If you’ve read pretty much anything I’ve written, you’ll know that I’m—shall we say—a tad pro-vaccine. I read about vaccines, I talk about vaccines, and I write about vaccines. But even I’ve had tremendous difficulty finding an explanation for why we give newborn babies the hepatitis B vaccine. And the anti-vaccine crowd has been making hay with this fact for a while now.
“Hep B is a sexually transmitted disease!” they cry. “Why are giving the vaccine to little babies?”
“Why not wait? Why are we doing it immediately? Why not just give it to babies of women with Hep B?”
Now, I knew there was a legitimate reason for the early administration of this vaccine. I believed that public health officials wouldn’t be going all out to be sure that babies got it in the first day or two of life without a reason. But I’ll be damned if they haven’t made it hard to find that reason.
I’ve twice been the exhausted, miserable, and frightened mother of a preemie and I’ve twice looked into an isolette at a baby who weighed about 4 1/2 pounds and was losing weight. I’m surprisingly sympathetic to bewildered parents who say “Can’t we wait? Why do we need to do this right now? Can’t we just hold off until my baby is less helpless-looking?”
I’m certainly not the first person to comment that doctors, public health officials, and the CDC need to figure out how to get their message out to everyone. But in this specific case, I think their message is lacking even to those of us who are pro-vaccination.
If you read the CDC’s Vaccine Information Statement on HepB (which is what I received in the hospital) and the chapter on HepB in the CDC Pink Book, it says very firmly that infants should get the vaccine at birth, but it then goes on to give a list of adults who are at risk and should be vaccinated: men who have sex with men, drug users, people with jobs that involve contact with blood…all of which make it sound like it’s just an STD.
The only thing that’s even close to a good explanation in the Vaccine Information Statement is the note that chronic, rather than acute, infections (which are very very bad) are much more common in infants and children.
The CDC’s HepB FAQ page also has one piece of the puzzle…all the way at the bottom of the page.
Can a baby be protected from getting Hepatitis B from his or her mother during birth?
Yes, almost all cases of Hepatitis B can be prevented if a baby born to an infected woman receives the necessary shots at the recommended times.
Okay, but someone reading just this page could still be left with the impression that the only people who have HepB are drug users, etc.
The very last item on the page is good, but it isn’t quite enough.
Why is the Hepatitis B vaccine recommended for all babies?
Hepatitis B vaccine is recommended for all babies so that they will be protected from a serious but preventable disease. Babies and young children are at much greater risk for developing a chronic infection if infected, but the vaccine can prevent this.
I agree…but I can understand why parents might say “Sure, that’s fine, but why on the first day? Why not wait until when all the other vaccines are given? And I’m sure I don’t have it, so why does my baby need it?”
I started doing what parents do…I googled. Wikipedia didn’t explain the early administration. Neither did the vaccine information page from the Hepatitis B Foundation.
The Medline Plus article on the vaccine (from the National Library of Medicine) had an okay sentence:
If the baby’s mother carries the hepatitis B virus, the baby receives the first vaccine shortly after birth.
Fine, we’ve established that. But what about those parents above who are sure they don’t have it?
I finally delved into the WHO report Introduction of hepatitis B vaccine into childhood immunization services and found mention of child to child transmission in day care centers and schools. That’s a start. But the US is an area with lower rates of HepB. Why newborns? Section 3.1 has probably the best explanation I was able to find in an official document:
The routine vaccination of infants is also a high priority in countries of low endemicity because this is the only strategy that can prevent HBV infections acquired in all age groups (children, adolescents and adults). In these countries the majority of chronic infections are acquired among adolescents and adults but early childhood infections are important in maintaining the burden of chronic infection. Furthermore, many children who are infected have mothers who are NOT infected with HBV. These infections would not be prevented by identifying infants born to HBsAg-positive women and giving them a birth dose of hepatitis B vaccine.
Now we’re cooking! We’ve got to nip it in the bud early.
And then WHO explains that to prevent transmission from the mother, the vaccine must be given within 24 hours.
There is no evidence of protection against perinatal transmission if the first dose of vaccine is given more than seven days after birth.
Too bad the appendix containing the sheet of information for parents doesn’t have any of this on it. ::sigh::
By this point I was getting a bit desperate and I clicked on a BabyCenter page on the Hep B vaccine. And tada!
Hepatitis B is generally considered an adult disease because it’s known to be transmitted through unsafe sex and shared needles. But many who get it, including children, don’t engage in these “high-risk” behaviors. They’re either infected at birth or they contract the disease from close contact during childhood with others who are infected.
Hepatitis B is highly infectious. An estimated 800,000 to 1.4 million people in the United States have the virus, and 20 to 30 percent of them acquired the disease in childhood. Many of them never feel sick and don’t know they have it, but those who become infected as children are more likely to have long-term health problems such as cirrhosis and liver cancer. About 3,000 Americans die from hepatitis B-related illness every year.
Hooray! That’s probably the best explanation I found! Still not perfect, but a lot more useful than many.
Let’s put together what we’ve learned: HepB is highly infectious. Many people who have HepB don’t know it and children can transmit it to each other. Giving the vaccine within the first day a) prevents transmission from the mother and b) prevents the later transmission that is more common in countries like the US. Just because you, the mommy and daddy, don’t have HepB doesn’t mean the kids in daycare or school don’t.
Now, why the heck did I have to hit multiple websites and pull out quotes to synthesize my own (still incomplete) answer to this? It needs to be front and center so that worried parents have an easy-to-find answer to an entirely reasonable question.
(Thanks to Ken of Autism News Beat for putting me on the right track.)