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Hepatitis B vaccine – new recommendations for vaccinating infants

The American Academy of Pediatrics (AAP) is now recommending that infants receive their first dose of the hepatitis B vaccine within 24 hours of birth. This recommendation is in line with the guidance of the CDC.

Hepatitis B is a serious disease that is easily preventible with the vaccine. Yet, the hepatitis B vaccine is one of the most vilified of the vaccines by the anti-vaccine crowd.

This article will take a look at hepatitis B, the vaccine, and some of the nonsensical claims of the anti-vaccine world.

About hepatitis B

Hepatitis B is a viral infection that is transmitted through activities that involve percutaneous (puncture through the skin) or mucosal contact with blood or body fluid that infected with the virus. Generally, the virus is transmitted in the following ways:

  • Sex with an infected partner
  • Injection drug use that involves sharing needles, syringes, or drug-preparation equipment
  • Birth to an infected mother
  • Contact with blood or open sores of an infected person
  • Needle sticks or sharp instrument exposures
  • Sharing items such as razors or toothbrushes with an infected person

HBV is not spread through casual contact. Sharing food, water, or eating utensils, breastfeeding, hugging, kissing, coughing or sneezing will not transmit the virus.

An estimated 850,000–2.2 million persons in the United States have chronic hepatitis B virus infection. Worldwide, it is estimated that over 240 million are infected with the virus.

There are two versions of a hepatitis B infection – acute, which can be asymptomatic or mild, or chronic. According to the CDC, approximately 25% of children along with about 15% of adults who become chronically infected die prematurely from cirrhosis or liver cancer. In the USA, hepatitis B infection kills about 1,800 people a year.

The reason the hepatitis B vaccine is so important for infants is that approximately 90% of infants along with 25-50% of children aged 1-5 years who contract hepatitis B will remain chronically infected. On the other hand, approximately 95% of adults recover completely from a hepatitis B infection, and never become chronically infected.

hepatitis b vaccine
CDC, 2017

The hepatitis B vaccine has been immensely successful in reducing the number of cases of hepatitis B in the USA. The rate of new hepatitis B infections has declined by approximately 82% since 1991, when routine vaccination of children was first recommended.

No, this decrease did not result from a miracle cure, new sanitation technology, or better nutrition – without a doubt, it’s a result of vaccines.

AAP recommendations

In 2005, the CDC’s Advisory Committee on Immunization Practices (ACIP) issues hepatitis B vaccine recommendations that contained permissive language that allowed practitioners the option to delay the first dose until the child’s first well baby visit. Unfortunately, the CDC found that only 72% of infants had received the birth dose of the vaccine,

In October 2016, the ACIP rescinded the permissive language and stated that (page 20, pdf), “For all medically stable infants weighing greater than or equal to 2000 grams at birth and born to hepatitis B-negative mothers, the first dose of vaccine should be administered within 24 hours of birth. Only single-antigen hepatitis B vaccine should be used for the birth dose.”

As a result of the ACIP recommendations for the vaccine, the American Academy of Pediatrics has decided to rescind the same permissive language to sync with the CDC’s vaccine schedule.

The safety of hepatitis B vaccines has been examined extensively. As a result, there is no evidence of a causal association between “hepatitis B vaccine and neonatal sepsis or death, rheumatoid arthritis, Bell’s palsy, autoimmune thyroid disease, hemolytic anemia in children, anaphylaxis, optic neuritis, Guillain-Barré syndrome, sudden-onset sensorineural hearing loss, or other chronic illnesses.” Essentially, we can call the vaccine objectively safe for use in children

Here comes the vaccine deniers

Despite the fact that the hepatitis B vaccine prevents the chronic version of the disease in infants. Despite the fact that chronic hepatitis B is deadly to children. Despite the fact that the hepatitis B vaccine has reduced infections by 82% since first recommending the vaccine. Despite all of that, the anti-vaccine forces loathe this vaccine.

These people make all kinds of unsupported claims about the “dangers” of the hepatitis B vaccine. Of course, all medical procedures have risks, some serious. However, vaccines are among the safest medical procedures. And as far as I can tell, the hepatitis B vaccine is one of the safest of vaccines – this is supported by real scientific evidence.

Furthermore, the anti-vaccine world tries to convince everyone that risk of hepatitis B is overstated. Essentially, in the eyes of the anti-vaxxers, the only infants that are at risk for the infection are the children of drug addicted prostitutes. Unfortunately, that seriously trivializes the risks of hepatitis B.

Even if the mother is hepatitis B-free, there are other unpreventable risks that could happen. A friend or family member could have asymptomatic, and spread the virus through a cut or something else. The child could engage in sexual or other risky activities as a teen. And I could imagine dozens of other scenarios where the infant or child could be at risk of contracting the disease.

Similar to the case made about the HPV vaccine, the anti-vaccine crowd says that their child will never engage in activities that would put them at risk. They never will be in a situation that would put them at risk. But that’s just an incredibly naive way to look at the world. We vaccinate not because we think our children will do things that put them at risk. We give our children the hepatitis B vaccine because we cannot predict when or if a situation arises that does put our children at risk.


Michael Simpson
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