What is Hepatitis B? Why NOT vaccinate for it? [Part Two]

This post is going to focus on reasons NOT to vaccinate for Hepatitis B. 

How is this vaccine created? 

"A portion of DNA from the hep B virus is integrated into the DNA of some yeast cells that live in a solution of soy, sugar, amino acids, and minerals. The yeast cells then use this DNA to generate a protein that makes up the outer capsule of the hep B virus. The yeast cells are broken up, and the hep B virus is filtered out and purified. Aluminum is then added to help the vaccine work better. It is put in a saline solution. ... Recombivax HB uses formaldehyde to purify the vaccine. Engerix-B does not.

 Note: Adults receive a double dose of hep B vaccine, so each adult dose contains 500 micrograms of aluminum." [3]

"However, the greatest concern about recombinant DNA vaccines is that they may cause the immune system to produce antibodies, which in turn attack the body and cause health problems. Much is still not known about the effects of recombinant DNA vaccines." [4] 

Well, that sounds okay, right? Not so bad. NOT. Very little is known about this type of vaccine (recombinant) and any potential long-term effects of it. It is still a relatively new type of production without hardly any studies done on the potential repercussions. Basically, a recombinant vaccine is a vaccine that is genetically engineered/altered. The potential ethical issues and potential catastrophic fallout with a vaccine that is partially genetically engineered is enormous. It creates a situation where scientists can realistically tinker with DNA and alter genomes...and we just don't know what the long-term effects of it are on DNA or RNA, both human and virus. It is even proposed that this is the method in which Herpes Virus Type 6 crossed over into human telomeres (homologous recombination). I think it is important to think of the possible ramifications this can cause as far as autoimmune disorders and autoimmune reactions. From what we do know, improper homologous recombination can lead to cancer, cancer-related illnesses (such as Bloom's Syndrome), and fetal chromosome variants that lead to such chromosomal abnormalities like Trisomy 18. So think about it this way...if scientists decide to create a vaccine with two or three strains of an illness, and someone mucks up even a little bit, in a way no one could know...we could realistically have a brand-new mutated hybrid strain, or even several. This happens in nature all the time, and why it is almost impossible to completely eradicate any communicable disease.

Vaccine Escape Mutants [1]

Even the WHO (World Health Organization) is extremely concerned about Vaccine Escape Mutants (VEMs) and ADAP-VEMs (antiviral drug-associated potential vaccine escape mutants). VEMs are strains of the virus that have mutated because of overuse of a vaccine, in this case the Hepatitis B vaccine. The WHO page puts it a little more mildly by stating it is "riskier" for highly populated areas (AKA we are overusing this vaccine!!) Also, as a disease that thrives in highly populated areas, does this mean the vaccine is pretty much ineffective since the rate of VEMs is higher in highly populated areas? The WHO has stated that in order for a strain to be truly dangerous it must meet four qualifications; 1. it must be stable, 2. it must be so radically different that it is resistant to the vaccine, 3. it has to be transmissible, 4. it must cause acute/chronic infection. The WHO states: 

"Of these four characteristics, to date we have evidence that three have been fulfilled, although we do not know if ADAP-VEMs have the same propensity to cause disease as do strains of HBV that are already circulating. However, given the high rate of HBV drug resistance and the discovery of ADAP-VEMs in individuals who have received lamivudine therapy, we suggest at least two features of HBV treatment programmes may increase the likelihood that an ADAP-VEM of public health importance will emerge."

"It has been recognized that the administration of hepatitis B vaccine can increase the mutation rate of the virus. In high-prevalence countries such as China, Thailand as well as Province of Taiwan. China, monitoring for more than a decade has shown that hepatitis B immunization programmes have increased the incidence of HBV variants with mutations in the surface antigen protein9,10 even as they reduce the overall burden of chronic hepatitis B infection.11 ... Infection of immunized individuals with a vaccine escape mutant (VEM)20 is therefore possible. Some of these variants are associated with high levels of viraemia and have persisted in the host for more than 10 years, suggesting they are stable and transmissible variants. In addition, the antibody responses against the surface antigen protein elicited by the recombinant yeast-derived vaccine now in use are weaker and more specific than those achieved with the previous plasma-derived surface antigen vaccine.22–24 In Province of Taiwan, China, up to 28% of children with chronic hepatitis B infection also harbour hepatitis B surface antigen mutants. So VEMs capable of causing infection in fully immunized individuals are not uncommon in countries with high rates of endemic HBV infection and universal hepatitis B infant immunization programmes.12,20 However, to date the emergence of VEMs has not had a known negative impact on any country’s immunization programme.25"

The WHO contradicts themselves over and over. "However, to date the emergence of VEMs has not had a known negative impact on any country's immunization programme."? If this were true, why would it affect countries with a high infant vaccination program? The US vaccinates over 95% of its newborn babies with Hep. B before leaving the hospital, or at the first well-check appointment. So this practice IS negatively affecting things if VEMs are capable of infecting fully vaccinated individuals in our country. It means that it doesn't work. If it were true, how would they be able to measure how likely it is in certain areas, how many individuals are affected by VEMs? They wouldn't. Also, since they can't monitor VEMs well enough to know whether a VEM has caused acute/chronic infection (since many don't even know they have Hepatitis B until they are hospitalized), they don't know how prevalent VEMs are, since most will have minor illness and full recovery from Hepatitis B.

There are some other troubling issues surrounding treatment of Hepatitis B and how some of the antiviral agents used can cause a strain to mutate or become stronger and resistant to antivirals and vaccines.

"Lamivudine, although it is relatively inexpensive, has been shown to rapidly result in the selection of primary antiviral drug-resistant polymerase variants. These variants in turn also select for compensatory mutations, some of which may have altered surface antigens.33,34,39 ... All of these newer medications, however, are more expensive and their long-term efficacy is still being established. Consequently, for the foreseeable future many countries, especially in the Asia-Pacific region, will probably continue to treat chronic hepatitis B infection with lamivudine even though it is no longer considered the first-line treatment, and despite the fact that drug resistance may rapidly emerge.41"

Wait wait wait a minute. So these drugs have been contributing to this problem and yet they are still allowed to be used because they are CHEAP? The newer medications have no long-term efficacy studies done? That must also mean we don't know long-term adverse events and effects of these drugs as well. We have bigger issues at hand than a world vaccination program.

Some more troubling quotes:

"The second potentially problematic feature of current treatment programmes is the way patients are selected. ... Antiviral drugs are the only long-term treatment option for chronic hepatitis B infection,40 and many investigators have argued that all patients who are viraemic should be treated. ... In addition to being costly, this approach may generate antiviral drug resistance since current agents never lead to eradication of the virus, but only to control of replication. This effect, in turn, can complicate second-line therapies and may favour the appearance of ADAP-VEMs. ... However, there is no consensus globally regarding which patients to treat, and WHO has not yet produced international recommendations to guide therapy (Daniel Lavanchy, personal communication, 2008). Inappropriate inclusion criteria, improper application of these criteria or lack of compliance with treatment could greatly influence the emergence of both drug resistance and ADAP-VEMs."

So we don't know how to treat this effectively? Just "control" its replication inside the already-infected person's body? Sweet. Let me just inject myself with the vaccine putting this virus into my body when the WHO has already stated that it's not going to effectively lower my chances! What is with all of the "costly" stuff? Why is money an issue when lives are at stake and there is plenty of financial surplus? I'd love to hear this. You can only treat some people, because it's "for the greater good" and "survival of the fittest"? That's the only argument I ever hear, for the record. If the drugs and the vaccines in use are contributing to ADAP-VEMs and VEMs, shouldn't we be spending money on trying to find or create an antiviral agent that can treat this (not "control" it) or some way to help prevent it more reliably, instead of injecting people with a vaccine which will have long-term health effects and still not prevent transmission in a huge amount of people (therefore cannot be counted as a preventative measure)?

"The public health risk of treatment programmes in different populations may also depend upon features of the circulating viral genotype. There is evidence that the genotype of the virus influences the speed and frequency of development of resistance to treatment, which may in turn influence the likelihood that ADAP-VEMs will emerge."

Taken from WHO website. [1]

 So really, we have no control over this at all?

"Among children born to mothers who are HBeAg-positive, 90% will become infected whereas only 10% of children born to HBeAg-negative mothers will become infected."

So we are injecting all newborns with this why? Shouldn't we just be recommending the vaccine for infants most at risk? Oh yeah, let's revisit that CDC quote.

"Infants born to HBV-infected mothers require Hepatitis B vaccine and Hepatitis B immune globulin (HBIG) withing 12 hours of birth to protect them from infection. However, because errors or delays in documenting, testing, and reporting maternal HBsAg status can and do occur, administering the first dose of Hepatitis B vaccine soon after birth to all infants acts as a safety net, reducing the risk for perinatal infection when infection maternal HBsAg status is either unknown or incorrectly documented at delivery. Also, initiating the Hepatitis B vaccine series at birth has been shown to increase a child's likelihood of completing the vaccine series on schedule." [2]

Hmmm...so in case of a health-care providers muck-up? Because you don't trust mothers and even if their test is negative, they must be positive? Is there really that many errors and false negatives that EVERY American newborn needs this vaccine? If the answer is yes, we  have bigger problems. If the answer is no, why the hell are we still advocating and allowing this? Oh, to further the vaccine schedule. That makes complete sense, since the only reason for the child to complete every vaccine on the schedule is for profit. Every child does not NEED over 50 vaccines by adolescence.

"For example, the efficiency of transmission from an HBeAg-positive mother to her child during the perinatal period creates a very high risk for chronic hepatitis B infection. This risk makes it important to monitor for ADAP-VEMs among treated women of childbearing age, especially if lamivudine is used as monotherapy, since neither hepatitis B immunoglobulin nor active immunization would prevent infection with an ADAP-VEM transmitted from mother to child. In addition, the child may then spread the ADAP-VEM to other children, immunized or not. ... On the other hand, it has been estimated that the proportion of all HBV infections acquired among children more than 5 years of age ranges from 10% where prevalence of hepatitis B infection is high to as much as 90% where prevalence is low.47 These numbers suggest that monitoring for ADAP-VEMs may be needed in other populations in addition to HBV-infected HBeAg-positive women of childbearing age." Note: my emphasis.

So the vaccine and HBIG really don't do anything? If you don't know the rate of what is a common strain and what is a(n) (ADAP-) VEM, how do you know that the vaccine is going to work? What percentage of strains are VEMs? They certainly aren't figured into efficacy rates, no, because that would lower it. Humph. How interesting. So I should vaccinate myself and my child for what reason?

Hepatitis B Immune Globulin (HBIG)

"Anyone who is exposed to hep B-infected blood can be given an HBIG injection, which is made of hepatitis B antibodies filtered out through donated blood units from volunteers who have high antibody levels. This blood product is sterilized and filtered through various techniques. The injection contains the antibodies in a saline solution with polysorbate 80." [3]

Well, if this were so convenient, why do we vaccinate for it? Why isn't this ever mentioned to new mothers who are negative for Hep. B? Instead of putting their babies at risk with toxic ingredients as a (faulty) preventative measure, why not mention a reactive measure she can take if the child is ever exposed (highly unlikely)? We know that it is an acceptable method of prevention for those who are at risk (45-75%), but not everyone is at risk. [15] It is also important to note that this is a blood product - some have religious objections and some are not willing to risk trans-virus contamination (such as Creutzfeldt-Jakob Disease) and/or being infected with Hep. B via the HBIG.

Here's where it gets real interesting. The first-line recommended practice for infants most at risk is to have the newborn receive both the Hep. B vaccine and the HBIG within 12-24 hours after birth. Although it is effective, it has not been tested for pediatric usage, and its possible overdose limits haven't been tested at all. So, we really have no idea what side-effects it can have, especially on infants who aren't at risk anyways. [16]

Okay, phew, now that that's out of the way. So what is polysorbate 80 and why is it in his immune globulin? It is supposedly an adjuvant, a surfactant, something that is supposed to help stabilize a compound. However, it is also considered the most likely candidate for a birth control/sterilization vaccination by several agencies worldwide and is already being used to sterilize horses and cattle. It is known to cause impaired and/or premature development of sexual organs and abnormalities. It is a 'hidden anaphylactoid' and has been linked to anaphylaxis, even resulting in death, in many cases. [17] I am doing a post on Polysorbate 80 very soon. The risks of the HBIG should also be weighed against the benefits closely.

How likely is it my child could catch that from somewhere, anyway?

Very unlikely. See Part One for how it is transmitted.

"Only about thirty infant, thirty children aged one to four, and seventy children five through fourteen are diagnosed every year... Virtually all of these cases are due to transmission from an undiagnosed hep B-positive mother during delivery." [3]

Also, if almost all of those cases are from mothers undiagnosed during delivery, isn't that the care provider's fault? Shouldn't we be strengthening up protocol instead of injecting every infant whimsically because you don't want to teach care providers any better and/or reprimand them?

Maintaining a healthy diet whilst pregnant can help reduce perinatal infection risk (as can avoiding cervical checks and internal interventions during labor and delivery). [13]

An infant's immune system is immature until around six years of age, and the blood-brain barrier isn't mature until adolescence. This leaves infants and young children vulnerable to immunotoxicity and autoimmune reactions.

Which would make vaccinating an infant for these diseases pretty useless for long term-protection. An infant is mostly incapable of developing TH1/TH2 cells (needed for immunity) until after six to nine months of age, and from then on slowly matures. So to inject a newborn to six/nine month old with up to 24 vaccines is pointless, since the premise of vaccination is to develop antibodies that will last long enough to protect the infant! Even afterwards, the infant still cannot produce enough immune reaction to make enough antibodies to be considered "immune."

"The infant immune system matures during the first year, and is more mature at age two, but the immune system does not reach full maturity until the child is around six years old." [7]

The "critical window of exposure" for chemicals to damage the fragile immune system is birth to one year. This includes benzopyrene which is a main component of cigarette smoke, and dioxin, a main ingredient in disposable diapers. Being vaccinated during pregnancy or vaccinating your infant exposes them to harmful chemicals as well, which can suppress the immune system rather than help it. I'm just giving an example here.

"Women can mount a stronger T-cell immune response and produce higher levels of antibodies, higher titres  These are estrogen-driven traits. However, there's a price to be paid for this difference in females. Women are considerably more prone to develop autoimmune disease. ...But at pharmacological levels this is immunotoxic. And at very low levels of exposure the same is true of dioxin. These latter two compounds produce a very prolonged postnatal immunosuppression. A recent concern, and a new concern of the NIH (which sent out a related RFA not long ago) is that exposure to these compounds may induce or exacerbate autoimmune disease in the human population." [14]

According to Mary Barbera, RN, MSN...

"The blood-brain barrier isn't intact until at least six weeks of life. This is why a newborn with a fever must be subjected to a spinal tap to rule out meningitis. Any virus or bacteria that a newborn is exposed to can go directly to the immune system.
This is why the Hepatitis B vaccine at birth is so dangerous. Between 1991 and 1999, when the shot contained thimerisol, giving it at birth would have resulted in mercury crossing into the brain since the blood-brain barrier was not yet intact.  As a nurse, I'm concerned that this information about the normal timing of a blood-brain barrier forming is not more readily known.
I think this normal delay in the forming of a blood-brain barrier is an important piece of the puzzle and one of the reasons for the surge of autism in the 90's."

The blood-brain barrier is semi-permeable, it however can be forced to "open" and "close." One way scientists do this is via the agent Polysorbate 80, (and other Polysorbates). Basically, certain things attach to polysorbate 80 which forces the BBB "open" to permissible and pass what is attached to P80 through. That means all of the toxins, foreign DNA, and viruses. It cannot get back through without being forced "open" again and even then there is little on the subject of actually ridding the body of it once it has crossed the BBB. It is considered incredibly improbable to impossible. This includes MSG and other chemicals in food too - so commercial infant formula, rice cereal, and other drugs commonly given to newborns unnecessarily. For example, Erythromycin is smeared onto newborn's eyes to "protect" from infections and "Vitamin" K is injected at the same time that the Hep. B vaccine is administered, making the newborn also at risk for passing the Erythromycin and synthetic "Vitamin" K through to the brain.

"Polysorbate 80 is a very effective surfactant used to trick and open the blood-brain barrier, and allow nano-drugs to be dragged through to the brain." -- Hilary Butler

It is not very well know exactly how these agents cause autoimmunity, but evidence is mounting that it does in fact cause autoimmunity. Some theories are that it attacks the brain, and when our antibodies are sent to protect the brain, it attacks the brain as well, unable to determine which is foreign and which is self due to the nature of P80 and the trace of foreign invaders on the brain. Another is that the foreign agents attach to the brain specifically, and antibodies are sent to "kill" them, however since it's now technically part of the brain that is an ongoing battle (forever). [18]

In addition, there are other ways to help prevent this illness (well, illness in general). Yippee! Ways to be healthy!

Avoid hand sanitizers and anti-microbial/anti-bacterial products. But, why, my dears? Yes indeed they are perpetuated to make thinks much "cleaner" and get rid of "germs." However, they are also helping superbugs form because they only kill 99.9% of "germs." So that 0.1% that does seem so insignificant, will now become antibiotic resistant meaning there will be NO WAY to treat it. Now THAT'S a deadly disease after several hundred lifecycles. Not just for that reason though; we don't know much about the microbiome (all of the microbes on each of our bodies is its own microbiome) that mostly helps protect us. Brand new research (just this month!) has come out on the microbiome basically explaining how little we know, but what we do know is that it plays a MAJOR role in preventing disease.

"But when the normal composition of the microbiome is thrown off balance, researchers say, the human host can get into serious trouble—especially because the 5 million to 8 million different microbial genes in our bodies vastly outnumber the 20,000 or so human genes. Indeed, recent research has implicated microbiome imbalances in disorders as diverse as cancer, obesity, inflammatory bowel disease, psoriasis, asthma, and possibly even autism (Science, 26 November 2010, p. 1168; 1 April 2011, p. 32)." [5]

So altering your microbiome can be harmful; which is what hand sanitzers, anti-microbial and antibacterial products do.

In infants, method of delivery/birth (vaginal vs. cesarean), breastfeeding vs. formula-feeding, and weaning age determine variance outcomes of the microbiome. So it is important to have a vaginal birth (if possible; including VBACs), and to breastfeed as long as inherently possible. It's not just that breastfeeding increases the health of microbiome, but that it actually gives passive immunity to the infant for many diseases and is also more nutritionally sound (nutrition is an important part of health).

"The microbiota of the infant is seeded at birth and is initially undifferentiated across the various body habitats. A variety of factors—including method of delivery (vaginal versus Cesarean section), breast feeding, and weaning—influence the infant microbiota (Fig. 1). For example, the microbiota of babies delivered vaginally are dominated by Lactobacillus, Prevotella, and Atopobium, whereas babies delivered by Cesarean section have a microbiota that more closely resembles that of the maternal skin community, with staphylococci being a dominant early member (4)." [6]

"Human milk has been found to contain 90 different oligosaccharides forming over 900 different chemical structures, each of which can block infection by preventing a particular strain of bacteria from sticking to the gut wall. ... Unlike antibodies, they are able to protect a baby from bacteria or viruses that a mother has never been exposed to. What is more, oligosaccharides are just one in a class of human milk components -- there are others called glycoproteins and glycolipids -- that work by blocking the attachment of microbes to the cells of the gut, so preventing infection." "For example, it was found that the thymus -- a central organ of the immune system -- is twice as big in breastfed infants compared with formula-fed infants at four months. The size difference was also seen at ten months." "Since breastfeeding is the biological norm, and since organs of the immune system like the thymus can only develop to their full potential through breastfeeding, an inevitable conclusion must be that people who were never breastfed (or those who were weaned too early) will have deficient immune systems -- not just in infancy but for the rest of their lives." [7]

"Childhood malnutrition is a global health problem that cannot be attributed to food insecurity alone. The gut microbiota may contribute to this devastating health disorder. ... This effort will require elucidation of the interrelationships between breast milk composition and the development of the microbiota and immune system in the context of the maternal-infant dyad." [8]

In children and adults, nutrition is so incredibly important. You don't want things to enter your body that can disrupt your symbiotic microbiome. Yet, we consume these things every day...genetically modified food, pesticide-laden fruits, veggies, and other products, meat treated in ammonia coming from sick and unhealthy cows, cow's milk laden with antibiotics, growth hormones, disease, and pus, overly processed food containing multitudes of chemicals (many banned in most other countries), and other things. Maintaining a truly healthy diet diverse in organic and natural foods will greatly boost the immune system and help prevent disease. [9] Also, supplementing your diet with probiotic-rich foods such as yogurt or over-the-counter probiotics has been said to improve gut functionality (micriobiome) and help the immune system.

Vitamin A deficiency and excessive intake are shown to hinder immune system functions, and it is well-established that it is an essential vitamin to overcoming illness and developing immunity. Long-chain polyunsaturated fatty acids (PUFA) are also essential nutrition that should be consumed in healthy amounts as they function to help innate and acquired immunity. These include n-3 PUFA (α-linolenic) and n-6 PUFA (linoleic acid). You may have seen "DHA" and/or "ARA" or "EPA" marketed in supplements, baby formula, etc. and they are synthesized from a type of fermented algae and soil fungus, of which neither are native to the human diet and processed with a neurotoxic petrochemical called hexane (hexane is a byproduct of gasoline refinement and is highly processed. Even organic formulas have been guilty of adding this "substitute" into their formulas, which has repeatedly been shown in meta-analyses to have no effect on infant brain and eye development. Almost four years ago, it was finally announced that a plan to remove this additive from infant formulas and foods was going to be developed (still no updates on that) and both the National Organic Program and FDA have admitted that this is something that violates the USDA organic standards and is not allowed to be in an organically-labelled product as it is considered genetically modified. In addition, recent studies mothers in the Amazon have a healthier n-3:n-6 ratio than mothers in the United States due to diet (which consists of no processed foods, freshwater fish, locally grown staples, and game.) As it is critical in brain development and other aspects of health, it is essential to try and maintain healthy levels from natural sources. Vitamins B6, B12, C, D, and E, as well as Iron, Zinc, and a host of other nutrients, are entirely crucial to the immune system. [10][11]

"Vitamin A is essential for cells of the immune system. The considerable immune benefits (to cells of the innate and acquired immune system), which would contribute to reduce the risk of various pathogen-mediated diseases, warrants a recommendation to supplement individuals with minimal or poor vitamin A status." [10]

"Feeding EPA and DHA has been shown to modulate specific functions of innate and acquired immunity." [10]

"Clearly the essentiality of vitamin C to cells of the immune system has been established. Although not all clinical data agree with an effect of vitamin C on viral infections, there is convincing evidence from feeding studies in humans and animals and experiments done on primary cultures that vitamin C has a positive effect on host defense." [10] Note: Vitamin C can be taken in very high doses without any negative effects.

"Vitamin E and Se are essential to immune function and are supplemented routinely in the diets of domestic animals for their immune benefits [94]. These nutrients have long been known to have anticarcinogenic effects by means of their antioxidant properties." [10] Note: Vitamin E And Selenium (Se) word synergystically (work together but separately), so it is a good idea that if you supplement with Vitamin E to find a supplement with Selenium, too.

Keeping a healthy weight and body-mass index (BMI) also helps immune response. In obese health care workers, their antibody response to Hep. B vaccination was significantly lower than those with lower BMIs. Why obese people have lowered immune response is not well studied, but studies are clear that there is a significant number more hospitalizations for viral and bacterial infections in obese individuals. [12]

Resources

[1] Clements, John, et al. (2009, October 23). Global control of hepatitis B virus: does treatment-induced antigenic change affect immunization? World Health Organization Int. Bulletin of the World Health Organization 2010;88:66-73. doi: 10.2471/BLT.08.065722. http://www.who.int/bulletin/volumes/88/1/08-065722/en/index.html

[2] CDC. (2012, January 1). Hepatitis B Information for Health Professionals. Centers for Disease Control and Prevention.  http://www.cdc.gov/hepatitis/HBV/HBVfaq.htm#overview

[3] Sears, MD, FAAP, R. W. (2007). The Vaccine Book. New York, New York: Little, Brown & Company.

[4] Cave, MD, FAAFP, Stephanie. (2001, September). What Your Doctor May NOT Tell You About Your Children's Vaccinations. New York, New York: Warner Books, Inc.

[5] Balter, Michael. (2012, June 6). Taking Stock of the Microbiome and Disease. Science. doi: 10.1126/science.336.6086.1246. http://www.sciencemag.org/content/336/6086/1246.full

[6] Nicholson, J. K., et al. (2012, June 6). Host-Gut Microbiota Metabolic Reactions. Science. doi: 10.1126/science.1223813. http://www.sciencemag.org/content/336/6086/1262.full

[7] Ochert, Ayala. (2009). The Science of Mother's Milk. New Beginnings; Vol. 29, No. 3, pp. 28-29. http://www.llli.org/nb/nbiss3-09p28.html

[8] Gordon, J. I., et al. (2012, June 6). Malnutrion; The Human Gut Microbiota and Undernutrition. Sci. Transl. Med. doi: 10.1126/scitranslmed.3004347 http://stm.sciencemag.org/content/4/137/137ps12.abstract

[9] Hooper, L. V. (2012, June 6). Interactions Between the Microbiota and the Immune System. Science. doi: 10.1126/science.1223490 http://www.sciencemag.org/content/336/6086/1268.full

[10] Field, C. J., et al. (2002, January). Nutrients and their role in host resistance to infection. Journal of Luekocyte Biology Vol. 71, No. 1, pp. 16-32. http://www.jleukbio.org/content/71/1/16.full

[11] Keusch, G. T. (2003, January 1). The History of Nutrition: Malnutrition, Infection, and Immunity. Journal of Nutrition, Vol. 133, No. 1, 336S-340S. http://jn.nutrition.org/content/133/1/336S.full

[12] Karlsson, E. A., et al. (2010, December). The burden of obesity on infectious disease. Experimental Biology and Medicine, Vol. 235, No. 12,  pp. 1412-1424. doi: 10.1258/ebm.2010.010227 http://ebm.rsmjournals.com/content/235/12/1412.full

[13] Goldenberg, R. L. (2003, May 1). The Plausibility of Micronutrient Deficiency in Relationship to Perinatal Infection. Journal of Nutrition, Vol. 133, No. 5, 1645SS-1648SS. http://jn.nutrition.org/content/133/5/1645S.full

[14] Development and Maturation of the Immune System: Vulnerability to Toxins. http://oehha.ca.gov/public_info/public/kids/pdf/Holladayed.pdf

[15] Palmer Beasley, R., et al. (1981, August). Hepatitis B Immune Globulin (HBIG) Efficacy in the Interruption of Perinatal Transmission of Hepatitis B Carrier State. The Lancet, Vol. 318, Issue 8243, pp 388-393. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(81)90832-1/abstract

[16] Talecris HyperHepB S/D Manufacturer's Insert. http://www.talecris-pi.info/inserts/hyperhepb.pdf

[17] Karpasea-Jones, Joanna. Polysorbate 80 Causes Infertility. http://suite101.com/article/polysorbate-80-causes-infertility-a60320

[18] Singh, Vijendra K. Evidence suggests a pathogenic role of brain autoimmunity in central nervous system diseases. http://www.aarda.org/infocus_article.php?ID=55