Rethinking The Hepatitis B Vaccine
How Common is Hep B in Infants?
There are two main ways infants can get Hepatitis B: from the parent who is giving birth to them, or from another family member in their home who is Hep B positive. This is why all parents or adults living with an infant should be tested for Hepatitis B. This can get a little tricky - there have been cases of people getting tested for Hepatitis B in the beginning of their pregnancies who became infected during pregnancy who didn’t find out till later. In addition, the Hepatitis B virus has an incubation period up to five months (though 90 days is closer to the average). So in an unvaccinated birth parent with risk factors, it’s important to test for Hep B at the beginning and at the end of pregnancy, just to be sure. This is especially true for parents who may have had an exposure through unprotected sex, who are IV drug users, or whose partners have Hep B or engage in any high-risk behaviors.
Of the 30 cases of infants contracting Hep B in the United States every year, the vast majority get the virus from an undiagnosed birth parent during the birthing process.
If you or your partner has Hepatitis B, then vaccination at birth is essential. Vaccination (along with treatment with hepatitis B immune globulin) can prevent 85-95% of transmission of hep B from a hep-B positive birth parent to their infant.
What about Infants with Hep B Negative Parents?
So… if infants with Hep B negative parents are so unlikely to get the virus, why do we vaccinate for hep B at such an early age?
The Hepatitis B Initiative
The infant Hepatitis B vaccine is part of a public health initiative to get rid of the virus in the adult population in the US. Starting in the 80’s and 90’s various states and organizations began initiating "birth dose" initiatives, in hopes of both protecting infants whose birth parent had an undiagnosed Hep B infection and of eventually eradicating Hep B in our general population. Since then, giving the Hepatitis B vaccination at birth has become increasingly common - current estimates are that 70% of hospital-born infants are vaccinated in the hospital soon after birth.
So Why Do Some Parents Decide Not to Vaccinate for Hepatitis B?
There is some concern that giving infants vaccines before 2 years of age can push an infant's immature immune system towards immune disregulation, increasing risk of conditions such as allergies, eczema, and asthma.
Although very few studies have been conducted to explore this concern, there have been some informal surveys of parents of both vaccinated and unvaccinated kids comparing rates of allergies, asthma, and autism. The most famous of these is an ongoing survey of around 12,000 kids by a very decidedly anti-vaccination German website impfschaden.info (the German counterpart to vaccineinjury.info). In those surveys, parents of unvaccinated kids reported significantly lower rates of asthma, allergies, autism, and ADHD, as compared to kids who were vaccinated.
Some parents chose not to vaccinate their kids before age two, just to avoid any risk of increasing their child’s chance of developing these and other allergic or inflammatory-type conditions.
Specific Risks Associated with the
Hepatitis B Vaccine
- Aluminum. Hepatitis B vaccine contains around 250 mcg of aluminum per dose. While this is a fairly small amount, aluminum can build up in the system and cause a wide variety of neurological issues. While the FDA has insisted that the level of aluminum in vaccines poses “extremely low risk” to infants, many parents are uncomfortable with the idea injecting heavy metals into their kids.
While the newborn Hep B vaccine is generally given by itself, an infant on the normal CDC schedule will get 5 different shots at their two month visit, three of which most likely contain aluminum (HIB, Pc, and DTaP). This can add up to as much as 1225 mcg aluminum in that single visit. There are few human studies that show the safety of injected aluminum at these levels.
- Autoimmune Disease Risk. Hepatitis B vaccine has a relatively high association with development of autoimmune disease, especially lupus and multiple sclerosis. There are hundreds of documented cases of this, but these have all been in adults. Infants rarely develop autoimmune conditions, though long-term autoimmune risk in people vaccinated as infants is harder to predict. That said, almost any infection (vaccine, virus, bacteria…) could theoretically lead to an autoimmune disease.
Other adverse effects reported after Hepatitis B vaccination include Stevens-Johnson syndrome, nerve dysfunction or paralysis, seizures, and inflammation of the blood vessels or the optic nerve.
Who Should Get the Hep B Vaccine, then?
A popular and quite reasonable option for parents who want their kids to be protected against Hepatitis B is to wait till their child is at least two years old or even an adolescent before giving the vaccine. This ensures that the child’s immune system is fully mature before receiving the vaccine, and still offers protection before the child is likely to engage in any high risk behavior.