Why Doctors Recommend Newborns Receive the Hepatitis B Vaccine – by Dr. Nicole Betancourt, Bassett Pediatrician

The hepatitis B vaccine has been given to infants across the United States shortly after they are born for more than three decades, but this practice is now receiving new attention from politicians, members of the media, and social media commenters.

At a meeting earlier this month, the CDC’s Advisory Committee on Immunization Practices (ACIP) voted to remove the universal birth dose recommendation. It is now recommending different procedures based on the hepatitis B status of the infant’s family members. New York State is part of the Northeast Public Health Collaborative, which has released a statement saying its member jurisdictions, including New York, will not change their vaccination practices.

With all this, it can be hard to sort through what is fact, what is opinion, and most importantly, what is best for our babies. As a pediatrician with more than 14 years of experience caring for infants, children, and adolescents, I have seen firsthand how tiny decisions at the beginning of life have outsized consequences down the road. For this reason, I want to provide you with the evidence, the public-health rationale, and the practical takeaway. If you are pregnant or planning a pregnancy, I want to encourage you to have a conversation with your healthcare practitioners. Here at Bassett, we are committed to providing the best care to you and your baby.

What to Know About Hepatitis B

Hepatitis B is a virus that attacks the liver, causing inflammation which leads to liver damage and potentially long-term liver disease. Our liver filters toxins out of our blood, helps with digestion of food, stores energy, and makes proteins and clotting factors that help to keep the body working healthily.

Hepatitis B is the most common liver infection in the world. The World Health Organization (WHO) estimates that as many as 2.4 million people around the globe are living with hepatitis B. In the United States alone, there are an estimated 640,000 cases, according to the Centers for Disease Control and Prevention (CDC). As many as one out of two of those people with hepatitis B do not even know that they are infected.

The hepatitis B virus can spread from person to person through bodily fluids, which include blood, saliva, semen, vaginal fluid, menstrual fluid (period blood), or amniotic fluid (the liquid around a fetus in the womb). Hepatitis B is considered both hardy and highly contagious, with studies showing that if one of these fluids comes into contact with a surface that is not disinfected, the virus can remain there for up to seven days at room temperature and even longer in colder temperatures.

Hepatitis B can lead to serious health issues including liver disease, cirrhosis (which is the scarring of the liver that limits its function), liver cancer, or even death.

Chronic vs. Acute Infection

There are two different types of hepatitis B infection: acute and chronic. The term “acute” refers to a new infection while “chronic” refers to long-term. While some adults can clear an acute infection within about six months, other individuals must manage the infection for the rest of their life, in partnership with their healthcare providers.

Infants have a higher risk of developing chronic hepatitis B following the acute infection. This risk is directly related to the age first exposed to the virus; the younger the child, the greater their risk. A staggering 90% of infants infected with hepatitis B develop chronic infection.

The History and Life-Saving Impact of the Universal Birth Dose

Since 1991, the CDC had recommended that a birth dose of the hepatitis B vaccine be administered to all newborn babies before they went home from the hospital. In the decades that followed, this recommendation has resulted in an astounding 99% decline in reported acute cases of hepatitis B among children, teens, and young adults. This is an incredible success for our public health efforts with the vaccine providing documented protection against hepatitis B infection for 35 years.

In all of the years since the hepatitis B vaccine has been given, serious adverse side effects remain extremely rare.

Testing During Pregnancy Is Important, but Not a Replacement for Vaccination

Back in September, the ACIP voted to recommend that all pregnant people be tested for hepatitis B virus, but procedures mandating this had already been in place for over 35 years at hospitals across the country. This screening is typically completed with a blood test in their first trimester. If the test comes back positive, it directs the care that the patient and baby receive for the rest of the pregnancy and following birth. On top of receiving the universal birth dose of the hepatitis B vaccine before discharge from the hospital, an infant born to a hepatitis B-positive mother would also receive hepatitis B immune globulin (HBIG) which provides temporary protection against the hepatitis B virus.

While the majority of pregnant patients are screened for hepatitis B during pregnancy, the CDC estimates that currently anywhere between 12 and 16 percent of pregnant patients are not screened. For this population, the hepatitis B vaccine serves as a safety net, protecting all babies at birth and throughout their life.

Unvaccinated children can also contract hepatitis B through household or community transmission. Recall that the virus can survive for a long time on surfaces, and as many as 50% of people with hepatitis B do not know they have it. An unvaccinated child with a parent, sibling, or relative with hepatitis B could contract it from them through close contact, shared spaces, and shared products.

Let’s Talk About It

Here in New York State, the Northeast Public Health Collaborative continues to advise that all newborns born to a hepatitis B negative birth parent receive the hepatitis B vaccine birth dose within 24 hours of delivery. Infants born to birth parents who have tested positive for hepatitis B, or who have an unknown status, should instead be vaccinated within 12 hours of birth. It is also recommended that all infants complete the full vaccine series, which is three doses, before they are 18 months old. This is in-line with recommendations from the American Academy of Pediatrics and other associations of trained, experienced medical professionals.

It’s important to remember that this guidance is not a mandate. Completion of the hepatitis B vaccine series is, however, required before a child can attend a public school in New York State.

If you are about to become a parent and you have questions about the vaccine, we understand and we’re ready to listen! A newborn baby is precious, and we understand the stress that comes with trying to make the best decisions for their future. Bassett’s pediatricians, obstetricians, and midwives are ready to have nonjudgmental conversations with their patients as they prepare to become parents. We all want to make sure future generations are healthy!

About the Author
Nicole Betancourt, MD, is a pediatric hospitalist at Bassett Medical Center and the Bassett Birthing Center in Cooperstown. She has been providing care to newborn babies and children admitted to the hospital for over 14 years. Dr. Betancourt completed her medical degree at Albany Medical College, residency at Albany Medical Center, and fellowship in pediatric critical care medicine at St. Christopher's Hospital for Children in Philadelphia, PA. She is board-certified by the American Board of Pediatrics.