Q&A: How to Balance Risks and Benefits of Hep B Vaccine

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9131353649_4fc639d9f4_oHailey M. Asks: I am trying to balance the risks versus benefits of the newborn hepatitis B vaccine for my family. I have no problem giving it to my children when they are a little older, but I question doing it at birth when I feel like they have a very minimal chance of coming in contact with hepatitis B. This study seems to suggest that perhaps waiting may be safer? Are you aware of any research that refutes this?

Our Answer: Hi Hailey, thank you for writing to us. We get a lot of questions regarding why the hepatitis B vaccine is given at birth; it’s one many parents wrestle with. Even some of our own staff were initially uncertain about why this vaccine is provided to newborns. I’ll start by addressing your concerns with the study, and then give you some background on why a vaccine for what we typically think of as a sexually transmitted disease is recommended at birth.

This study looks at data concerning maternal recall of newborn hepatitis B vaccine and diagnosis of autism from National Health Information Surveys from 1997­-2002. Maternal recall means that they’re asking women after the fact whether or not their child had the hepatitis B vaccine at birth. These kinds of studies have a very high potential for bias and inaccuracy.

But the more fundamental flaw in this study is that the children surveyed were between 3 and 17 years of age. This means that children were born before and after the introduction of the newborn hepatitis B vaccine. Since autism diagnosis has been rising, mostly from increased awareness and expanded diagnostic criteria, it is expected that this study would show more autism among children vaccinated for hepatitis b. The children that were born before the hepatitis b vaccine was available would have lower rates of autism because it was being diagnosed less frequently.

The study itself also references two other studies, which do not have the same problems as this study and which show no link between giving the hepatitis B vaccine at birth, and autism rates.

I hope that helps to allay some of your concerns about this study; if there’s anything else we can explain about it specifically, please let us know.

As for why the vaccine is given to newborns, the vaccine was originally recommended at birth because there were so many children being born to mothers who had hepatitis B and didn’t know it. Basically only about half of women who had hepatitis B were identified before giving birth. About 16,000 newborns a year were born with a hepatitis B infection, and 90% of newborns who contract the disease become chronic carriers, which puts them at higher risk for cirrhosis and liver cancer. You can see a more detailed explanation of this rationale here.

There were a number of reasons that so many children were born to hepatitis B­ positive mothers who didn’t know it: a) some mothers contracted hepatitis B between testing during prenatal care and giving birth, b) false negatives can occur in testing, c) the wrong testing could have been ordered or the results may have been misinterpreted (hepatitis B testing is a bit more complicated than some other forms of testing), and d) the results could have been miscommunicated between the lab and doctor’s office.

In addition to the possibility of a missed Hepatitis B infection in the mother, the hepatitis B virus can live on surfaces for up to 7 days, including in dried blood. It’s blood­borne, but not just through sexual contact, it can also be transmitted through bites, which happen frequently in daycare or playgroup settings.

Because it can live a week on surfaces, needles or bandaids discarded at city parks, etc. can also be sources of infection. It’s not a common method of transmission, but the risk is not zero either.

Along with this, the Hepatitis B vaccine is one of the safest vaccines with the fewest number of possible side effects (mostly just pain and soreness at the injection site) and no documented serious side effects.

If there is something serious that can happen from the hepatitis B vaccine, it’s so rare that it hasn’t been detected at the level of one dose per several millions of doses. The safety of the vaccine, combined with the possibility of infection at birth or in infancy, is the reason this vaccine in particular is given right at birth. Hepatitis B can be quite serious when contracted at a young age, about a third of kids under 5 who get a hepatitis B infection will become lifetime chronic carriers, and they may never know they were infected ­­ and therefore never know they are carriers.

I hope this helps address your concerns regarding the hepatitis B vaccination, please let us know if you have any other questions.

Further Reading:

A complete explanation from the Immunization Action Coalition of the birth dose of hepatitis B vaccine.

Immunization Action Coalition handout about medical errors related to hepatitis B, showing need for birth dose.

Photo Credit to Joshua Rappeneker. Creative Commons license.