Question: My wife and I recently had our first child. We were advised by our pediatrician to have him vaccinated for hepatitis B. However, we don't consider ourselves at risk for hepatitis. Isn't it a bit excessive to vaccinate all newborns for this?
Answer: The emergence of HIV and AIDS over the past 25 years has made wicked stepsisters of most other infectious diseases, at least in the public's mind. Collectively, we tend to consider infections like hepatitis of only minor significance.
Truth be known, however, hepatitis B is much more common than HIV, and many more people worldwide die of hepatitis B complications every year than of AIDS.
It is estimated that fully one-third of the world's population has been exposed to hepatitis B, and more than 350 million people are chronically infected (compared with 35 million AIDS patients worldwide). In some areas, such as Southeast Asia and Sub-Saharan Africa, 20 percent of the population is infected with hepatitis B virus.
At least six different kinds of hepatitis exist, but types A, B, and C are the most common. Hepatitis B is responsible for 40-45 percent of all hepatitis cases in the United States. About 300,000 people get acute hepatitis B annually, although only about 50 percent of those have symptoms (loss of appetite, nausea, abdominal pain and jaundice). More than 1 million Americans are chronically infected with hepatitis B, and about 6,000 people die each year from complications of chronic hepatitis B infections.
Some people with chronic infection are completely healthy, even though the virus actively replicates in the body and they may be infectious to others. However, some chronic infections lead to progressive liver deterioration (cirrhosis and liver failure) or liver cancer. This is another example of a cancer where a virus is its primary cause (cervical cancer is another).
Hepatitis B is spread or acquired through exposure to infected blood or secretions from a person's body. The highest concentrations of the virus are in blood, semen, vaginal secretions, breast milk and saliva. The virus is in low concentration in feces and urine, making acquisition through food, water and casual contact very unlikely. All donated blood is automatically screened for hepatitis B; therefore, it's extremely uncommon to get it from a blood transfusion.
In the United States, the most common mode of transmission of hepatitis B is sexual intercourse. Other modes are I.V. drug use, subcutaneous injections of illicit drugs, tattooing, body piercing and transmission from mother to child during childbirth.
Out of concern for the latter, for at least a decade it has been standard practice to screen all pregnant women for hepatitis B. Children born of infected mothers are treated with immune globulin to prevent them from acquiring the virus.
A vaccine for hepatitis B has been in existence for about 20 years. Persons at risk for hepatitis B, particularly health-care workers, are routinely given the vaccination, which consists of three injections of a laboratory-prepared protein over a six-month period. There is no risk of actually acquiring hepatitis or any other infection with the vaccine, since is it not derived from humans or animals.
The Center for Disease Control and Prevention recommends universal vaccination for all newborn infants and children at age 12. This is because hepatitis B almost always results in chronic liver disease in infants and children who acquire the virus (as opposed to only 5 percent of adults), and chronic disease often results in death.
Fortunately, the hepatitis vaccination provides lifelong immunity. Negative reactions to the vaccine are extremely rare, and the costs are often covered by health insurance benefits.
Since the potential upside is so great, and the downside is negligible, I encourage you to have your infant son vaccinated, as recommended by your pediatrician.
Stephen Lamb practices OB/GYN at the Millcreek Women's Center in Salt Lake City. He is also the co-author of "Between Husband and Wife." E-MAIL: firstname.lastname@example.org