Jeremy Hammond, a wonderful writer, has posted a superb piece about this subject here. Four years ago, I wrote an interesting article about hepatitis B vaccine, telling my own story of how I came to be vaccinated, while eschewing vaccination for my grandchildren. A bit later, I wrote about how it was that CDC kept moving the Hepatitis B vaccine goalposts, until newborns became the primary target, for whom uptake was almost 100%
Hepatitis B is a killed vaccine and protection wears off over time, so babies may actually lack protection if and when they do become "at risk" of contracting Hepatitis B, as a teen or adult.
If the goal was to provide adolescents with protection when they become sexually active, they should be vaccinated later, as is recommended for the Tdap and Men A vaccines. After all, immunity from vaccination in the first six months may have worn off by then.
The fact is, no public health agency has ever provided a scientific or logical reason why babies need to be given this vaccine at birth. Here is CDC's 2017 explanation, which makes absolutely no sense if the family is uninfected:
For children and adolescents, the new guidelines strengthen the recommendation that the birth dose of the HBV vaccine be administered to infants within 24 hours of birth. This is a change from previous recommendations that were more flexible, allowing for vaccination at birth or at first pediatric visit, often 2 or more weeks after birth. However, delaying vaccination leaves infants at risk for a longer period of time. Additionally, providing the vaccine as soon as possible after birth can provide some protection for infants whose mothers had undiagnosed HBV at the time of delivery.
These updated recommendations strengthen our national response to viral hepatitis and contribute to implementing strategies identified in the National Viral Hepatitis Action Plan, 2017 – 2020.But what are babies "at risk" for if they and their mothers tested negative? And why is your newborn needed to "strengthen our national response" anyway?
The state of Oregon does its best to provide a "better" reason. The reason is--get this--that, although mothers and newborns are all tested for Hepatitis B and should therefore be treated when found to be positive, well, sometimes people make mistakes. Results might get lost. So we better vaccinate every baby (4 million babies a year at 3 doses each, costing an estimated $500 million/year)-- just in case a positive result gets lost. (I guarantee that if hospitals were told they would be fined $50,000 for losing a single Hepatitis B test, not a single one would ever be lost.) From Oregon:
We all know that medical errors happen—some serious—and with some regularity. Because HBV positive test results don’t always find their way to the birth hospital, or to the right person, many U.S. children are now chronically infected with HBV and at least one infant has died...The birth dose of hepatitis B vaccine serves as a “safety net” to prevent perinatal infection in these infants.You've gotta be kidding me. Not only do mothers and newborns have to pay to be tested for Hepatitis B, they have to pay (and risk an adverse reaction) for 3 doses of vaccine in case the hospital loses their test results. What is wrong with this picture???
Here is the information CDC provides about the number of perinatal cases of Hepatitis B in 2016 (below). It would be interesting to know how many of these cases were vaccinated, and how many were detected through lab testing. Why did these cases occur? Were they cared for appropriately?
Would it not make more sense to put the effort and expense of 12 million Hepatitis B shots yearly into correctly identifying the small number of truly at-risk newborns and making certain they are optimally treated by their medical providers?
Update: Only about 73% of US newborns actually receive the Hepatitis B vaccine within 3 days after birth. The rest have savvy parents or health professionals.
Table 3.6. Number of newly reported case* reports† of perinatal hepatitis B§ submitted by states and jurisdictions, 2016
State/Jurisdiction | No. Perinatal hepatitis B case reports† submitted |
---|---|
California | 15 |
Georgia | 1 |
Kentucky | 2 |
Louisiana | 1 |
Minnesota | 1 |
New York | 2 |
North Carolina | 1 |
Pennsylvania | 2 |
Tennessee | 2 |
Texas | 2 |
Washington | 1 |
West Virginia | 1 |
Wisconsin | 1 |
Total | 32 |
Source: CDC, National Notifiable Diseases Surveillance System.
*For case-definition, see https://wwwn.cdc.gov/nndss/conditions/hepatitis-b-perinatal-virus-infection/case-definition/1995/
†Reports may not reflect unique cases.
§ Perinatal hepatitis B is not reportable disease in ALL jurisdictions
Here are the ingredients in the 2 hepatitis B vaccines sold in the US, in addition to the Hep B antigens:*For case-definition, see https://wwwn.cdc.gov/nndss/conditions/hepatitis-b-perinatal-virus-infection/case-definition/1995/
†Reports may not reflect unique cases.
§ Perinatal hepatitis B is not reportable disease in ALL jurisdictions
Hep B (Engerix-B): 250 mcg aluminum as aluminum hydroxide, up to 5% yeast protein, sodium chloride, disodium phosphate dihydrate, sodium dihydrogen phosphate dihydrate
Hep B (Recombivax): soy peptone, dextrose, amino acids, mineral salts, phosphate buffer, formaldehyde, 250 mcg aluminum, yeast protein
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