Before we discuss the Hepatitis B vaccine, let’s step back and talk about what Hepatitis B is and why we want to prevent it in our children. Hepatitis B is a potentially life-threatening infection caused by the Hepatitis B virus (HBV) that attacks and injures the liver. This disease process may lead to mild illness lasting a few weeks, or it can develop into a serious and lifelong disease.
Acute hepatitis B infection is a short-term illness with symptoms such as fever, fatigue, loss of appetite, nausea, vomiting, jaundice (yellow skin or eyes, dark urine, clay-colored bowel movements), and pain in the muscles and joints, and stomach. These symptoms typically appear 3-4 months after becoming infected with the virus.
Chronic hepatitis B infection is a long-term illness that occurs when HBV remains in a person’s body. It is unpredictable; we don’t have any way to know who will develop the chronic form of the infection. Most people who go on to develop chronic hepatitis B do not have symptoms. However, it is still very serious as it can eventually lead to liver damage (cirrhosis) and/or liver cancer. Liver cancer is the fourth leading cause of cancer deaths throughout the world. Almost half of all liver cancers are caused by chronic infection with hepatitis B.
How Common is Hepatitis B?
More than 1 million people in the United States are currently living with lifelong Hepatitis B infection. In the United States, about 22,000 new hepatitis B infections occur every year, and 4,000-5,000 people die from the infection and its complications.
One of the reasons we prioritize vaccinating newborns is because when HBV is contracted in infancy or early childhood, there is a 95% chance of it progressing to cirrhosis (chronic liver disease) and liver cancer, often when they are young adults. In the US, this is relatively rare, thanks to high vaccination rates. Worldwide it is still a very serious and worrisome problem and is one of the major causes of hepatic carcinoma (liver cancer).
The World Health Organization (WHO) estimates 296 million people live with chronic hepatitis B infection in 2019, with 1.5 million new infections each year and 820,000 deaths.
How is Hepatitis B spread?
Hepatitis B is spread when blood or other bodily fluids infected with the hepatitis B virus enters the body of a person who is not infected. Contact with the blood of someone who has Hepatitis B, even via casual contact, is the most likely way to catch hepatitis B. The virus can live on objects for seven days or more.
Infections can be transmitted through:
- In the birthing process, newborns of mothers with hepatitis B can become infected.
- Living in the same household as a person with a lifelong form of the infection.
- Sharing items such as razors or toothbrushes (the virus is present in saliva as well!) with an infected person.
- Contact with the blood or open sores of an infected person.
- Exposure to blood from needlesticks or other sharp instruments such as healthcare workers.
- Having unprotected sex with an infected partner.
- Sharing needles, syringes, or other drug-injection equipment.
It is extremely important to note that Hepatitis B can be transmitted by relatively casual contact with items contaminated with an infected person’s blood. Because many people infected with the hepatitis B virus may not even know they have it, it is virtually impossible to be “careful enough” to avoid this infection. If your child accidentally gets a sharp injury and is vaccinated, it is one less bloodborne infection you have to worry about. To give some perspective, Hepatitis B is 100x more transmissible by needlestick than HIV!
You may think that your child is not at risk for exposure, and thus the vaccination is not needed. However, here are some facts to consider:
- One-third of people infected with HBV in the United States do not know how they got it. Most do not feel sick and have no idea they carry this virus. They are surprised when they are told they are infected.
- Nearly half of the more than 5,000 adult Americans who die from hepatitis B each year caught their infection during childhood.
- 1/2 children with HBV acquire it from an infected mother and 1/2 from casual contact or silent carrier.
- Even if a mother’s test is negative during pregnancy, there’s no guarantee that she isn’t infected for two reasons; no test is perfect, and a pregnant woman could inadvertently acquire Hep B after the test is performed.
Is there a cure for Hepatitis B?
Unfortunately, there is not a cure. There is also no specific treatment for acute infection other than offering supportive care to maintain comfort and adequate nutrition balance. There are medications to help those with lifelong Hepatitis B infection, but no medicine “cures” it.
Who Should be Vaccinated and When?
Infants should get their first dose of the hepatitis B vaccine at birth, preferably within the first 24 hours. They will usually complete the series at six months of age (sometimes, it will take longer than six months to complete the series). Babies who receive their first vaccine at birth are more likely to complete the three dose series. Children and adolescents younger than 19 who have not yet gotten the vaccine should also be vaccinated.
Hepatitis B vaccine is also recommended for certain unvaccinated adults:
- People whose sex partners have hepatitis B
- Sexually active persons who are not in a long-term monogamous relationship
- Persons seeking evaluation or treatment for a sexually transmitted disease
- Men who have sexual contact with other men
- People who share needles, syringes, or other drug injection equipment
- People who have household contact with someone infected with the hepatitis B virus
- Health care and public safety workers at risk for exposure to blood or body fluids
- Residents and staff of facilities for developmentally disabled persons
- Persons in correctional facilities
- Victims of sexual assault or abuse
- Travelers to regions with increased rates of hepatitis B
- People with chronic liver disease, kidney disease, HIV infection, infection with hepatitis C, or diabetes
What are the Different Hepatitis B Vaccines?
There are three Hepatitis B vaccines currently available in the United States:
- Engerix-B® — a 3 dose series, approved at birth, given via intramuscular injection.
- Recombivax HB® — a 3 dose series, approved at birth, given via intramuscular injection.
- Heplisav-B® — a 2 dose series; approved for 18 years and older, given via intramuscular injection.
Two combination vaccines include Hepatitis B currently available in the United States:
- Twinrix® (Hep A + Hep B) is a 3 dose series; approved for 18 years and older; inactivated Hep A + recombinant Hep B; given via intramuscular injection.
- “Inactivated” means that the killed version of the germ that causes a disease is used. Inactivated vaccines usually don’t provide immunity (protection) that’s as strong as live vaccines. So you may need several doses over time (booster shots) to get ongoing immunity against diseases.)
- “Recombinant” vaccines use specific pieces of the germ, such as its protein, sugar, or capsid, a casing around the germ. Because these vaccines use only specific germ pieces, they give a strong immune response targeted to key parts of the germ. They can be given to almost everyone who needs them, including people with weakened immune systems and long-term health problems.
- Pediarix® (DTaP-HepB-IPV) — 3 dose series (given at 2, 4, 6-month doses); approved 6 weeks through 6 years; inactivated, given via intramuscular injection.
How Effective is the Hepatitis B Vaccine?
The original strategy (started in the early 1980s) was to vaccinate only those at the highest risk (for example, healthcare workers, patients on dialysis, and intravenous drug users). But because the disease can be transmitted to those, not in high-risk groups, this vaccine strategy didn’t work. The incidence of hepatitis B virus disease in the United States was unchanged 10 years after the vaccine was first used! For this reason, the vaccine strategy changed. In 1991, it became the routine recommendation that all newborns receive the hepatitis B vaccine at birth. And the incidence of hepatitis B virus infections in the United States has declined. Indeed, the new vaccine strategy has virtually eliminated the disease in children less than 19 years of age.
The Hepatitis B vaccine is a very safe and effective way to prevent the transmission of hepatitis B. More than 98% of children who receive all the recommended doses of the vaccine are fully protected against HBV. Most people who are vaccinated with the hepatitis B vaccine are immune for life.
What are the risks and side effects of the Hepatitis B Vaccine?
People with minor illnesses, such as a cold may be vaccinated. People who are moderately or severely ill should usually wait until they recover before getting the hepatitis B vaccine.
Hepatitis B vaccine may be given at the same time as other vaccines.
Vaccines, like any medicine, can have side effects. These are usually mild and go away on their own. The side effects most common for the Hepatitis B vaccine include:
- Soreness at the vaccination site
People sometimes faint after medical procedures, including vaccination. As with any medicine, there is a very remote chance of a vaccine causing a severe allergic reaction, other serious injuries, or death. Keep in mind that the likelihood of this is very, very rare. Discuss any questions and concerns that you have with your medical provider.
As with anything (and we know this all too well during the pandemic!), we make decisions for our children based on the information we have in front of us and the risks and benefits related to our families. I hope this article was informative and helpful in understanding why your pediatrician routinely recommends this very safe and effective vaccine.
Centers for Disease Control and Prevention, https://www.cdc.gov/
American Academy of Pediatrics, https://www.aap.org/
Immunization Action Coalition, https://www.immunize.org/
Hepatitis B Foundation, https://www.hepb.org/
World Health Organization, https://www.who.int/
Disclaimer: While I am a doctor, I am not your doctor. All content presented in this article is for educational purposes only. It does not constitute medical advice and does not establish any kind of doctor/patient relationship. Speak to your healthcare provider about any questions or concerns you may have.