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Hepatitis B at Birth or For The Very Young

Posted Oct 29 2010 5:31pm
The US is unusual in vaccinating all newborns against Hepatitis B at birth.   Much more common is only vaccinating high risk babies at birth. The definition varies by country but it always includes mothers known to be Hepatitis B positive.

Because Hepatitis B is often transmitted sexually, there's a concern that vaccinating against Hepatitis B somehow sexualizes the innocent newborn as Hep B is usually transmitted through sexual contact.. But here's the punch line most don't know: While vaccinating all newborns is unusual, vaccinating very young infants against Hepatitis B is not.

Parents who are concerned about Hepatitis B vaccination of newborns and the very young  should have their concerns allayed when they realize that: "As of 2007, 171 of the 193 member countries of the World Health Organization (WHO) had implemented the recommendations of the Expanded Programme on Immunization to offer universal hepatitis B vaccination to infants"

I live in the province of Ontario, Canada, which only vaccinates high risk infants at birth and vaccinates the rest of the population in Grade 7 through a school vaccination program.  That's quite unusual.  A recent article in the Canadian Medical Association Journal  Hepatitis B immunization strategies: timing is everything  explains the benefits of universal vaccination of infants.  I strongly recommend that concerned parents read this article..

For the American view on vaccination at birth  see   A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States  Recommendations of the Advisory Committee on Immunization Practices (ACIP) Part 1: Immunization of Infants, Children, and Adolescents  December 23, 2005

My personal view:   There's no downside to the American practice except cost and causing unfounded fears in some parents.  In a country where health care isn't supplied universally, a system that provides a safety net by vaccinating at birth seems to make sense.

In any case add Hep B to the DTaP  or DTaP-IPV  vaccine series that starts at 2 months so that an additional injection isn't needed.

The evidence doesn't support waiting until adolescence to protect against Hepatitis B.

Here's a great quote from the CMA Journal article

Chronic HBV infection, with the attendant risk of cirrhosis and hepatocellular carcinoma, occurs in 1%–5% of adults and up to 90% of infants who are infected with HBV. Providing vaccinations during adolescence without offering vaccinations during infancy misses this critical period when the acquisition of a HBV infection can be the most harmful. Epidemiologic studies show that the age distribution of HBV varies by jurisdiction and suggest that roughly one-third of chronic infections are acquired during infancy and early childhood. An ideal vaccine schedule should protect against infection both in infancy, when the risk of becoming a chronic HBV carrier is highest, and in adolescence, when high-risk sexual and drug-using behaviours occur more frequently.
Epidemiologic data are critical for informing decisions about vaccination. Estimating the age-specific incidence of acute infections is valuable for planning prevention measures. However, acute infections in infants and toddlers may be missed because HBV infection is often asymptomatic in young children. In many jurisdictions, the age-specific incidence of HBV infection is unknown.
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