Monday, August 13, 2012

To Hep B or Not to Hep B...

The Hepatitis B vaccine, particularly the infant birth dose has been somewhat controversial as of late.  The reasons for this are based upon fallacious claims by so-called experts and dodgy studies.  But parents need to base their decisions on facts, not junk science and not proclamations from self-proclaimed experts who have never even conducted research.  Let's examine the facts about hepatitis B disease and vaccine:

Mythical Claim: Hepatitis B is a sexually or IV drug transmitted disease.

Fact: Hepatitis B is not just a sexually or IV drug transmitted disease.  It is the primary mode of transmission in industrialised countries, like the U.S. but in others, vertical transmission i.e. from mother to newborn during birth is the most prevalent mode of transmission and worldwide, accounts for 40-50% of hepatitis b infections.  Hepatitis B virus is spread via infected blood or bodily fluids through breaks in the skin and mucosa.  Additionally, hepatitis b virus can remain infectious on inanimate objects such as razors and surfaces for a week.

Prior to 1991 in the U.S. it has been estimated that 16,000 children under the age of ten years old were infected each year through contact with HBsAg-positive family/household members and outside contacts.  Also during that time, 30-40% of adults infected had no risk factors which implies more casual contact with infected people and/or fomites with hepatitis b virus contamination.

Mythical Claim: Most people who get hepatitis B virus clear it.

Fact: Most adults who become infected with hepatitis b are able to clear the virus, however it is estimated that 17.5% of those who acquire hepatitis b remain infected and become lifelong carriers.  About 25% of carriers who experience acute clinical illness die of cirrhosis or primary liver cancer.  The younger the age at infection, the greater the risk of becoming a chronic, lifelong carrier is.  Seventy to ninety percent of infants born to HBeAg positive mothers and don't receive immunoprophlaxis (hepatitis b vaccination and immunoglobulin) will become chronically-infected by the age of six months old.

Mythical Claim: I don't need to get tested for hepatitis b when I'm pregnant.

Fact: The recommendation is for all pregnant woman to get tested for hepatitis b surface antigen (HbsAg). It is crucial that you know what your test results are and what they mean.  The tests used are not 100% accurate but do have excellent specificity and sensitivity.  Anyone in the household or other close contacts should also be tested.  If using a midwife, please be sure that hepatitis b testing is done.

Mythical Claim: Other countries don't give a birth dose of hepatitis b vaccine.  The U.S. shouldn't be giving newborns a vaccination.

Fact: Other countries do administer a birth dose of hepatitis b vaccine:  Bulgaria, Croatia, Estonia, Germany and Latvia (if mother is HbsAg positive or unknown status), Poland, Portugal, Romania, Spain and Turkey.  This is just the EU.  Some factors to consider when trying to compare the U.S. to other countries that don't vaccinate for hepatitis b is healthcare systems, epidemiology of the disease and immigration.  The U.S.doesn't have universal healthcare as do many EU countries which means that many hepatitis b infected pregnant women and their contacts fall through the cracks and don't know their hepatitis b status.  The U.S. has a high rate of immigration and visitors from countries with high endemicity of hepatitis b.  Although the UK is experiencing an increasing rate of hepatitis b-infected pregnant women who have emigrated from other countries.  During the period of 1990 to 2004, the incidence of hepatitis b infection declined in children 19 years and younger by 94% when the hepatitis b series starting from birth was implemented.  This didn't happen by magic.

Hepatitis b infection in newborns carries an extremely high risk of chronic infection and complications of fulminant liver disease.  There is no guarantee that teenagers who become sexually-active and become infected will clear the virus and not also become chronic carriers, not even your beliefs in a "superior" lifestyle.  Please base your decisions on facts and not fictitious claims meant to incite fear, uncertainty and doubt.


  1. When would you suggest starting the Hep B series for those infants/children with no risk factors? And when for those with minimal to moderate risk factors?

    1. Hi MR, "no risk factors" is a pretty tall order and doesn't exist but I think I know what you mean. Very low risk, i.e. no daycare, no travel (by household contacts either) to high hep b endemic areas, no hep b antigen positive contacts, etc. then vaccinate by school age. Those with higher risks, i.e. any of the criteria above should continue with the infant series. Sadly, daycare providers are not required to stay current on their vaccinations. Given the risk of complications for infants and you can't control every factor, like where you live and emergent situations and that the vaccine is often bundled with others in combo jabs, it is just easier and one less thing to worry about.

    2. What? They make restaurant workers get all those Hep vaccines and not daycare workers? WTH?

    3. STP, I think you are thinking of hepatitis A vaccine and even that's not required. But yes, daycare workers are not required to be up to date on their own vaccinations. I take extreme issue with that.

  2. I think you need to reread Science Mom's post Middle Roader.

    Here are the recommendations from the ACIP (Advisory Committee on Immunization Practices) to immunize all infants with hepatitis B vaccine, before they are discharged from the hospital to home.

    The reason for this recommendation is to prevent horizontal transmission of the virus to infants and young children, whose mothers are not carriers of the virus.

    Infants born of mothers who are chronic carriers of the virus are at extreme risk to contract the disease and extreme risk to remain as lifelong chronic carriers of the virus.

    The protocol that is put in place for infants whose mothers are chronic carriers is to provide the first dose of the vaccine and a dose of HBIG (Hepatitis B Immune Globulin) within 12 hours of prevent vertical (mother to child) transmission of the virus.

  3. Baby dies after injection of Hepatitis B vaccine
    A 44-day-old baby, named Nguyen Ngoc Minh, died around 2 p.m. on Friday, six hours after having been injected with Hepatitis B vaccine at Ngoc Thuy Ward medical station in Hanoi’s Long Bien District.

    According to Dr. Nguyen Thi Thuy, director of Long Bien District Preventive Health Center, the baby’s family agreed to let the Forensic Department conduct an autopsy on the infant to determine the cause of death.

    The center also demanded the Bac Giang General Hospital to temporarily cease using the Euvax B vaccine, as well as requesting health officers monitor the health of the 193 babies who were also injected with the vaccine, produced by South Korean-based LG Co.

    Source:, news report, 6th January 2008.

    Note, the ingredients of this children's vaccine are:

    Aluminum hydroxide, Thimerosal , Yeast, Sodium chloride, Sodium phosphate-monobasic, Virus: Hepatitis B, Potassium phosphate.

    Although thimerosal in children's vaccines was phased out in America in 2001, I have found Aventis Pasteur data sheets dated 2003 which list thimerosal in countries other than America.

    Thimerosal is also used in the manufacturing process of most vaccinations and according to the manufacturer's, may still contain trace elements of the mercury derivative, even if it is labelled as mercury free.

    1. Since this happened over four years ago there should be an autopsy report. What did it say?

      According to this recent article Viet Nam continues to give children a hepatitis b vaccine, so we can assume that there was some other reason found in the autopsy.

    2. Many babies have died and no many countries in europe only vaccinate if the mum is infected, the vaccine is not safe, and the childs immunity is fragile while many babies may do well on the shot many haven't so people need to research the risks. Another thing we rarely see the thousands of adverse affects and deaths reported due to vaccines unless a protocol is in due process to being changed. More babies have died from the measles vaccine in the last 10 years than the measles in the US. I'm pro vaccine but I'm not an idiot, with a science background I chose to select and refuse some. The risks out weighed the vaccine. This blog is quite biased I am yet to find a blog that acknowledges both sides.

    3. There is no citation - anon is merely parroting anti-vax talking points.

      There is also no "two-sides." There is the side supported by sound science & the other side which merely uses emotional fear-mongering.