In a story in the anti-science website GreenMedInfo, author Sayer Ji attacked hepatitis B vaccines (HepB) based on one small, recently published study by Pande et al. I’ve previously written about Mr. Ji mostly showcasing his pseudoscience ideas, formed from a postmodernistic hatred of real science. Mr. Ji is thoroughly antivaccine, believing that vaccines subvert evolution (it’s clear that Ji thinks that those who die of vaccine preventable disease deserve to die) and that vaccines are not natural, so they harm the immune system. He also despises Bill Gates’ efforts to bring vaccines to parts of the world that would benefit from the medications.
Sayer Ji is simply a lunatic about vaccines, searching the internet for anything that supports his pseudoscientific beliefs. And he seems to be pround to engage in the logical fallacy of Cherry Picking, where only select evidence is accepted in order to persuade the audience to accept a particular position, that is, vaccines don’t work, and evidence that would go against the position is withheld. One important point–the stronger the the withheld evidence, the more fallacious the argument.
And Ji has probably broken the fallaciousness meter with his opening quote, which is wholly dependent on the one small study mentioned above:
An eye-opening new study published in the Journal of Viral Hepatitis reveals that conventional hepatitis B vaccine- and hepatitis B immunoglobulin-based treatment for infants of mothers who tested positive for hepatitis B infection is nothing near “95% effective in preventing infection and its chronic consequences” that the World Health Organization (WHO) and a myriad of health organizations around the world claim it to be. To the contrary, researchers were able to detect through highly sensitive polymerase chain reaction (PCR) DNA testing that 42% of the infants still had ‘occult’ hepatitis B infection, 24 months after initiating treatment at birth, despite the fact that the vaccine reduced the incidence of overt infection.
Ignoring Ji’s crusade for a moment, let’s review what the article actually stated. In the study, babies, immediately after delivery, were randomized into one of two groups: either receiving hepatitis B immunoglobulin (HBIG, which is given as postexposure prophylaxis for people at risk to develop hepatitis B because they have been recently exposed to body fluids of individuals who have hepatitis B), or receiving a HBIG placebo. Additionally, both groups were given the HepB vaccine (at 0, 6, 10, and 14 weeks). Approximately 128 were in the HBIG group and 131 in the placebo group, for a totally of 259 in the study (a rather small one).
The important results for the study were:
- Babies that developed an overt HepB infection-3%
- Babies that no HepB infection (but a poor immune immune response)-5%
- Babies had developed an occult HepB infection-64%
I’m a bit concerned that one of the two groups, in which the babies were randomized, includes treatment that is not the standard of care developed over the past few years by the CDC and WHO, not giving half of the babies any immunoglobulin. This seems unethical.
If you just look at the numbers for an “overt HepB infection”, 3%, you’d think that Ji was hyping the wrong study. The more important issue is that 64% had developed an “occult HepB” infection. It’s important to understand what is an occult HepB infection: the HepB surface antigen (HBsAg) is most frequently used to screen for the presence of this infection using an anti-HBsAG antibody test. This antigen is the first detectable viral antigen to appear during an HepB infection. However, early in an infection, this antigen may not be present and it may be undetectable later in the infection as it is being cleared by the host.
Let’s focus on two points. First, 97% of the children in this puny study did not get a detectable HepB infection from an HepB infected mother after vaccination and immunoglobulin, a standard medical protocol. Second, the study did show that about 64% of babies may have developed an occult HepB infection. However, this may have resulted from the virus being cleared from the baby prior to becoming symptomatic. Or it could be an HepB viral variant (or mutant) that are becoming more prevalent or even endemic in the area where this study was performed, New Delhi, India.
On the hierarchy of research publications, the one being hyped by Ji is of middling quality, since it’s a primary research study with rather small numbers. Systematic research, like meta-reviews from Cochrane, are typically (but not always) of the highest quality, and one such review, published in one of the best medical journals, has concluded that “hepatitis B vaccine, hepatitis B immunoglobulin, and vaccine plus immunoglobulin prevent hepatitis B occurrence in newborn infants of mothers positive for hepatitis B surface antigen.”
Now, that being said, if the research by Pande et al. bears out in subsequent research, then real science researchers will be (and actually have been) studying ways to improve the HepB vaccine to cover more subtypes. This is how science works, it’s not dogmatic.
But Sayer Ji, employing the Nirvana logical fallacy, which states if it’s not perfect then it’s useless, concluded that “this study not only clearly calls into question the standard of care for preventing hepatitis B infection in infants born to infected mothers, but it also challenges core tenets of vaccinology, including hepatitis B vaccine safety and effectiveness.” Since other studies, like the systematic review which I mentioned previously, included nearly 300,000 patients, examined the occult HepB antigens, and were well controlled, showed that the “vaccine decreased the risk of hepatitis B infection among infants of mothers positive for hepatitis B surface antigen.”
In other words, especially with mothers with HepB, the vaccine saves lives. Ji’s conclusion of challenging the core tenets of vaccinology is ridiculous. In fact, if this research is legitimate and repeated later, it only confirms that science works.
Sayer Ji’s cherry-picking of one study, ignoring the few hundred that support the safety and effectiveness of the HepB vaccine, provides evidence of his vaccine denialism and general anti-science belief. Just ignore him–nothing important is said there. Because as I stated, the more evidence you ignore in your cherry-picking, the worse your argument is.
If you need to search for accurate information and evidence about vaccines try the Science-based Vaccine Search Engine.
- HIV Variants and Hepatitis B Surface Antigen Mutants. Proceedings of a symposium, May 22-24, 2005, Washington, DC, USA. J Med Virol. 2006;78 Suppl 1:S1-70. PubMed PMID: 16937554.
- Hu KQ. Occult hepatitis B virus infection and its clinical implications. J Viral Hepat. 2002 Jul;9(4):243-57. Review. PubMed PMID: 12081601. Impact factor=3.082.
- Lee C, Gong Y, Brok J, Boxall EH, Gluud C. Effect of hepatitis B immunisation in newborn infants of mothers positive for hepatitis B surface antigen: systematic review and meta-analysis. BMJ. 2006 Feb 11;332(7537):328-36. Epub 2006 Jan 27. Review. PubMed PMID: 16443611; PubMed Central PMCID: PMC1363909. Impact factor=17.219.
- Mast EE, Margolis HS, Fiore AE, Brink EW, Goldstein ST, Wang SA, Moyer LA, Bell BP, Alter MJ; Advisory Committee on Immunization Practices (ACIP). A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) part 1: immunization of infants, children, and adolescents. MMWR Recomm Rep. 2005 Dec 23;54(RR-16):1-31. Erratum in: MMWR Morb Mortal Wkly Rep. 2007 Dec 7;56(48):1267. MMWR Morb Mortal Wkly Rep. 2006 Feb 17;55(6):158-9. PubMed PMID: 16371945.
- Pande C, Sarin SK, Patra S, Kumar A, Mishra S, Srivastava S, Bhutia K, Gupta E, Mukhopadhyay CK, Dutta AK, Trivedi SS. Hepatitis B vaccination with or without hepatitis B immunoglobulin at birth to babies born of HBsAg-positive mothers prevents overt HBV transmission but may not prevent occult HBV infection in babies: a randomized controlled trial. J Viral Hepat. 2013 Nov;20(11):801-10. doi: 10.1111/jvh.12102. Epub 2013 Apr 23. PubMed PMID: 24168259. Impact factor=3.082.
- Plotkin SA, Schaffner W. A hepatitis B vaccine with a novel adjuvant. Vaccine. 2013 Nov 4;31(46):5297-9. doi: 10.1016/j.vaccine.2013.09.019. Epub 2013 Sep 17. PubMed PMID: 24051160.
- Shuler CM, Fiore AE, Neeman R, Bell BP, Kuhnert W, Watkins S, Kilgour K, Arnold KE. Reduction in hepatitis B virus seroprevalence among U.S.-born children of foreign-born Asian parents — benefit of universal infant hepatitis B vaccination. Vaccine. 2009 Oct 9;27(43):5942-7. doi: 10.1016/j.vaccine.2009.07.087. Epub 2009 Aug 11. PubMed PMID: 19679217. Impact factor=3.458.