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.