Amidst vaccine debate, experts urge staying the course with vaccination
Fact checked by Ros Lederman
Above photo: Heather Hazzan, SELF Magazine and the American Academy of Pediatrics
Parents increasingly show up at their pediatricians’ offices questioning the risks and benefits of vaccinations. And can anyone honestly blame them? Most haven’t witnessed the ravages of infectious diseases that once sickened hundreds of thousands of children.
The hepatitis B vaccine is currently in the spotlight, following a September meeting of the newly appointed Advisory Committee on Immunization Practices (ACIP). The committee reviewed the national vaccine schedule, but ultimately made no changes to the long-standing recommendation to begin the three-dose hepatitis B vaccination series at birth.
Still, the public challenge to this protocol — and to vaccines more broadly — has left many people confused and concerned.
Why the hepatitis B vaccine matters
The hepatitis B virus attacks the liver and can go undetected for years or decades, quietly damaging tissue. Over time, it increases the risk of cirrhosis and liver cancer.
Before the vaccine’s introduction in 1982, up to 300,000 people in the United States were infected annually, including approximately 20,000 children. After ACIP recommended universal infant vaccination in 1991, new hepatitis B infections among newborns and children dropped by 90%, according to Jonathan Pinsky, MD, medical director for infection prevention and control at Endeavor Edward, and Jennifer Grant, MD, system medical director of infection control and prevention for the Endeavor Health system.
Because treatment for hepatitis B is difficult, vaccination at birth remains the first line of defense, both to prevent early transmission and to protect against future exposure.
“Hep B is a blood- and body fluid-related virus, which means it is easily transmitted during birth,” says Archana Chatterjee, MD, PhD, dean of Chicago Medical School and senior vice president for medical affairs at Rosalind Franklin University of Medicine and Science.
While birth is a primary mode of transmission, the virus also can spread through sexual contact, shared needles, or exposure to infected body fluids.
An estimated 2.4 million people in the U.S. are living with hepatitis B infection, but only about half know they are infected.
That means infants and young children remain at risk, even when parents test negative for the virus before delivery. Without vaccination, exposure can occur through:
- Contact with infected blood from cuts or scrapes
- Shared food or utensils
- Shared toothbrushes or washcloths
- Contact with contaminated surfaces or clothing
- Exposure at daycare, school, or medical facilities
“The hep B virus is very hardy and can survive on surfaces for over seven days at room temperature,” says Stephanie Gretsch, senior epidemiologist with the Vaccine Preventable Diseases Program at the Chicago Department of Public Health.
“Young children who become infected are at a much higher risk of becoming chronically ill compared to adults,” Gretsch says. “Up to 90% of infants with hepatitis B go on to develop chronic, lifelong infection, and 25% die prematurely of liver cirrhosis or liver cancer.”
Low risk, high reward
Vaccination for hepatitis B begins within the first 24 hours of birth. Pinsky and Grant say that early administration is key because it:
- Prevents perinatal transmission
- Provides a safety net when a parent’s infection status is unknown
- Protects against potential household transmission from an infected family member or caregiver
- Increases the likelihood of completing the full three-dose series
While some parents hesitate to vaccinate a newborn, Chatterjee says the benefits outweigh the minimal risks.
“An infant infected at birth is infected for life,” she says. “Waiting even a month or two months from birth allows the virus to take hold.”
“Most side effects are mild, such as pain at the injection site,” say Pinsky and Grant. Severe adverse reactions are extremely rare, and experts have never linked any deaths to the hepatitis B vaccine itself.
Chatterjee offers reassurance for new parents. “Because the hep B vaccine is given to newborns, it has been extensively studied to make sure there is no increased risk from a potential fever or other reactions.”
Since its introduction in the early 1980s, healthcare providers worldwide have administered more than 1 billion doses of hepatitis B vaccine. In addition to the extensive pre-approval testing, decades of ongoing monitoring continue to demonstrate the vaccine’s safety and effectiveness.
Talk with your child’s pediatrician or another trusted healthcare professional about your vaccine questions. Avoid getting information from unofficial social media or politicized sources. Your pediatrician has your child’s best interest at heart.
Gretsch also recommends parents visit the Chicago Department of Public Health website and follow the department on social media for accurate and understandable information on vaccines and other important public health topics.
Rebecca is an experienced registered dietitian, freelance writer, and yoga teacher who loves to read, hike, and tend her garden.
