Q:I was amazed to read the inaccurate, outdated and unnecessarily alarmist article on hepatitis B vaccination by Anthony Morris and Hilary Butler (WDDTY Vol 3 No 4). I am not going to get involved with the pros and cons of mass hepatitis B vaccination. Suffice it to say that hepatitis B disease can be a lethal infection in a small proportion of sufferers.

Furthermore, those who become chronic carriers (about 10 per cent) of the virus have 400 times greater chance of getting liver cancer than the general population. Some of the contents of the article would probably have applied to the vaccines produced in the early 80s.However, the hepatitis B vaccines that are now being used, especially those proposed for mass vaccination of children, are genetically engineered. This means that they do not come into contact with human blood or serums, and therefore there is no possibility of catching HIV or any other infections from them. The only side effects listed are occasional local redness and swelling, as well as transient mild fever, headache, joint and muscle pains, nausea and abdominal pain.

Whether or not the generalized side effects are related to the actual vaccine has not yet been established. Dr Kai Kermani, Loughton. Essex.

A:As some of you may or may not know, Dr Kermani is one of our panel members, who has treated many AIDS patients through a combination of conventional and alternative treatments such as autogenic training.

It's worth remembering that the article to which you refer mainly concerned the wisdom of launching a nationwide immunization programme for infants.

We went back to another panel member, immunization expert Anthony Morris, who authored the report on vaccination. Here is what he had to say.

"Most of the work in New Zealand was based on vaccines made from human plasma. However, as recently as the early 1990s, Smith Klein and French was licensed to use the genetically engineered vaccine, which is grown on yeast cells. However, the earlier plasma derived vaccine was never withdrawn, and even those drug companies which stopped producing the blood derived product kept selling it until it was used up. So until very recently, anyone receiving the vaccine could have received a blood based vaccine.

"The other issue you raise concerns the safety and efficacy of the yeast derived or 'recombinant' vaccine. You say that the contents of our article only applied to this earlier vaccine. However, let us call your attention to several paragraphs toward the end of the article, which included extracts from a report prepared by one very concerned New Zealand doctor about the effect of the new vaccine on children. As we reported, the doctor wrote that the HB vaccine, given with the DPT triple jab and/or the polio vaccine, causes a 'significant immune suppression in a significant number of children, as witnessed by the number of recurrent infections.' The doctor also points out that the HB vaccine, when given to newborns, caused a number of cases of prolonged, post natal jaundice, lasting up to two or three weeks. This doctor had never seen either problem in vaccinated babies before the HB vaccine was introduced.

"My biggest reservation with the new HB vaccine is that there's a good deal we don't know about it. Although the American Centers for Disease Control recommends that all newborns get the jab and the UK is beginning nationwide prenatal screening for the disease, top medical authorities basically admit that we don't really know whether it is effective, what the side effects are in babies and children, or even when the effect wears off. For instance, the 1991 edition of The Red Book, produced by the American Academy of Pediatrics, includes the report of the Committee on Infectious Diseases of the AAP, which says that routine screening of mothers to be for HB virus is 'recommended,' not mandatory tacit acknowledgement that the jab itself is only necessary for the newborns of infected mothers. Elsewhere in the volume, the AAP admits that the duration of protection and the need for booster doses is 'not yet fully divined. ' And between 30 and 50 per cent of people vaccinated with three doses of the vaccine lose detectable antibodies within seven years. This could mean that you may need a booster shot every five years for the rest of your life.

"Again, the AAP admits this with the statement that 'the possible need for booster doses after longer intervals than five to seven years will be assessed as additional information becomes available.' Finally the AAP says that 'in 1-2 per cent of cases the recommended regime . . . is not effective.' Therefore, infants should be tested at nine months or later to see if it's taken. This means that 2 out of every 100 babies won't be protected by the vaccine.

"This high failure rate has been reproduced in adults; a study published in the Journal of Infectious Diseases (April 1992) showed that 10 per cent of volunteers vaccinated failed to produce antibodies.

"There is also the possibility that the hepatitis B vaccine can itself cause a mutant strain of the virus. In a study in southern Italy published in the Lancet (11 August 1990), 44 of the 1,590 infants born of HB carriers became HB positive, 32 of whom showed evidence of infection and one, serious disease. The study group concluded that the vaccine caused a viral 'escape' mutation ie, a slightly different organism resistant to the protective effects of the vaccine.

"Finally, there have been reports (the Lancet, 25 April 1992) of people misdiagnosed as HIV positive after being vaccinated with the HB vaccine. "

In our view, the studies Dr Morris cites demonstrate that no definitive statements can be made as to the safety or efficacy of either the old or new HB vaccine for children.