My Thoughts on Hep B Vaccine

One of my parents recently suggested that I should address some of the healthcare topics that politicians are discussing on my blog.  I will present my assessment of the situation from the perspective of someone who has cared for children for 26 years, has witnessed patients die from infectious diseases, and has completed over a decade of college courses in chemistry, biology, statistics, and infectious disease.  

First up, the suggestion that Hep B should be given later in life instead of as a newborn.  Hepatitis B is primarily spread through secretions exchanged in sex, as well as through blood exposure.  Blood exposure is a risk for health care workers/first responders, IV drug users, and the unfortunate preschooler who steps on a bloody needle in a playground.  Most of these risks seem to take place later in life, so why do we give the shot at birth?  3,600,000 births take place in the US every year.  Of these women, 0.5% of them have Hepatitis B (Clinical Overview of Perinatal Hepatitis B | Hepatitis B | CDC), which would equal 18000 of births are by moms with Hepatitis B.  Of those babies, 90% of them will develop chronic Hepatitis B due to the exposure to their moms, which equals 16200 babies infected with Hepatitis B without vaccination or treatment. Of those, 25% of the babies would die (4050).  Now you are thinking, "But with testing mom and treatment (the vaccine is part of the treatment, along with antibodies) for the baby, these numbers must be much lower."  Correct, with treatment, more than 90% of these infants will not develop chronic Hepatitis B (Prevention of Perinatal Hepatitis B Virus Transmission - PMC .).  So, with vaccine and treatment, 1,800 babies will be infected with Hepatitis B (much less than 16,200), and 450 will die.  

So, what is the issue?  The issue is that no labs are perfect.  Lost samples, mislabeled samples, etc, plus even when done perfectly, 1-2% of lab results are wrong - false negatives.  Assuming only a 1% false negative rate, of these 18000 births to Hepatitis B positive moms, 180 of them will be told they don’t have Hepatitis B.    According to the CDC, giving the Hep B at birth will stop 75% of the infections in babies born to moms with Hepatitis B.  So, of the 180 babies born whose moms had false negative tests, the vaccine will stop 135 of them from developing Hep B and 34 of them from dying (Hepatitis B Perinatal Vaccine Information | Hepatitis B | CDC).

Now you might be thinking, “All that math above, and Dr. Fisher is saying giving three and a half million babies hep B vaccine at birth will stop 135 from getting sick and 34 of them from dying seems like a lot of shots to save a life.”  Is this necessary?  Yes, because you are going to give them anyway!!  Why would you delay a shot until 12 years old if you could have saved 135 families from a miserable situation?  You were already going to do it later, why not do it now?  I honestly don’t understand why this is something that would be suggested by anyone who cares about kids' health.  Hep B vaccine is incredibly safe.  I have never seen a side effect from it.  Not one.  Not with thousands of babies over 26 or more years.  Suggesting that we delay the Hep B vaccine is a little like suggesting we should only use seatbelts on kids 12 and up.  It just makes no sense.  

Until next time, good luck parenting,

Dr. William Fisher

Fisher Pediatrics