By Mehrsa Hashemi
There are many reasons why parents are reluctant to vaccinate their children, but hepatitis B has a particular problem. Many parents associate hepatitis B with high-risk behaviors like drug use or promiscuity. Because of the stigma surrounding this disease, many parents, even those who vaccinate against other diseases, wonder why their baby needs this vaccine. Despite this stigma, public health agencies around the world agree: babies need the hepatitis B vaccine, and here’s why.
What is hepatitis B?
Hepatitis B is a serious and often deadly liver infection caused by the hep B virus (HBV), a virus that causes 30 million new infections worldwide annually. Chronic infection with HBV can lead to serious conditions like liver cancer, liver failure, and cirrhosis of the liver. According to the CDC, most young children and 50-70% of older children and adults show no symptoms of the virus. But even though they’re asymptomatic, they can still spread the virus to others.
HBV is transmitted from person to person through bodily fluids like blood and semen, typically through unprotected sex and sharing needles that have been in contact with infected blood. But hep B is not solely transmitted through intercourse or drug use. It can also be transmitted by sharing personal items like razors or even toothbrushes. The virus can live on objects for 7 days or more.
According to the Centers for Disease Control and Prevention (CDC), hepatitis B is spread through contact with blood of an infected person (even if they show no symptoms), and that contact can come in many different forms, including:
- At birth
- Through open cuts or sores
- From sharing toothbrushes or other personal items
- By chewing food for a baby
Any infected family member or caregiver can pass the virus to your baby.
Does Hepatitis B Affect Babies?
There are approximately 21,000 infants born each year to HBV-infected mothers in the United States. Without vaccination, the results can be devastating. About 90% of those infants will become infected themselves, and 90% of infected infants will develop chronic infections. Approximately 25% of infected infants will die prematurely of liver-related complications, including hepatocellular carcinoma, the most common form of liver cancer, or cirrhosis of the liver.
Infants and young children typically show no symptoms, but 3-4 months after infection, they may show symptoms that include loss of appetite, fever, fatigue, joint and muscle pain, dark urine, nausea, diarrhea and vomiting. Because most infected kids are asymptomatic, the virus is able to spread to caregivers or others with whom they have close contact (article continues after infographic).
Is the hepatitis B vaccine safe?
The CDC continuously monitors the safety of all vaccines, including the hep B vaccine, and updates the vaccine schedule accordingly. There is no evidence of long- or short-term adverse events associated with the hep B vaccine For example, one study compared 3,302 full term newborns who were vaccinated within 21 days of birth with 2,353 full term newborns who were not vaccinated and found no evidence that newborn hep-B vaccination is linked with any increase in fevers, sepsis, allergy or brain problems. Another study of more than 350,000 live births between 1993 and 1998 showed no association between hep B birth immunization and neonatal death.
The hep B vaccine is a recombinant protein vaccine and does not contain any live viruses, which means it can’t cause hepatitis B. However, on very rare occasions, the vaccine may cause allergic reactions. In fact, the CDC recommends against vaccinating individuals with a yeast allergy because the recombinant proteins used in the vaccine are produced in yeast cells. The most common side effect of the hep B vaccine is a sore arm at the site of injection that lasts for one to two days.
Is the hepatitis B vaccine effective?
The hep B vaccine is highly effective when the entire series of vaccines is given. The series consists of three doses, one given shortly after birth, another at one month and then the third round at six months of age. After three completed doses, more than 90% of adults and over 95% of infants, children and adolescents develop the antibody response required to produce immunity. The vaccine is 80-100% effective in preventing infection and hepatitis-B related diseases in those who receive the full three dose series. Immune memory lasts for 30 years and protection against the infection continues even after antibody levels decrease.
Why give my baby the hep-B vaccine?
Since many parents associate hep B with sexual intercourse or drug use, they don’t think that babies need to be vaccinated against hep-B. However, 30-40% of infected individuals have no identified risk factors. As discussed earlier, the virus can be transmitted in many ways unrelated to these stigmatized behaviors and can live on objects like these for seven days or even longer. In addition, many infected individuals are asymptomatic, inactive carriers so that mothers who have HBV may not even realize they’re infected and pass the virus on to their babies during childbirth or shortly thereafter.
When the hep B vaccine was introduced in 1981 in the United States, there was a 90% reduction in new infections. While this is good news, this falls short of public health goals. Early on, public health agencies focused all of their hep B vaccination efforts on identifying at-risk, primarily adult populations. This strategy of vaccinating based on risk factors turned out to be less effective than necessary because 30-40% of infected individuals have no identified risk factors.
Healthcare professionals also struggled to identify inactive carriers. Inactive carriers show no signs of the illness or infection but can still spread the disease and are amongst the largest group of chronic, HBV-infected patients.
For these reasons, in the early 1990s, public health experts recommended a change in vaccination strategy focusing vaccination efforts on newborns, regardless of risk factors. However, in 2016, only around 70% of newborns received the first vaccine dose, which is below the Department of Health and Human Services’ Healthy People 2020 target of an 85% vaccination rate within 3 days of birth. As of 2017, The American Academy of Pediatrics Committee on Infectious Diseases and the Committee on Fetus and Newborn and ACIP recommend “giving the birth dose within the first 24 hours of life in all medically stable infants weighing greater than or equal to 2000 g.”
Many parents wonder why we can’t screen mothers for hepatitis B and only vaccinate babies born to positive mothers. Unfortunately, since the rate of asymptomatic, inactive carriers is so high, infected people can pass the virus onto children unknowingly. In two-thirds of the cases of childhood transmission of hep B, the mother was negative but the unvaccinated infant was exposed from a family member or caregiver.
When considering whether to give your baby the hep B vaccine, remember that the risks for getting the vaccine are low, while the risks of hep B infection are high. Numerous safety studies show no increase in illnesses like fevers and only mild side effects. Infected babies are highly vulnerable to serious liver diseases and premature death. You can protect your baby from those risks when you vaccinate, and help provide immunity to the entire community and that’s something that benefits us all.
CDC: Hepatitis B Information HHS: Hepatitis B Basics WHO: Hepatitis B American Academy of Pediatrics: AAP Recommends Infants Receive First Hep B Vaccine Dose Within 24 Hours After Being Born Addressing Common Concerns of Vaccine-Hesitant Parents
About the author: Mehrsa Hashemi resides in Canada and has an undergraduate degree in Biochemistry. She worked mainly as a clinical researcher in Oncology before deciding to pursue a graduate degree in Public Health and follow her passion of becoming a health writer. Mehrsa is passionate about science and medicine. She loves to help disseminate information through her writing to the public in an effort to educate and improve lives.