?

I'm intrigued now and am reading all sorts. Will post if I find more useful info.

[August]

Here we are!

Today, the anti-D blood group reagents that have been approved by the FDA contain both monoclonal IgM and IgG antibodies. The former detect D antigen during immediate spin and the latter detect D antigen in the antiglobulin phase of testing. Weak D phenotypes are detected with these reagents. Many weak D variants that previously were only detected in the antiglobulin phase using older polyclonal reagents are now detected by routine typing.

Today, weak D antiglobulin testing is required for blood donors and newborns of D negative mothers to detect potentially immunogenic weak D red blood cells. Weak D typing is not required, nor encouraged, for transfusion recipients and pregnant women. By eliminating the antiglobulin phase of testing for these patients, some partial D variants at risk of forming anti-D will be classified as Rh negative. Therefore, these patients will be candidates for Rh immune globulin during pregnancy and transfused with Rh negative red blood cells.

Controversy still exists regarding whether pregnant women who were previously identified as weak or partial D should be given Rh immune globulin prophylaxis. Arguments against giving RhIG include the relatively low risk of anti-D formation and the lack of evidence supporting its efficacy. Arguments in favor of RhIG administration include the possibility of a partial D phenotype and the unknown risk anti-D formation. In these situations, the medical director of the transfusion service should consult with the obstetrician.

Occasionally, discrepancies in D typing occur between laboratories because of the various methods and reagents used for testing. An obstetrical patient may have been previously tested for weak D in another laboratory or as a blood donor. Laboratories following current guidelines will not perform weak D testing and classify this patient as Rh negative. Another possibility is that an obstetrical patient, who really has a weak D phenotype but was classified as Rh negative, may have a falsely positive postpartum fetal rosette test due to reaction with maternal red blood cells.

http://www.clinlabnavigator.com/weak-d-testing.html

The bit about the controversy / newborns is because someone with partial D can test as weak D, but actually behave like D negative and form antibodies. So they need to be treated as D negative. (Can expand if you like, think it has to do with which epitopes are there)

Now I'm thinking out loud/geeking out

Off- topic I really wish someone had some insight to my previous question about being told I was " rh negative but showed up as positive"

,

This phrasing is REALLY interesting. A weak D should be called "Rh positive but showed up as negative", I think you might be partial D. Partial D is, as far as I can tell, a new discovery and is treated in some situations as negative, some as positive.

[apple1]

Mama Mia, You asked that question before, and (on the Naugler thread) I put a fair bit of effort into an answer, but you never responded.

Disclaimer: Obviously, I have never tested your blood. YMMV.

Here goes:

The most significant (not the only, but still, the most significant) of the Rh group of red cell antigens is D. When someone is called "Rh positive" this means that they have the D antigen on their red cells. When someone is called "Rh negative" this means that they do not have the D antigen on their red cells.

However - As you might expect, it's not quite that simple.

http://www.bbguy.org/education/glossary ... t=w&id=228

As mentioned in the quote above, the exact testing methods and the philosophies on exactly how all of this works has changed over even the time that I have been a professional. Included in some of those changes have been beliefs over the need - or lack of need - for Rhogam by weak or partial D women.

There are also differences of opinion among professionals as to whether the husband's blood type should be considered in prenatal Rhogam administration. Post natal administration is determined by the baby's blood type.

Also - to add to the confusion - as a DONOR, a person with weak D is DEFINITELY typed as Rh positive. As a RECIPIENT, the same individual may be called Rh negative.

Hope this helps understand some of the nuances.

[Petrel]

Interesting to see the another confirmation that it's good public health policy, but not necessarily necessary in each personal situation. Like prenatal rhogam, it's easier to just tell everyone to have it, but for an individual it might not be any advantage.

(rhogam is a pooled human blood product, so if you don't need it, best not to have it. But, because so many babies are not fathered by the putative father it's something caretakers insist on. You can get out if it, but it's a complicated judgement call by the care provider)

That's actually the exact argument the article was refuting. :/ Yeah, on an individual level a person might have a small risk, but if we don't vaccinate the whole population despite their perceived risk level, hepatitis B will hang around much longer than it should. It's vaccine-preventable, we should have 0 new cases a year, but it persists because people are not vaccinated, and skipping vaccination (which is extremely safe!) of neonates means they are unprotected when the danger if they are infected is greatest.

As long as we do not have universal newborn vaccination we are guaranteed to have supposedly low-risk babies become infected. It might not be your baby, but it will be someone's baby.

[August]

No, that article, and others I've read on Hep B, do not say it's low risk newborns getting infected. It's high risk mistakenly ID'd as low risk who get infected. And that's why making it a broad policy works (catch people in denial), but also why an individual decision working off accurate info is perfectly reasonable.

[Petrel]

You've only ever had sex with your husband, but he goes out and cheats on you with five different women. Suddenly your risk is much higher than you perceive. People's assessment of their risk level is not always accurate.

Curious--do you think pregnant women should opt out of HIV testing if they perceive themselves at low risk? Same type of thing--huge consequences for the child if the mom is positive and doesn't know.

[ShepherdontheRock]

I want a shiba Inu.

Guess it'll happen when I'm financially stable and have a permanent address.

[Ali]

Here we are!

http://www.clinlabnavigator.com/weak-d-testing.html

The bit about the controversy / newborns is because someone with partial D can test as weak D, but actually behave like D negative and form antibodies. So they need to be treated as D negative. (Can expand if you like, think it has to do with which epitopes are there)

Now I'm thinking out loud/geeking out

,

This phrasing is REALLY interesting. A weak D should be called "Rh positive but showed up as negative", I think you might be partial D. Partial D is, as far as I can tell, a new discovery and is treated in some situations as negative, some as positive.

This is really interesting. I am A+, but there was antibodies in my blood. My OB ordered further testing. I am curious to see if this is what caused antibodies in my blood.

[church_of_dog]

You've only ever had sex with your husband, but he goes out and cheats on you with five different women. Suddenly your risk is much higher than you perceive. People's assessment of their risk level is not always accurate.

Curious--do you think pregnant women should opt out of HIV testing if they perceive themselves at low risk? Same type of thing--huge consequences for the child if the mom is positive and doesn't know.

Haha -- I actually scrolled back a bit because I didn't remember that Curious was participating in this conversation -- then I realized you meant the word curious and not the person Curious... :lol: :doh:

[Rajah061014]

Regarding blood types and antibodies.....

Our red blood cells (RBCs) are coated with dozens upon dozens of antigens, from various "families". The most important family, and most well known, is the ABO group. That's what your "blood type" generally refers to. A, B, AB, and O are the four possible blood types from that group.

Rh stands for Rhesus. It's the name of another family, but is commonly used to refer only to the D antigen. D is not the only antigen in the Rh family though- there's also c, C, E, e, f, and g (amongst others). D was discovered first, which is why it's normally referred to as Rh.

Outside of those two main families, there are many other blood antigen families that people can develop antibodies to. The typical panel used to screen for antibodies has about 20 antigens in it (not including the ABO group). There are even more families that aren't covered in the basic panel because they are so rarely seen.

When someone is told they have an antibody, it could be to any of the commonly screened for families, or a rare family. Development of an antibody occurs after exposure to someone else's blood, either via transfusion or pregnancy. So women who have been pregnant at least once may have RBC antibodies, but not necessarily to D. Even a pregnancy that ends prematurely can lead to antibody formation if enough of the baby's blood comes into contact with the mother's blood. That's why women receive Rhogam prior to birth. If there is any mixing of their blood with the baby's prior to the birth, it could potentially lead to antibody formation.

This is also why even D+ (Rh+) women get their blood typed and screened for antibodies during pregnancy. While D is one of the most common antibodies that causes issues, there are others that are even more dangerous if present. Generally, if a pregnant woman has any RBC antibodies that shouldn't be there, the antibody level is determined to predict the risk of harm to the fetus. Those levels are typically followed throughout the pregnancy at certain intervals. Higher levels may mean more frequent surveillance of the baby while still in the uterus.

Sorry for the long spiel. Blood banking is a big part of my training in residency, so I've learned a lot about it recently.

[Mama Mia]

August and apple and Rajah ---- thank you so, so much for your in- depth replies! I really appreciate it!

Apple, I'm really sorry I never saw your first reply - I had Internet issues for a bit and must have missed it when I was off- line and not seen it when I came back. Thank you for going to all that trouble!

The internet really is amazing isn't it. My last baby is turning 25 this month, so at the time, it was just a question at the back of my head with no easily accessible way to find the answer. I did try to search a few times one the web was a thing, but not being versed in the vocabulary came up with nothing. Thanks again !

[OkToBeTakei]

You've only ever had sex with your husband, but he goes out and cheats on you with five different women. Suddenly your risk is much higher than you perceive. People's assessment of their risk level is not always accurate.

Curious--do you think pregnant women should opt out of HIV testing if they perceive themselves at low risk? Same type of thing--huge consequences for the child if the mom is positive and doesn't know.

Is HIV testing routine also?

Completely unrelated I had a Shiba Inu called Alan. I was very attached. Unfortunately he was a Nintendog :cry:

[ShepherdontheRock]

Is HIV testing routine also?

Completely unrelated I had a Shiba Inu called Alan. I was very attached. Unfortunately he was a Nintendog :cry:

Idk if I'd call it routine, but, as a young person, the obgyn, etc strongly encourage sexually active people to get STD tests, which include HIV. Even if you only have had 1-2 partners/use condoms/ otherwise do something to lessen the risk. They just really don't want you to take your chances. HIV testing is often offered free at the student commons at my school. I think it's a very good thing. And we'd all line up for an HIV vaccine if hhere were one.

And shiba Inu, real or otherwise, are the cutest.

[Mama Mia]

Is HIV testing routine also?

Completely unrelated I had a Shiba Inu called Alan. I was very attached. Unfortunately he was a Nintendog :cry:

When my youngest children were born in 89 and 90 HIV testing was routine during pregnancy, at least with my physicians. I don't recall, but I assume they also did other common STI tests.

I worked at residential substance abuse treatment centers for women with children in the mid nineties, and all staff were tested for HIV every six months. I think that sort of thing has probably lessened by now though, probably more part of the HIV panic than an actual need. Although I did work with the infants and toddlers of IV drug users, so I suppose there was some extremely small risk if a child bit me or something.

IIRC , at least a few of my kids received some sort of comprehensive STI , including HIV, testing as part of their routine physicals, at some point during adolescence. That would have been in the late 90s to mid 2000's. Don't know if they had HIV testing during pregnancy, but I would assume so - they never seem to take away tests, only add more.

[Petrel]

The CDC recommends HIV testing for pregnant women on an opt-out basis (that is, by default every woman is tested, although you can decline the test). I think the practice still varies state by state.

I got tested even though I perceived my risk to be 0%.

[Ali]

Regarding blood types and antibodies.....

Our red blood cells (RBCs) are coated with dozens upon dozens of antigens, from various "families". The most important family, and most well known, is the ABO group. That's what your "blood type" generally refers to. A, B, AB, and O are the four possible blood types from that group.

Rh stands for Rhesus. It's the name of another family, but is commonly used to refer only to the D antigen. D is not the only antigen in the Rh family though- there's also c, C, E, e, f, and g (amongst others). D was discovered first, which is why it's normally referred to as Rh.

Outside of those two main families, there are many other blood antigen families that people can develop antibodies to. The typical panel used to screen for antibodies has about 20 antigens in it (not including the ABO group). There are even more families that aren't covered in the basic panel because they are so rarely seen.

When someone is told they have an antibody, it could be to any of the commonly screened for families, or a rare family. Development of an antibody occurs after exposure to someone else's blood, either via transfusion or pregnancy. So women who have been pregnant at least once may have RBC antibodies, but not necessarily to D. Even a pregnancy that ends prematurely can lead to antibody formation if enough of the baby's blood comes into contact with the mother's blood. That's why women receive Rhogam prior to birth. If there is any mixing of their blood with the baby's prior to the birth, it could potentially lead to antibody formation.

This is also why even D+ (Rh+) women get their blood typed and screened for antibodies during pregnancy. While D is one of the most common antibodies that causes issues, there are others that are even more dangerous if present. Generally, if a pregnant woman has any RBC antibodies that shouldn't be there, the antibody level is determined to predict the risk of harm to the fetus. Those levels are typically followed throughout the pregnancy at certain intervals. Higher levels may mean more frequent surveillance of the baby while still in the uterus.

Sorry for the long spiel. Blood banking is a big part of my training in residency, so I've learned a lot about it recently.

Thank you so much for this information. I learn so much from Free Jinger.