Why do we give the Hepatitis B Vaccine at day 1 of life?

If you type into google, "Why do we give..."  the 1st suggestion is "hepatitis B vaccine at birth?"

Where can we get Hepatitis B (and C)?

• Direct contact with infected bodily fluid (Blood and semen)

  • Sexual activity

  • Mother-to-child transmission

  • Hygiene surrounding

    • Sharing needles, toenail clippers, hair clippers

      • Hepatitis B DNA was detected on 27% of nail scissors and in 50% of nail specimens from 63 serum Hepatitis B positive patients.  

      • Recent study out of South Africa suggesting that 42% of barber clippers were found to have Hepatitis B remnants. 

    • Estimated 2/3 of people with Hepatitis B don't know they have it

Americans don't realize how often they come in contact with other people's blood. 

Do you get your hair cut at a salon?

Do you get your nails done?

Do you share utencils at a restaurant? What if someone had an open sore in their mouth?

The risk is low but why would we risk getting a chronic liver infection that could lead to cirrhosis, liver failure and liver cancer?

Yes we have the blue liquid at the hair salons to kill Hepatitis vaccine but it only works on non-porous surfaces and after 10 minutes.  What about towels?

You might think its different in America.  Prevalence of Hepatitis B is 50% less in America.  But what happens when no longer vaccinate? This is evidence as to how many people are asking this question. 

It is important to ask questions especially about medication and treatments for our children.  We should be natural skeptics.  That being said, a skeptic that can't receive and digest new information is simply a denialist.  We can discuss the best time to give Hepatitis B vaccine but to deny that it is necessary is dangerous.

Facts about Hepatitis

Hepatitis can be acute or chronic. There are currently two forms of Hepatitis that can transition from an acute infection to a chronic one; Hepatitis B and C.  The USPSTF recommends we test all adults for Hepatitis B and C due to increased prevalence and lack of symptomatology in early stages.  When a condition has few or common symptoms, it is more likely to spread.  This is the case for measles as it presents like a cold 10-14 days before the rash.

Screening includes a blood test.  The testing is slightly more nuanced with Hep B because we actually have a vaccine and therefore, the lab testing is more complicated.  People are losing their healthcare due to high costs.  They will not have access to these tests.

Everything is risk versus benefit.

- Opponents of Hepatitis B vaccine given on day 1 of life believe risk is low given that standard of care includes testing the mother before birth.  The risk of vertical transmission (from mother to child) is highest during vaginal delivery.

- Depending on the antigens found on bloodwork, the risk of transmitting HBV during delivery is 10 - 90%. Infants who became infected had an approximately 90% chance of developing a chronic, lifelong HBV infection.

- When administered 12 hours of birth, the combination of the vaccine and HBIG is 85% to 95% effective at preventing transmission. This reduces the rate of transmission to less than 1% for mothers who are HBeAg-positive.

High-Risk Groups for More Frequent Screening:

• People who inject drugs

• People with multiple sexual partners

• People born between 1945 and 1965 (baby boomers)

• People with chronic liver disease

• Healthcare workers exposed to HCV

• People with a history of receiving blood transfusions before 1992

• People on long-term hemodialysis 

Screening for Pregnant Women:

• Infants born to HCV-infected mothers should be tested at birth and again at 18-24 months of age. 

• Pregnant women should be screened for HCV during each pregnancy. 

Laboratory Blood Testing:

• Hepatitis

  • Hepatitis A Antibody, Total

  • Hepatitis B Surface Antibody, Qualitative

  • Hepatitis B Surface Antigen with Reflex Confirmation

  • Hepatitis B Core Antibody, Total

  • Hepatitis C Antibody with Reflex to HCV, RNA, Quantitative, Real-Time PCR

Nail scissors and fingernails as reservoirs of hepatitis B virus DNA: Role of nail scissors in household transmission of hepatitis B virus. American Journal of Infection Control. Volume 46, Issue 7, July 2018, Pages 793-797

Spengane Z, Korsman S, Mkentane K, Davids LM, Zemanay W, Africa M, Mbhele S, Nicol M, Gumedze F, Ngwanya D, Khumalo NP. Blood and virus detection on barber clippers. S Afr Med J. 2018 Mar 28;108(4):278-282.