HepB vaccine: Why so early?

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.)

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About mamamara

I'm a 40-year-old, work-at-home mother of two. I'm pro-vaccine, pro-medicine, pro-science, and an avid reader of information about all of the above, and I want to combine my love for my children with my love for science. So here we are!
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6 Responses to HepB vaccine: Why so early?

  1. Ross DeHovitz says:

    Mara

    As a Pediatrician, i get this question an awful lot and I totally understand where you are coming from. And I totally agree that lots of this information should be much easier to obtain. Here is my perspective.

    Hep B historically is a disease that once you are infected, it may not ever be cleared. If you are a chronic carrier, you have an increased likelihood of getting liver failure or liver cancer or give it to others. Also, it can be transmitted by casual contact. Even through saliva. Only half of children with the disease in the 1970s got it from their mothers. The rest contracted it after birth.

    This vaccine saved so many lives when it came out in the 80s. For the first time, millions of infants would not get their mothers disease and would have a clean start in life. So it was first given to those infants whose moms were hep B positive. And to other children and adults who were deemed high risk through their health habits (iv drug abusers) or through their health situation (on dialysis) A truly life saving intervention.

    After a few years it became clear that the incidence of the disease was not changing. We were only preventing part of the new infections. We also learned how safe it was to give to infants. And we also learned that targeting high risk is not enough as you can never prevent all infections that way. So, it became clear that to give it to all infants would take care of the problem of children who might get it as they got older through close contact or through sexual activity as a teenager. With a universal vaccinated cohort, we would not have to worry about who would become high risk.

    One other benefit was seen. There are women who convert to positive serology while pregnant and after their initial screen is drawn. I have seen this. There are also children who will need a blood transfusion as they get older and could be susceptible to Hep B if they are not vaccinated. This captured population of infants that we immunize would be protected in all of these scenarios.

    The decision to immunize a newborn is always a difficult decision because of the image of injecting something into a beautiful perfect infant. But Hep B vaccine ( and other vaccines) have helped to keep these children healthy as they enter this (unfortunately) imperfect world.

    By the way, My favorite websites on this are:

    http://www.chop.edu/service/vaccine-education-center/home.html

    http://www.vaccines.gov

    • mamamara says:

      Thank you, Ross! That was a heck of a lot clearer than the CDC or WHO sites were 🙂 I really don’t understand why CDC and Medline, which are usually so clear and good at hitting the most important points have completely dropped the ball on this particular point. Am I the only one who’s seeing this question all over the place?

      Hmm, I didn’t check the AAP’s site. I wonder if they have a better explanation. The two sites you recommend look great and I’ve got them bookmarked.

      Of course, Avi and I didn’t argue when the NICU nurses showed up to give Yael and Barak their HepB shots. I’m so grateful for all the things my kids are protected against! Now if we could protect them against all the cars on the road, all cancers, and falling in love with unsuitable people, parents could rest easy, right?

  2. Jamie says:

    What about the nearly 300% increased incidence of liver damage seen in Hep B vaccinated kids? Or the altered expression of 144 genes seen in mice within 1 day of vaccine injection? When you have to search so thoroughly for a shred of a reason to jab a newborn, I think that’s an indication to reconsider.
    http://www.greenmedinfo.com/blog/hep-b-vaccine-damages-liver-it-supposed-protect

    • mamamara says:

      I wish I had the time to read the journal articles cited in the greenmedinfo post, because I would be curious to read their methods and see if I agree with their conclusions.

      Since I *don’t* have the time, I’ll simply ask you why you think the medical profession would want to give shots to babies if they thought it was going to be harmful. I don’t trust the companies that make pharmaceuticals any further than I can throw them, but why would organizations like the CDC and NIH think it was so important if the vaccines were actually harmful? We’ve seen that when there *is* a problem (see: the first rotavirus vaccine), the problem is caught and the drug is pulled from the market immediately.

  3. Nick says:

    True research means looking for both support and criticism of your hypothesis and beliefs. You seem to only have time to find support but not look at the scientific evidence challenging your beliefs. One-sided debates inhibit understanding, they don’t further it. Please take the time to provide a more well-rounded perspective in future posts. This discussion is important.

    • mamamara says:

      Dude! I do read the evidence challenging my beliefs. I’ve broken my brain reading more posts on NaturalBS.net or what-have-you than you’ve had hot meals. Today I don’t have time to read the articles because my kid has swim lessons, my other kid is sick, and my house is a mess. It takes *time* to properly read a scientific article and determine if it’s good science. Believe it or not, I’ve got a life that doesn’t revolve around reading anti-science screeds. Hmmph.

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