Read the interview of the Dr. @chari.cohen, president of the Hepatitis B Foundation, explaining there is no scientific basis for scaling back newborn hepatitis B shots.
The Hepatitis B Foundation warns new guidance could undo decades of progress : NPR
I disagree with this. As someone who was diagmosed with chronic hepatitis B as an adult and who was told by my doctor at the time that the virus is usually transmitted sexually in Western countries, the obsession with vaccinating newvorn babies makes no sense to me.
Hi @Barry,
As mentioned in other threads, newborns are particularly vulnerable to getting a chronic infection if they are exposed to the virus (either at birth or horizontal transmission as infants). Given only ~10% of people with Hep B know they have it, it is better to be safe than sorry. In other countries, the birth dose vaccine has prevented millions from getting chronic hep B, liver failure, and liver cancer (both adult and childhood cases).
If done as “catch up” vaccinations later in life, it takes at least 6 months before one is completely protected. Moreover, as mentioned in the article, the safety of these vaccines have been shown over and over.
Given that there is no detectable downside and could potentially prevent a life-long, cancer-causing condition, the original public health recommendations of everyone getting birth dose vaccination is really the best option available to us.
@chari.cohen, please feel free to add to this.
Thomas
Sorry, not buying it. The only newborns at risk of contracting hepatitis B are those whose mothers are infected with the virus as well. If the mothers are tested for hepatitis B during pregnancy (I’ve asked before on this forum whether they are or they aren’t tested and didn’t get a definitive answer). In Western countries, this is a very small percentage of women. Even then, I’m confused how a vaccine given to a baby already infected during birth can help. It’s also important to remember that there is a very large ethnic component to this virus. The great majority of babies born with hepatitis B are Asian or African. The chances of a white or Hispanic woman having hepatitis B and transmitting it to their baby is tiny. (That’s why when I was growing up in Ireland I never heard of anyone (child or adult) with hepatitis B.) It would make much more sense to encourage sexually active adults to get vaccinated. If you ask me, it comes down to money: vaccine manufacturers can make more money from vaccinating babies than adults, the reason being most people get every vaccine for their child that’s recommended by the authorities. Adults on the other hand tend to be more reticent - most young adults don’t bother with the flu shot for example and wouldn’t have taken the Covid “vaccine” either were it not for the fact that we were bullied and coerced into taking it. In fact, I recently came across an article on Twitter from the New York Times from 1991 about the hepatitis B vaccine that more or less said the exact same thing: the real at-risk groups in the US: those with multiple sexual partners and intravenuous drug users weren’t coming forward for the vaccine. This annoyed the vaccine manufacturers, who then put pressure on the public health authorities to have the hep B vaccine added to the list of scheduled vaccines for young babies.
Don’t misunderstand me: I’m not actually opposed to newborns getting the hepatitis B vaccine - if their parents so wish - I simply don’t think it’s as important as many of you are making out. Moreover, as someone who contracted hepatitis B in his late 30s I’m annoyed at the double standard in relation to the vaccine. I was at greater risk of contracting that virus than a newborn baby born to a hepatitis B-negative mother, yet no one ever advised me to get the vaccine. This annoys me and makes me suspicious.
Hi @Barry ,
To answer your question on whether all mothers are tested for hepatitis B, the short answer is that they are supposed to be (it is standard of care), but real-world data shows that in the US, the screening is done about 85% of the time, meaning that 15% of women are never tested. Also, transmission of hepatitis B in the womb is rare (though this can happen, especially if a procedure such as amniocentesis is performed), so for the vast majority of babies born to HBsAg positive mothers, their first exposure to the virus is at the time of birth. The rationale behind giving the vaccine at birth is that it can give the immune system enough of a boost to prevent the infection from taking hold. I actually think it’s pretty remarkable that the vaccine works as well as it does for post-exposure prophylaxis!
I also think that giving the vaccine to infants is the best way for us to get high vaccine coverage rates across the population. Like you said, adults with behavioural risk factors are not coming forward to get the vaccine, because many healthy adults don’t see their doctor regularly. I also think that if we do what you’re suggesting, and do away with official recommendations, and just rely on patients to make decisions for themselves, I think that we as patients need to take responsibility for those decisions, where we can’t really blame the doctors anymore for not recommending the vaccine if it’s not part of the standard of care. That’s also why I think it’s important to prioritize vaccinating infants/children, because babies don’t have any decision-making capacity of their own, so they rely on adults to protect them.
If we assumed hypothetically that adults and children were all equally likely to have an acute infection turn chronic, I would actually agree with your suggestion to focus on vaccinating adults. But that’s not what we see from the data. I also want to add that the protection from the hepatitis B vaccine lasts for several decades (possibly lifelong, but the current vaccines have only been around for ~40 years), so it’s likely that if it had been routine when you were a child, you would still be protected today.
I am adopted from China, and grew up in Toronto, Canada. Unfortunately, Canada does not have nationwide birth dose (or even infant) vaccination, though there are multiple groups trying to push for this. I found this paper showing the cost-effectiveness of infant (and birth dose) vaccination. The analyses here estimate that there are a non-negligible number of children who are not born to HBsAg-positive mothers, who are still catching hep B before age 10. That being said, I don’t think delaying the vaccine until 2 months old is the end of the world, especially if we still continue to vaccinate babies at birth if their mothers were not tested. It actually concerns me more that the current advisory committee is suggesting that people only need one dose of the hep B vaccine and should have their antibody levels tested to see if they need more. @chari.cohen also covered that in her interview, and the data suggest that if we move forward with that approach, only about 25% of people would develop protective immunity, and that immunity also may not be long-lasting (we don’t know because there are no longitudinal studies evaluating a single dose schedule).
Sorry for the long reply, but I hope this helps.
Thanks for the thoughtful response. There’s lots there to dissect but I’d like to make two points:
I think you’re confusing exposure with infection. Exposure has the potential to lead to infection, but if the immune system can respond quickly enough, it will not. For example, if you’re sitting next to a stranger on an airplane who is coughing and sneezing, you will undoubtedly inhale some of their respiratory droplets being in an enclosed space together. But this doesn’t mean that you automatically caught whatever they had (cold/flu) just because you sat next to them. The same thing goes for babies born to HBsAg positive mothers. They would end up with some viral particles floating around in their bloodstream, but if the immune system can inactivate the virus before it sets up camp in the liver, the baby can avoid catching Hep B. You are right that the vaccine wouldn’t help babies who were infected through the placenta before birth, but like I said, that’s not a common mode of transmission, so it’s still better to vaccinate these newborns, because we would miss the critical 12-24 hour window if we performed a blood test to see if the baby was already infected and had to wait for the results to come back.
I agree with you that we need to do more in terms of reaching adults who didn’t get the vaccine as children. Yes, the 5-10% of people who end up with a chronic infection can be a lot of people worldwide. But just because we need to do more for adults, that doesn’t justify removing a public health intervention (vaccinating babies) that has been shown to be effective.
I’ve also said this before that the recommendations are not a requirement for parents to get their kids vaccinated. Parents can, and have always had the right to say no. However, the recommendations do require insurance companies to cover the cost of the vaccine. I would say that the majority of parents who choose to vaccinate their kids do so because it’s convenient (since it’s free). I think that we would have much lower uptake of childhood vaccines if parents had to go out of their way to pay for them, even if they theoretically could afford it.
We have also seen other preventable diseases making a comeback due to declining childhood vaccination rates. The best recent example is measles. In 2025, the US reported a cumulative total of 2071 cases. This is still much lower than the number of reported cases before the MMR vaccine became available, but my point is that it’s only a matter of time before diseases that are currently uncommon make a comeback if we stop vaccinating children.
Hi @Barry,
Thank you for raising these great points. I’ve got a few thoughts regarding them:
There is no transmission that occurs while the baby is in the uterus, and exposure only occurs during birth. Birth dose vaccination is incredibly successful: there has been no reported chronic HBV infection from a HBV-positive mother with a HBV DNA less than 200,000 IU/mL when birth dose vaccination is provided. For women with higher viral loads, transmission risk can be reduced with antiviral therapy.
Indeed, this is an important point and should be driven. In Australia, there was a catch up campaign to make sure that teens were vaccinated too. We are also pushing campaigns out to raise awareness. One of the major reasons for birth dose being so widely pushed and successfully rolled out in Australia (we are at >90% birth dose vaccination for all newborns) is that the state govt controls much of the health aspects as well as the hospitals. So due to the combined responsibility, practical aspects of implementation, and bang-for-buck, birth dose vaccination was chosen as the higher priority to pursue.
Great point, though I don’t think any country implements forced vaccination. A large portion of the 5-10% unvaccinated newborns are due to parental objection.
Thomas
Great point @et5656. While we may not be in endemic countries at the moment, it seems very cruel and illogical to condemn a generation to increased risk of a chronic, cancer-causing condition until we decide to start the vaccination plan up again.