Anyone who follows or trolls my blog knows one thing – I am a passionate supporter of the HPV anti-cancer vaccine, known as Gardasil. But I didn’t want to ignore the hepatitis B vaccine, which is the “other” anti-cancer vaccine.
Recently, the CDC recommended a new hepatitis B vaccine for adults, and that prompted me to do something I haven’t really done – talk about hepatitis B, liver cancer, and the hepatitis B vaccine. In some respects, hepatitis B is just as an important issue as HPV with respect to preventing cancer.
Remember, despite what you read on pseudoscience website or from anecdotes on the internet, there are really only a few ways to prevent cancer. Don’t smoke. Don’t drink alcohol. Stay out of the sun. Keep a very healthy (read low) weight. And get your HPV and hepatitis B vaccines.
Yes, getting these vaccines will be more useful to avoiding cancer than drinking delicious banana–almond milk-blueberry smoothies. I know, that smoothie probably is more appetizing than getting poked by a sharp needle. It is possible that the smoothie could be part of a healthy diet which could contribute to maintaining a healthy weight. But it won’t directly prevent cancer like the two vaccines.
As I’ve mentioned many times, I think that Gardasil is one of the most hated vaccines that the CDC recommends. But to be honest, if you watch the anti-vaccine religion, you would know that the hepatitis B vaccine is way up there on the list of hatred.
So, let’s take a look at hepatitis B, liver cancer, and the vaccine.
Hepatitis B
Hepatitis B is a disease caused by the hepatitis b virus (HBV). Hepatitis B shouldn’t be confused with other types of hepatitis infections, hepatitis A and hepatitis C, caused by the hepatitis A and hepatitis C viruses respectively. In addition, there is a hepatitis D virus that only can infect someone if they already have HBV. There is also a hepatitis E that is closely related to the rubella virus.
Although all of these diseases share a similar name, the underlying viruses are not closely related (unlike influenza A, B, and C). The only similarity between the viruses is that they afflict the liver. For the purposes of this article, we are going to focus on HBV.
HBV is a bloodborne virus, so it easily transmitted through exposure to infected blood or body fluids containing blood. Not to be all scary about HBV, but according to the CDC, HBV is 50-100 times more infectious than HIV, which causes AIDS. The virus can be transmitted through sexual activity, sharing of intravenous needles, childbirth, and even through contact with open sores on infected individuals.
Hepatitis B has two forms – acute and chronic. The acute form of the disease has a short course, with the infection clearing itself – most people might not know that they had an acute hepatitis B infection. In children, the infection usually has no symptoms whatsoever, but in adults and children over the age of five, there can be several symptoms, including the following:
- Fever
- Fatigue
- Loss of appetite
- Nausea
- Vomiting
- Abdominal pain
- Dark urine
- Clay-colored bowel movements
- Joint pain
- Jaundice (yellow color in the skin or the eyes)
Obviously, some of these symptoms can be confused with other diseases, even the flu, but aren’t generally serious. Generally, the symptoms show up about 90 days after exposure to HBV, but the range is six weeks to six months. Unfortunately, the symptoms can last for a few weeks up to six months.
During this time, despite having what could be minor symptoms, the infected individual can still spread the virus to others.
The chronic form of hepatitis B is much more serious. About 95% of HBV infections in older children and adults are the self-limiting, acute form and clear the infection spontaneously.
Unfortunately, only 30% of younger children and 5% of newborns that become infected from their mother will clear the infection. These young children have a 40% lifetime risk of death from cirrhosis or liver cancer.
Overall, about 15-25% of people with chronic hepatitis B develop cirrhosis or liver cancer. And as the liver becomes diseases, many individuals still don’t show symptoms of the infections, although blood tests for liver function can be used to diagnose these diseases.
According to the CDC, there were officially 19,200 new HBV infections in the USA in 2014. However, that number is probably much lower than the actual number of infections. Most people don’t know that they are infected, may overlook their symptoms (if they have any), and may not seek medical attention for something that may appear to be innocuous.
The low apparent infection rate is betrayed by the estimated 850 thousand to 2.2 million people who have chronic hepatitis B in the USA. And there are another 240 million people infected by HBV worldwide. Hepatitis B contributes to 786,000 deaths worldwide every year. It is a serious and dangerous disease that is often overlooked.
As I wrote previously, the incidence and mortality from most cancers have dropped significantly over the past two decades. When people say that cancer is winning the war, it is demonstrably incorrect. However, the one cancer that seems to be on the increase is liver cancer (specifically, the most common form, hepatocellular cancer), mostly as a result of chronic hepatitis B and C infections.
Like HPV, hepatitis B virus infections are the leading cause of a dangerous and deadly cancer. Approximately 50% of hepatocellular cancers are related to an HBV infection. With around 41,000 newly diagnosed cases of liver cancer every year in the USA, nearly 20,500 result from hepatitis B. If only there were a way to eliminate the risk of being one of 20,500 who contracts this dangerous cancer.
The hepatitis B vaccine
Remember, most people, especially those with chronic hepatitis B, have no symptoms. So you might be exposed to the virus even if you do not engage in risky behaviors like multiple sexual partners or sharing IV needles or work in healthcare where infected blood can be encountered anywhere.
Other than living in a bubble and never having contact with anyone who has an HBV infection, knowing that you cannot easily determine if someone is infected or not, the only highly effective method to prevent an HBV infection is with the hepatitis B vaccine. The vaccine creates an immune response against the hepatitis B surface antigen (HBsAg), an antigen on the coat of the virus,
For newborns, the CDC makes the following recommendations for the hepatitis B vaccine:
- universal hepatitis B vaccine should be given within 24 hours of birth for medically stable infants weighing ≥2,000 grams.
- single-dose revaccination for infants born to HBsAg-positive women not responding to the initial vaccine series.
These recommendations for newborns then should be followed by completion of the vaccine series (2 subsequent doses at 1-2 months and at 6-18). These two doses can be used up to 18 years old to “catch up” on the hepatitis B vaccine schedule.
The CDC has recently recommended a new hepatitis B vaccine for adults, called HEPLISAV-B (hey, I don’t name these vaccines) which is a two-dose vaccine given to adults (See Note 1). There are 3-dose hepatitis vaccines that were previously recommended for adults.
Although anyone can request a hepatitis B vaccination as an adult, even if they were vaccinated as children, the CDC strongly recommends it for individuals in the following risk groups, regardless of childhood vaccination status:
- Chronic liver disease not related to hepatitis B itself, such as hepatitis C, cirrhosis, and other liver diseases.
- HIV infection
- Sexual exposure risk including sex partners of hepatitis B-positive persons; sexually active persons not in a mutually monogamous relationship; persons seeking evaluation or treatment for a sexually transmitted infection; and men who have sex with men.
- Receive care in settings where a high proportion of adults have risks for hepatitis B infection.
- Travel to countries with high or intermediate endemic hepatitis B
I’m not sure why it wasn’t included, but I would add that if your workplace includes unknown risks for hepatitis B exposure, like healthcare or first responders, I’d make sure to have the adult hepatitis B vaccine.
The anti-hepatitis B vaccine nonsense
We can’t have a useful vaccine without attacks from the anti-vaccine rabble. Many of their arguments center around giving the hepatitis B vaccine to all newborns:
- The mother isn’t a prostitute, so why does the baby need the vaccine?
- The mother isn’t an IV drug user, so why does the baby need this vaccine?
- Most hepatitis B infections resolve themselves, so why does anyone need this vaccine?
- You only need the vaccine if you’ve been exposed, so you can protect yourself by using brand new sterile needles, never have sex with anyone without having their blood tested, and live in a sterile bubble.
- There’s the old myth that “newborns haven’t developed an adaptive immune system and the immune system won’t remember so why vaccinate in infancy?” (Thanks to loyal reader and commenter harriethuestis for the heads up.) This belief is utter nonsense since we have scientific data, published in the highly rated peer-reviewed journal, Science Translational Medicine, that even the fetus has an adaptive immune system. It’s ridiculous to believe that a baby is born into the world without this part of the immune system. Of course, a baby’s immune system isn’t as fully developed as an adult, but it can form adaptive immunity to the hepatitis B vaccine.
- The hepatitis B vaccine causes autism (no it does not). In fact, as far as I can tell, the myth that the hepatitis B vaccine comes from bad articles published in predatory journals written by the convicted fraud, Mark Geier.
This is why we can’t have nice things. And these are the same ridiculous arguments that we hear about the other cancer-preventing vaccine, Gardasil. It’s tiresome.
Despite the anti-vaccine rubbish, the uptake of the hepatitis B vaccine is very high worldwide, ranging from 80-90% in Europe, 94% in Australia, and 93% in the USA. The public health efforts seem to be working, as hepatitis B vaccine uptake rates have been increasing over the past decade.
Adult uptake of the vaccine is unknown, but in those people who might be susceptible to hepatitis B infection, uptake seems to be quite low. Maybe a renewed effort by the CDC with respect to adult hepatitis B vaccination will help.
Summary
The hepatitis B vaccine is incredibly important for preventing chronic hepatitis B infections which can read to serious health issues like liver cancer and cirrhosis. Because most people are asymptomatic for hepatitis B, it’s difficult to know when you might be exposed. We get vaccines precisely because we don’t know if we (or our children) are going to be exposed to a pathogen. And if that pathogen could lead to a deadly cancer? Well, then it makes even more sense.
The hepatitis B vaccine is incredibly safe and incredibly effective according to the best science available to us. It is important for babies, children, and adults. I’m not a hypocrite – I received the three doses of the hepatitis B vaccine because I don’t like cancer. You might think, “oh I’m not in a high-risk group,” that’s wishful thinking. Especially when it comes to protecting yourself against cancer.
Notes
- This new recommendation was just made at a meeting this week of the CDC’s Advisory Committee on Immunization Practices (ACIP). The recommendation will be reviewed by the CDC and published in a few weeks – at that time, I will try to remember to update links to that official recommendation. Currently, all we have are news reports based on a Dynavax, a member of Small Pharma who hasn’t made a penny as of yet, press release. And no, there is no evidence they gave shares of stock, cash, or free dinners to ACIP to get this approved. The ACIP decision was all about science to protect adults from cancer.
Citations
- Dienstag JL. Hepatitis B virus infection. N Engl J Med. 2008 Oct 2;359(14):1486-500. doi: 10.1056/NEJMra0801644. Review. Erratum in: N Engl J Med. 2010 Jul 15;363(3):298. PubMed PMID: 18832247.
- Kumar, Vinay, Abul K. Abbas, and Jon C. Aster. Robbins and Cotran pathologic basis of disease. Philadelphia: Elsevier Saunders, 2015. ISBN 978-1455726134. pp 870-3.
- Rechavi E, Lev A, Lee YN, Simon AJ, Yinon Y, Lipitz S, Amariglio N, Weisz B, Notarangelo LD, Somech R. Timely and spatially regulated maturation of B and T cell repertoire during human fetal development. Sci Transl Med. 2015 Feb 25;7(276):276ra25. doi: 10.1126/scitranslmed.aaa0072. PubMed PMID: 25717098.
- Shepard CW, Finelli L, Fiore AE, Bell BP. Epidemiology of hepatitis B and hepatitis B virus infection in United States children.Pediatr Infect Dis J. 2005 Sep;24(9):755-60. Review. PubMed PMID: 16148839.
- Swedish Council on Health Technology Assessment. Vaccines to Children: Protective Effect and Adverse Events: A Systematic Review [Internet]. Stockholm: Swedish Council on Health Technology Assessment (SBU); 2009 Feb. Available From http://www.ncbi.nlm.nih.gov/books/NBK447995/ PubMed PMID: 28876765.
- Yue X, Black CL, O’Halloran A, Lu PJ, Williams WW, Nelson NP. Hepatitis A and hepatitis B vaccination coverage among adults with chronic liver disease. Vaccine. 2018 Feb 21;36(9):1183-1189. doi: 10.1016/j.vaccine.2018.01.033. PubMed PMID: 29395521; PubMed Central PMCID: PMC5805590.
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