Why Infants Should Receive the Hepatitis B Vaccine at Birth

In honor of Hepatitis Awareness Month

The CDC recommends that the Hepatitis B vaccine be administered to infants soon after birth and before hospital discharge.   Parents, who are often uninformed regarding the risks of contracting this disease or the chronic long-term effects of liver failure, cirrhosis, and liver cancer that come from being infected, may question why their child needs  a vaccination at such a young age.
During the recent airing of the PBS Frontline piece entitled, “The Vaccine War,” one parent defended her anti-vaccine views by questioning why her newborn child would need a vaccine against a sexually transmitted disease.  This comment explains the need for public education regarding the risks of the hepatitis B virus (HBV). Once parents understand the ways in which their child may become infected and the unique risks that the virus poses to their infant child, they should realize that vaccinating at birth can prevent chronic effects later in life.
According to information provided by the Immunization Action Coalition and the CDC, an estimated 1.25 million people are chronically infected with the hepatitis B virus in the United States alone, resulting in an estimated 2,000-4,000 deaths each year.  Surprisingly, 30%-40% of these chronic infections were acquired during childhood.  This fact alone presents a compelling case for vaccinating infants – before they become infected.
Parents need to understand that the hepatitis B virus can be spread by infectious blood and body fluids, and not solely through sexual contact.  As a parent myself, I can recall countless times that I have tended to children, both my own and others, who have suffered scrapes, cuts, nose bleeds and even bites from frustrated playmates.  These are realistic opportunities for exposure since the CDC has stated that the virus remains viable and infectious in the environment for at least 7 days and can remain present in inanimate objects absent of visible blood. Since only 7 out of 10 infected adults show any signs or symptoms, and infected children under age 5 rarely show any symptoms at all, it is obvious how the infected population can easily, and unknowingly, be transmitting the disease to others.
Many of those who become infected with the hepatitis B virus contract the disease from their unknowingly infected mother at birth.   Deborah Wexler from the Immunization Action Coalition explains,

“There are so many parents and healthcare professionals who think this vaccine is wrongly given at birth for an STD that might be acquired later in life.   But the most important reason for it is to prevent HBV infection early in life with the possible life-long complications  of chronic disease in the form of liver failure and liver cancer that affect so many who are infected at birth.  I wish this message were more broadly disseminated, but it is a difficult message to discuss due to its complexity, the need to explain how medical errors might occur and why testing isn’t infallible, or how exposures could occur in an infant.”

While OBGYNs suggest mothers be tested prior to delivery, there are many instances when this does not occur, or when it is possible that the mother contracts the disease in the period after testing, but before birth.  Properly identifying infected mothers is complicated since there can be errors in test ordering, result interpretation or even test inaccuracy.  Therefore, administering the first dose of the hepatitis B vaccine soon after birth minimizes the risk for infection from the mother or from other infected persons who may be living in the household.  Additionally, the hepatitis B vaccine can actually help prevent infection in infants who are born from mothers with the virus in their blood. This serves as another important fact to support vaccinating your child according to the recommended schedule.
Studies also indicate that the long-term chronic health issues related to this virus, such as liver failure, cirrhosis, and liver cancer, are directly related to when a person is first infected.  For example, 90% of infants who are infected will ultimately develop chronic symptoms later in life, however, when the illness is contracted at an older age, the chronic effects are less prominent.  Only 30% of children age 1-5 who contract hepatitis B will go on to develop these chronic issues.  Once again, these figures demonstrate the benefit of starting infants on the multi-dose vaccination series as soon as possible after birth in order to provide the greatest preventative effect on the population.
Perhaps you have other concerns or information to share regarding the hepatitis B virus.  Feel free to comment here or respond with a question so that you can be part of the conversation.