The Hepatitis B Vaccine for Newborns

A Pediatrician Explains Why It's Best for Babies To Get This Shot

Child getting vaccination
Science Photo Library - IAN HOOTON./Brand X Pictures/Getty Images

Q. If hepatitis B is a sexually transmitted disease, then why do newborns need to get the hepatitis B vaccination? Can't they wait until they are older? Connie, Texas

A. Hepatitis B is a viral infection that can lead to chronic liver infections, as well as cirrhosis and hepatocellular carcinoma. Hepatitis B is transmitted by blood and by other body fluids, so it is technically a sexually transmitted disease.

However, newborns are at high risk for getting hepatitis B from mothers who are already infected with the hepatitis B virus through childbirth (either via vaginal deliveries or c-sections).

You might wonder: Why vaccinate all children against hepatitis B? Why not just vaccinate newborns who are at high risk of developing the infection? 

Although simply vaccinating those infants of mothers who are infected with hepatitis B and delaying the vaccinations for other infants is one strategy for preventing hepatitis B in newborns, it is not as effective as what's called universal immunization. Health experts tried immunizing select newborns when the hepatitis B vaccination first came out and it didn't work. It wasn't until after the universal immunization program for the hepatitis B vaccine began that the rate of new hepatitis B infections in children began to drop.

That's why medical professional recommend universal immunization against hepatitis B.

 In a universal immunization program, all newborns are immunized against hepatitis B, even if their mothers test negative for hepatitis B infections.

The Birth Dose of Hepatitis B Vaccine

Giving this birth dose of the hepatitis B vaccination helps prevent the disease from developing in babies who have mothers who have hepatitis B infections but never knew it, perhaps because testing wasn't done or because there was a testing mistake.

It also prevents a scenario in which the mother has a known hepatitis B infection, but the baby somehow still misses his or her hepatitis B shot. That could occur if a mother fails to report her hepatitis B infection to her doctor or simply forgets that she has the infection.

Another good reason to give all newborns the hepatitis B vaccination is that, although most cases are known to be caused by exposure to blood and body fluids from somebody else who has a hepatitis B infection, about 30% to 40% of infections develop in people who don't have any risk factors for infection.

According to the Centers for Disease Control and Prevention (CDC), giving a birth dose of the hepatitis B vaccination is a good idea because:

  • It provides 'a safety net to prevent perinatal infection among infants who are born to HBsAg-positive mothers who are not identified because of errors in maternal HBsAg testing or failures in reporting of test results.'
  • The birth dose 'provides early protection to infants at risk for infection after the perinatal period.'
  • Infants who get the birth dose of the hepatitis B vaccination have 'higher rates of on-time completion of the hepatitis B vaccine series.'
  • It reduces the risk that a child could get hepatitis B later in childhood, even if he or she isn't at risk now from a mother who has hepatitis B, since that kid could be exposed to another caregiver or family member who has hepatitis B.

Most importantly, although young children often have no symptoms when they develop hepatitis B infections, they are very likely to go on to develop problems with chronic hepatitis. In fact, 90% of children who develop hepatitis before they are 12 months old will go on to develop chronic hepatitis B. Unfortunately, there is no cure for chronic hepatitis B and there are few reliable treatments. Therefore, vaccinating your child against this debilitating disease is a must. 

Sources:

Long: Principles and Practice of Pediatric Infectious Diseases, 2nd ed.

Gershon: Krugman's Infectious Diseases of Children, 11th ed.

MMWR. December 23, 2005 / Vol. 54 / No. RR-16. A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States.

Kliegman: Nelson Textbook of Pediatrics, 18th ed.

Hepatitis B. Weisberg SS - Dis Mon - September 2007; 53(9); 453-458.

Continue Reading