Hepatitis B Vaccination For Babies
One of the most deferred, and declined, vaccines on the childhood vaccination schedule is the hepatitis B vaccination, given at birth.
Whether your baby has the vaccine, or not, is another of those decisions that you, as a parent, need to make for your baby. No one else can make it for you.
Nothing can ever replace doing your own research, and feeling confident about what you decide is right for your family. To begin the process of decision-making, here are some of the facts and information you’ll need.
But don’t just take my word for it. Seek out more information to cross check what you know, and what you discover here.
Firstly, here is some basic information about hepatitis B.
What Is Hepatitis B?
Hepatitis B is a virus that attacks the liver and causes inflammation. The virus can be transmitted between individuals through infected blood and body fluids.
You cannot contract hepatitis B from coughing, sneezing, kissing, hugging, holding hands, or sharing crockery and utensils.
Hepatitis B can be either acute or chronic.
An acute infection is a newly diagnosed infection. According to the Hepatitis B Foundation, most healthy adults who are infected with hepatitis B do not have any symptoms, and their immune system is able to get rid of the virus without any problems.
Those who have cleared the hepatitis B virus will always show hepatitis B antibodies in their blood, but they won’t become infected again. They are classed as being immune.
Those who cannot get rid of the virus after six months are classed as having a chronic infection.
How Common Is Hepatitis B In Australia?
Australia is categorised as a ‘low prevalence’ country for hepatitis B. The virus affects around 1% of the population.
In 2013, approximately 210,000 people were living with chronic hepatitis B infection.
According to an article in Australian Family Physician, “two-thirds of Australians living with CHB [chronic hepatitis B] were born overseas, in endemic countries, or identify as being Aboriginal and/or Torres Strait Islander”.
The article also states: “The increased prevalence of CHB in Australia is primarily due to increased migration from endemic countries”.
Groups At Risk For Contracting Hepatitis B
In Australia, and around the world, there are specific groups that are at increased risk of contracting hepatitis B.
In the United States, more than 50% of Americans with chronic hepatitis B infections are of Asian and Pacific Islander descent. In Australia, we have a similar situation, with the level at around 40%.
Here is a checklist to see if your baby is at risk of hepatitis B exposure.
Do any of these apply to your baby?
- Having sex with a man who has sex with other men? (3% prevalence)
- Sharing needles with a drug addict? (4% prevalence)
- Being a migrant from a hepatitis B endemic country? (8% prevalence)
- Being of Aboriginal or Torres Strait Islander descent (4% prevalence)
- Being an inmate of a correctional facility?
- Born from a hepatitis B positive mother?
From 2009 to 2013, the most frequently reported source of exposure (where a source was identified) was injection drug use.
Preventing Risk For Babies
I certainly do not want to downplay the seriousness of this disease.
In fact, the younger a person is at the time of contracting hepatitis B, the more likely the disease will become chronic. The important thing you need to decide is whether the risks outweigh the benefits, or not.
It’s highly unlikely that a newborn baby will be getting a tattoo in the backstreets of an endemic country, or sharing needles with a hepatitis B positive baby in the nursery.
In all seriousness, the most likely way newborn babies would contract hepatitis B is via an infection from their mothers.
If a baby’s mother is not hepatitis B positive, the chances her baby will contract hepatitis B within days of birth are extraordinarily low. Another option is to give birth at home, with the help of a qualified independent midwife, where there are no such viruses or diseases. (Thought I would just sneak that one in).
Consider this question, and how it is answered, on the SA Health government website:
“Why do all newborn babies need to be immunised against hepatitis B at birth?
The birth dose of hepatitis B vaccine is recommended to prevent:
- the mother from infecting her baby, if the mother is a hepatitis B carrier
- the baby from contracting the disease from household members who are hepatitis B carriers”
In fact, most health and government websites will tell you that these two risk factors are the reasons why all babies should have the hepatitis B shot at birth.
However, mothers are usually aware of their hepatitis B status, before or just after they become pregnant.
Your doctor will usually include hepatitis B in the list of things to check when you have a blood test. If you are pregnant and haven’t been tested for hepatitis B, you can simply ask your doctor or midwife to do this.
As long as you and your partner are both hepatitis B negative, and you are certain that you haven’t had unprotected sex, or shared needles, with a hepatitis B carrier in the last three months, you should get a very accurate, negative test result.
Bear in mind that it is now very common practice for babies to share a room with their mothers after the birth, without separation. So the chances of infection from an accidental procedure, or through babies receiving breastmilk from a hepatitis B infected mother are very slim. If your baby is born by c-section or requires any procedure, make sure either you or your partner are with the baby at all times.
The chance of a needle stick injury occurring in a public place, and resulting in a positive hepatitis B (HBV) diagnosis is remote – especially where it involves an immobile, and fully supervised baby. Nevertheless, it is always important to take care, and in the unlikely event of this happening, you should always see a doctor.
A study in the UK found only 4.7% of needle and syringes picked up in four parks had any evidence of HBV, which means 95.3% did not. Viruses can survive outside the body for only a limited time. There are lots of reassuring studies on needlestick injuries here.
But Wait, Won’t The Hepatitis B Vaccine Protect My Baby In Future?
If you’re concerned that your baby will, in the future, shoot up with junkies, or have unsafe sex with men who have sex with other men, and educating them won’t be enough, then consider this:
- Countries such as the UK, Sweden, Denmark, Canada, Finland, Norway, Iceland and Switzerland only give the Hepatitis B vaccine to at-risk individuals. These countries all have a low prevalence of hepatitis B.
- Vaccine-induced immunity wanes (and vaccines are not 100% effective). From the H-B-VAX II insert: “The duration of the protective effect of H-B-VAX II is unknown. Therefore, it is not known whether a booster dose will be necessary”. Studies confirm this: “Antibodies against hepatitis B surface antigen (HBs) wane over time after vaccination for hepatitis B (HB); hence, the duration of protection provided by the vaccine is still unknown”.
- The younger babies are, the poorer the response triggered by their almost non-existent immune system will be. Premature babies have an especially poor response, and they are given the same dose as full term babies. Several midwives have expressed their shock at seeing preemies being given the same dose as 4 kilogram, full term babies. One was just 26 weeks old, despite evidence finding that there is a poor response in very premature babies.
When your baby is old enough to have sex, or perhaps just before, might be a better time to consider having the vaccine – if that’s what he or she wants.
How Effective Is The Hepatitis B Vaccine?
When you look at studies on the hepatitis B vaccine and the duration of immunity, at first glance the results are great. They suggest that the participants’ bodies still showed signs of antibodies many years later. But if you looked closely, you would see that a significant percent of the study participants did not have what is classed as immunity.
To be considered immune, a person must have protective anti-HBs levels greater than 10 IU/mL.
A 2014 study titled, ‘duration of protection after infant hepatitis B vaccination series‘, found only 24% of adolescents had protective anti-HB levels. It stated that 92% achieved protective levels after a challenge dose.
Another study found 40% had protective anti-HB levels 15 years after their primary vaccination series of shots, meaning 60% did not. You can find more studies showing the same results on Pubmed.
A Newborn's Almost Non-Existent Immune System
A baby’s immune system needs time to develop. It needs to learn what is foreign and what is not.
Breastmilk is designed to protect a baby while his or her immune system ‘learns'. This is normal, natural biological development. For various reasons, however, some mothers cannot breastfeed.
You might ask, ‘But isn’t that why we have vaccines, to give that protection to babies with such a vulnerable immune system?
Vaccines contain adjuvants, which are ingredients designed to ‘force' a response from the immune system.
Adjuvants have been the subject of huge controversy. You might have heard people talk about mercury or thiomersal in vaccines (more recently in flu vaccines), but most vaccines no longer contain these ingredients. The most common adjuvant used today is aluminium, which is a neurotoxin.
Even though vaccines contain small amounts of it, the less they are given, the better – especially in a developing newborn brain.
In newborn babies, it is notoriously more difficult to achieve an adult-like response, because the immune system just isn’t there to be stimulated.
According to a World Health Organization (WHO) document, titled Vaccine Immunology:
On page 32, “Antibody responses elicited before 12 months of age rapidly wane and antibody titers soon return close to baseline levels.”
“The induction of strong antibody responses to a single vaccine dose that would be given soon after birth unfortunately currently remains an elusive goal, and adult-like responses may eventually be only elicited in older infants”.
Effects Of The Hepatitis B Vaccination
While some vaccine inserts claim the hepatitis B vaccine will not have any impact on breastfeeding, the listed effects suggest the opposite. For infants, common side effects of the hepatitis B vaccine include: loss of appetite, irritability, fatigue, crying, headache, soreness, pain, and swelling.
Breastfeeding is critical to a baby’s immune system – especially in the early days. It helps to set up important foundations for life, and to protect babies against disease and illness. Without colostrum and early breastmilk, babies are more vulnerable.
Autoimmune and inflammatory effects have also been emerging as a concern. An example of this is multiple sclerosis – you can read about a large study in France based on official data over 12 years, here.
It’s also common knowledge that most drugs come with the risk of an allergic reaction, as well as a rare chance of death (even a household pain killer, like paracetamol, can be deadly in large doses). The hepatitis B vaccine is no exception. We can be allergic to anything, just like bee stings, peanuts, and latex.
On its website, the Centers For Disease Control and Prevention (CDC) states that, if you previously had allergies or severe reactions, you should not have the hepatitis B vaccine.
“If you ever had a life-threatening allergic reaction after a dose of hepatitis B vaccine, or have a severe allergy to any part of this vaccine, you may be advised not to get vaccinated”.
While it's not possible to know if a newborn baby has a severe allergy until he or she has had their first vaccine, the CDC advises signs of a severe allergic reaction can include hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, and weakness.
It then goes on to outline the United States’ National Vaccine Injury Compensation Program. We have no such thing in Australia, which seems prudent considering there is now legislation in place (in some Australian States ) to make sure all children attending kindergarten are fully vaccinated.
Deferring Hepatitis B Vaccinations
If you want to defer your baby's hepatitis B vaccination, you might be faced with questions and criticisms. I say might because I personally know of many midwives and medical doctors who don't or won't give their babies the hepatitis B shot at birth either.
It's difficult for them to talk about this publicly because they could easily lose their registration for not encouraging everyone to have all the vaccines. Even on Facebook, many professionals have been targeted and reported to authorities by aggressively pro-vaccine individuals and groups, for sharing information about vaccine concerns. Some have lost their registration, others have lost their shifts – and therefore livelihood. All of them are unable to speak up. This is the era we now live in. So it's more important than ever to do your own research.
What you can do is have an open discussion with your healthcare providers, to find out what their opinions are.
Always ask to read a vaccine insert before agreeing to any. Not a printed off information fact sheet that they'll likely try to give you, but the actual insert from the box of the vaccine.
It might help to know that the H-B-VAX II vaccine information specifically suggests that babies born to hepatitis B mothers have the vaccine at birth:
“For babies born to mothers infected with HBV, the first dose of H-B-VAX II should be given at birth, or as soon thereafter as possible. In addition to the H-B-VAX II, an injection of hepatitis B immune globulin is also given. It is important to return at the scheduled dates for the follow-up doses”.
Doing this can significantly help prevent transmission from mother to baby.
But for everyone else, it says: “H-B-VAX II is generally given as a total of three doses over six months. Each dose is given on a separate visit. The schedule is: 1st dose: at elected date; 2nd dose: 1 month after first injection; 3rd dose: 6 months after the first injection. For children and teenagers aged 11 to 15 years, a total of two doses may be given instead of three”.
And this is what happens in many countries around the world. But not Australia or the United States.
There are many controversial decisions we need to make as parents. When people are uncertain, they look to experts or higher powers for answers. But since our medical care providers are gagged and threatened with registration loss on the issue of vaccination, it is critical to research both sides of the issue, if possible, before discussing any concerns with your healthcare provider.
Many of us do our research before making any big purchases – of cars, homes or white goods. Surely it’s even more important to do some research before deciding on such a big ticket item as your family’s health.
Also, watch this clip and hear about what a mother from the United States had to endure when she declined the hepatitis B vaccine for her baby.