Why We Recommend Hepatitis B Vaccination for Newborns

The Center for Disease Control and Protection (CDC}’s vaccine advisory committee now recommends shared clinical decision-making for hepatitis B vaccination for newborns whose mothers test negative for the virus. At UVA Health, we align with the American Academy of Pediatrics (AAP) recommendation for universal hepatitis B vaccination for all newborns at birth based on decades of scientific evidence. “Yes,” Jeffrey Donowitz, MD, pediatric infectious diseases specialist at UVA Health, says. “We expect the vaccine to be available.”

Anne Ranney, MD, pediatrician, agrees. “Our department will proceed with offering the hepatitis B vaccine during the newborn period.”

Here’s what you should know about hepatitis B, how effective the vaccine is, and why this vaccine is so important. We also dispel some of the myths surrounding hepatitis B and share the success of this public health initiative.

What Is Hepatitis B?

Hepatitis B is a virus that can lead to short-term (acute) and lifelong (chronic) infections. In adults, only 2-10% of cases will become chronic. In children, though, up to 90% of those infected in the first year of life will develop chronic hepatitis B. Once chronically infected, there’s no cure.

Living with chronic hepatitis B can be very challenging, especially for young children. In addition to the ongoing medical care, there’s also a fair amount of stigma surrounding the condition. This can lead to psychological impacts in addition to the physical ones.

Around the world, 1.1 million people die every year from hepatitis B, and 254 million people are currently living with chronic hepatitis B infection.

While it’s a blood-borne pathogen, like HIV, it’s 50-100 times as contagious as HIV. It’s also a hardy virus. On surfaces, it can survive for up to 7 days. Cleaners like bleach and hydrogen peroxide can kill it, but many other popular cleaners (including vinegar) do not.

How Do Children Get Hepatitis B?

The most common route of transmission is during birth. If a mother has hepatitis B, her newborn is at high risk. This is called vertical transmission, and before routine vaccination, it accounted for about half of the cases in the United States. The remainder of cases came from contact with body fluids from an infected person, including through household contact. 

Before universal newborn vaccination, there were thousands of hepatitis B cases every year that had no known point of transmission. 

What Good Has Newborn Vaccination Done?

Hepatitis B vaccination at birth was first recommended in 1991. Before that, 18,000 children under 10 contracted the virus every year.

Now, fewer than 1,000 children a year get the hepatitis B virus. This is because of the vaccine’s success.

Will Insurance Still Cover Hepatitis B Vaccination?

Yes. The Vaccines for Children program will still cover the vaccine, and private insurance will follow that standard. If you want your child to be vaccinated at birth, it will remain free for now.

Myths vs Facts: Hep B Vaccination

There are a lot of myths surrounding hepatitis B vaccination for newborns. So, let’s dispel them head-on.

Myth: If Mom’s Negative, There’s No Reason to Vaccinate

Fact: Mom could test negative but still pass on the infection at birth.

“There are false negatives in the screening tests commonly used to test pregnant women,” Donowitz explains. In some studies, there was a 4-10% rate of false negatives.

But there are other barriers as well.

The incubation period for hepatitis B ranges from 2 to 5 months. You can be infectious before symptoms begin, and it can take months after infection to be detectable.

There are also occult hepatitis B infections. These infections mean that the virus can’t be detected in blood tests at all, but continues to be present in the liver, so the carrier remains infectious.

Myth: Newborns Don’t Engage in Risky Behavior

Fact: Children absolutely engage in risky behavior; it just looks different than it does in adults.

Young children are a risk group unto themselves. Many of the developmentally appropriate behaviors that young children engage in (biting, putting shared toys into their mouths, etc) are activities that are rarely even addressed in official literature because these aren’t concerns adults have.

In a pamphlet on preventing hepatitis B aimed at adults, you most likely won’t find “don’t bite your friends” because it’s just not something adults would even consider doing.

So, while they’re at low to zero risk for sharing needles and risky sexual encounters (cautions we share with adults), they’re at high risk for poking a friend’s booboo, picking up a cool-looking bandaid, or being bitten by a buddy.  

Myth: Newborns Are Perfect & Don’t Need Anything

Fact: Newborns are perfect. Unfortunately, they often need medical care.

1% of children are born with heart defects, which could lead to death if untreated. They’re also at higher risk for a variety of illnesses, some quite serious. And if they get hepatitis B, they’re more likely to die from it than adults who contract the virus.

Medical advancements like newborn screening, vaccinating against potentially deadly diseases, and checking for heart problems have saved countless lives. Vaccination uses the body’s natural immune mechanisms to recognize and neutralize the virus if it is encountered.

Myth: European Countries Don’t Vaccinate, Why Should We?

Fact: What’s interesting is that in some countries where “only risk groups” are advised to get newborn vaccination, the vaccination rate amongst the general public is still higher.

In the United States, hepatitis B vaccination rates for newborns have been around 75%.

Almost every single European country is higher. Most are above 93%. And most countries are moving towards more universal recommendations as we work globally to combat hepatitis B.

Myth: It’s Just for Profit

Fact: The Hepatitis B vaccine has been around since the 1980s. It’s actually one of the least expensive vaccines available. And for most, it provides lifelong immunity if the vaccine series is completed.  The cost of treating a single patient for cirrhosis or liver cancer due to hepatitis B infection would pay for thousands of vaccine doses.  If the goal was profit for hospitals and pediatricians, vaccines would be counterproductive.

Most doctors who went into pediatrics did so because they sincerely want a healthier future for every child. Hepatitis B vaccination is one way they can offer that.

Talk to Your Doctor

Balancing risks, talking through benefits, and understanding mountains of research can be challenging. But your doctor is your ally in this journey, and they’d rather you ask so you can talk about it together.

If you’d like to do more research on your own as well, try these sources:

Hepatitis B Foundation | Vaccination

American Academy of Pediatrics | Fact Checked: Vaccination Reduces Risk of Chronic Hep B Infection

Children's Hospital of Philadelphia | Vaccine Education Center: Hepatitis B