Hepatitis B Vaccination for infants

Specialties Pediatric


My son is only 6 days old and his pediatrician said that when I come to the baby's 1st dr appt at age 2 weeks, he will be getting his Hep B Vaccination. I asked if there is an epidemic going on and is this why we are going to get teh vaccine and the dr said no. I then asked why it would be necessary for a infant healthy to have this if it is only spread via sexual contact and bodily fluids....here is what he told me: "In case you are ever in a car accident and the baby needs a blood transfusion!" What kind of reason is this??? I understand the importance of vaccinations, I just cannot wrap my mind around why a newborn child would need this. Realistically, if we were in a car accident...would an infant even survive long enough to accept a transfusion?

I realize that when he gets older he will engage in sex and will probably need it before he becomes a teenager at least, but why in infancy? Could someone share their thoughts with me on this? When I told the dr that I will probably be refusing that vaccination he looked disapprovingly at me and wrote something in the baby's chart. Any thoughts/advice would be highly appreciated!! Thank you all. This is my 1st child and I want to make the right decision. -Tweetiepie


548 Posts

the blood transfusion argument is enough for me. also, a number of children each year contract hep b for unknown reasons, ie. not via an infected mother or blood product. according to this site, children can theoretically acquire it anywhere ("including playgrounds"):


from world health organization regarding hep b immunization programs in industrialized nations:

"in countries of intermediate hepatitis b viral endemicity (hbsag prevalence 2%-7%) and low endemicity (hbsag prevalence below 2%), routine infant hepatitis b vaccination is also the highest priority. this is because a high proportion of chronic infections are acquired during childhood in these countries, and most infections acquired during childhood occur among children born to mothers who are not infected with hepatitis b virus. these infections would not be prevented by perinatal hepatitis b prevention services that screen pregnant women for hbsag and provide post-exposure immunization for infants of hbsag-positive mothers."


the following is a long post from the texas dept. of health:

this is the html version of the file http://www.tdh.state.tx.us/immunize/docs/hepb_public.pdf.

[color=#0039b6]g [color=#c41200]o [color=#f3c518]o [color=#0039b6]g [color=#30a72f]l [color=#c41200]e automatically generates html versions of documents as we crawl the web.

to link to or bookmark this page, use the following url: http://www.google.com/search?q=cache:vfx5b_w-cm8j:www.tdh.state.tx.us/immunize/docs/hepb_public.pdf+acquiring+hepatitis+b+in+playgrounds&hl=en&start=1

google is not affiliated with the authors of this page nor responsible for its content. these search terms have been highlighted: acquiring hepatitis b playgrounds page 1 the importance of childhood hepatitis b immunizations

a public briefing


the office of the associate commissioner

for disease control and prevention


the bureau of immunization and pharmacy support

at the

texas department of health

december 2002

page 2


the case for childhood vaccinations

medical and public health experts strongly support universal vaccination against the

hepatitis b virus, but many parents still don't think that their children need to be

vaccinated. these parents mistakenly think that hepatitis b is basically a sexually

transmitted disease. it is not. though most adults in america are infected through sexual

and drug behavior, children become infected by other means. it is in the best interest of

any child to be vaccinated against hepatitis b at an early age.

before vaccination against the hepatitis b virus became routine in the past decade, almost

16,000 american children younger than 12 were infected each year by person-to-person

transmission. in the 1980s, public health experts saw 450,000 new infections each year;

in 1999, there were fewer than 100,000 new cases of hepatitis b. universal vaccination is

a proven success.

more than half of new hepatitis b infections strike young adults; 8 percent occur in

adolescents, 4 percent in children, and another 4 percent through perinatal transmission.

if infants and children are vaccinated at an early age, they can essentially pre-empt

acquiring an infection later in life.

infected infants and children can appear healthy and can unknowingly infect others. by

the time the infection is noticed, it is often too late to do anything about it. those infected

at an early age tend to develop chronic infection, leading to serious disability and

premature death. treatment for chronic infection is successful in only a half or a quarter

of the cases, and there is no specific treatment for acute hepatitis b infection.

with no cure, the key to controlling the disease is preventing it, and that can be done

through universal vaccination. the hepatitis b virus vaccine, developed in 1981, is the

only guaranteed protection. a well-accepted and safe vaccine that's given in three doses,

it has prevented the infection in thousands of children.

infection with the hepatitis b virus is a significant public health concern. it's estimated

that 1,000,000 to 1,250,000 americans are chronically infected, and 100,000 more are

infected each year. the virus is responsible for more than 11,000 hospitalizations each

year for related illnesses, and 5,000 americans die annually from its complications.

below, we'll describe how the virus is transmitted and explain the consequences of

becoming infected with it.


the hepatitis b virus is 100 times more infectious than the hiv virus.infection occurs

when blood or body fluids from an infected person enter the body of a person who is not

immune. the hepatitis b virus is in its most concentrated form in blood, but it's also

found in saliva, tears, sweat, mucus, vomit, urine, and feces. the virus is extremely stable

and can survive for up to a month on inanimate surfaces such as countertops and utensils.

page 3


though direct contact with blood or sexual fluids is the most common route of infection,

infants and children can encounter many opportunities for infection because of the highly

infectious and resilient nature of the hepatitis b virus.

* perinatal transmission

most infected babies get infected through perinatal transmission, or mother-to-infant

transmission at birth or shortly after birth. depending on the amount of virus in an

infected mother's blood, she has a 20 percent to 90 percent chance of transmitting the

disease to her newborn. babies infected perinatally have the greatest risk of serious life-

long consequences; 90 percent will become carriers and about 25 percent of these carriers

will eventually die of liver failure.

perinatal transmission can be averted by vaccinating the newborn. each year, the vaccine

prevents infection in about 9,500 infants.

texas state law requires pregnant women to be tested for hepatitis b infection at their

first prenatal visit and again at delivery. testing has reduced perinatal transmission but,

alone, it can't control the spread of hepatitis b among children, as they may still become

infected later in life. to protect all children from infection, it's necessary to vaccinate

them at the earliest possible age. in 1990, despite testing that showed no infection in their

mothers, almost 9,000 u.s. children had acquired the infection by the age of 10.

* person-to-person transmission

the hepatitis b virus can be transmitted to and from children through incidental contact

with blood or body fluids, and such person-to-person transmission is responsible for

thousands of new cases of infection annually. the normalplay of young children can

involve aggressive behavior such as biting or scratching, and rougher play can result in

open, bleeding wounds. young children are also notorious for unhygienic contact with

each other.

combine all of these elements, and one can see why instances of childhood infections

have occurred in child-care settings, schools, homes, and playgrounds. infection occurs

through bites or contact with breaks in the skin caused by cuts, bruises, or scratches. in

child-care centers, children mayalso become infected by coming into contact with the

bloody stools of other children or the open sores on any infected child-care providers. a

case of child-care transmission occurred in washington, d.c., when a 4-year-old boy was

bitten by an infected 2-year old with a history of aggressive behavior.

children can also infect adult teachers and child-care providers. consider the case of a

new hampshire elementary-school student who transmitted his infection to his teacher

when he sneezed a large amount ofmucus onto her dry, chapped (and thus vulnerable)

hands. the teacher, who was pregnant at the time, in turn transmitted the infection to her

newborn. in another situation, a child-care worker became infected after treating a scalp

wound on a 2-year-old infected child.

page 4


older children who play contact sports can also transmit the infection to each other. for

example, a u.s. high school's sumo wrestler transmitted his infection to other members

of his wrestling team. in sweden, an outbreak of infection occurred after track runners

shared the same water to clean their wounds. and in japan, the virus was spread among

members of an american football team who came into contact with each other's bleeding


infection can also be transmitted in the homes of chronically infected people through the

sharing of toothbrushes, razors, or eating utensils. because the virus can live on surfaces

for long periods of time, children with poor hygiene can infect their siblings and others in

the household. one example of household transmission involved a teenage immigrant

who infected his u.s.-born siblings by sharing and chewing the same pieces of gum.

many thousands of american children are infected by the hepatitis b virus through

person-to-person transmission. since more than half display no signs or symptoms, it's

difficult to know if a child is infected and unknowingly transmitting the infection to

classmates, playmates, and family members. since no state or federal laws exclude

infected children from child-care centers and schools, the uninfected are potentially at

risk on each and every school day.

a policy of vaccinating all children would assure parents that their children will not

acquire infection through child-care, school, and home contacts.

consequences of infection

after an initial acute infection with the hepatitis b virus, some people can become

chronic, life-long carriers. the younger a person is when infected, the greater the chance

that the person will become chronically infected.

as mentioned above, the youngest victims, those infected during the perinatal period,

face a 90 percent chance of becoming chronically infected. about 30 percent to 50

percent of acutely infected children between the ages of 1 and 5 develop chronic

infection, compared to the 6 percent to 10 percent of older children and adults who

progress from acute to chronic infection.

the majority of death and disability associated with hepatitis b infection is attributed to

chronic infection, which can lead to cirrhosis, liver failure, and liver cancer. about 3,000

to 4,000 americans die of hepatitis b-related cirrhosis annually; 100 to 300 die of

hepatitis b-related liver failure; and 1,000 to 1,500 die from hepatitis b-related liver


compared to healthy individuals, those with chronic hepatitis b infection are 12 to 300

times more likely to develop liver cancer, and those infected as children have a greater

chance of developing liver cancer or cirrhosis than those infected as adults.

page 5


up to 25 percent of infants and children infected by the hepatitis b virus will develop

liver cancer or cirrhosis later in life, while only 15 percent of those infected as

adolescents or young adults will develop these conditions.

prmenrs, RN

4,565 Posts

Specializes in NICU, Infection Control.

Lady Jez's answer is awesome!!

There is a public health thing called "herd immunity": the more members of the "herd" [that's us] that are immune against a disease, the lower the incidence of the disease in the UNimmunized members of the herd. Which makes for less disease altogether. A very good thing in the case of Hep B.

Please get your baby immunized!


23 Posts

Thank you for replying with such a detailed answer, Jez. Vaccinations are so important and parents need to be educated not just given a blanket answer of "blood transfusion". That doc missed an opportunity to educate. That or he just didn't know the answer.



12 Posts

Specializes in ER, L&D, postpartum, Peds.
I then asked why it would be necessary for a infant healthy to have this if it is only spread via sexual contact and bodily fluids....here is what he told me: "In case you are ever in a car accident and the baby needs a blood transfusion!" What kind of reason is this??? -Tweetiepie

I think it is wonderful that you dare to question.

When my first two children were born, they didn't give Hep B to babies. The oldest one got it when he went to 6th grade. I managed to survive until the age of 25 without getting Hep B vaxxed, and that's when I became a nurse and got it at the hospital I went to work for.

The answer of "blood transfusions" was not enough for me...My third child did not get vaxxed at birth, I refused. I did finally agree to it when he got his 4/5 year-old shots.

Re: "A handful of children get Hep-B for no apparent reason" (I'm quoting from memory here) , just as a handful of children have life-threatening side effects from the vaccination each year.


6 Posts

Specializes in DD.

I asked my doctor the same thing. He said, in truth, we really need to worry about it when they start becoming interested in "sex, drugs, rock and roll"... I had to laugh. I chose not vaccinate any of my 3 kids until just before middle school (5th grade). One school nurse was quite upset with me, saying "don't you think your child can ever get molested or raped?". Sure, but I really wanted them to be protected when they really were at greatest risk - when the potential for them to engage in sexual activity and drug use was greatest (I hoped they would engage in neither during their early teen years, but I am somewhat realistic). I didn't feel comfortable vaccinating the kids at such an early age then having to test for immunity, and re-boost because surface antibodies had waned by the time they turned 10 or 11. I feel that I made the right decision, in spite of the "herd" theory. I do realize there are risks- like accidents requiring blood transfusions or rape, and did not take those possibilities lightly, but felt the risks were greater leaving them unprotected, or underprotected when they really were at highest risk- now that they are starting to like rock-n-roll....

Every year people get MANY different diseases with no known risk factors, no known etiology...please. I lived to 23 without Hep B vax, and I doubt I would have gotten it then had I not entered the Air Force. I will say that if I had a teenage kid, it would get it, because you NEVER KNOW.

And how do we know that overvaccination isn't partially responsible for new, more virulent, more resistant strains of viruses? We don't.

They don't vaccinate like fiends in the UK, and I daresay my six-month-old British niece is JUST fine.

If we continue to shoot up kids for the "possible", we'll never let them leave the house....after all, people have gotten AIDS with no known risk factors, no known etiology....does that mean I don't leave my home and wrap my windows in duct tape? Of course not. Bring on the measles, mumps, the rubella, the diphtheria, the pertussis, the polio - all the stuff we've BEEN getting since birth, literally - and I'll do the rest when I think it's necessary. Hep B for someone who's six days old has always seemed obsessive to me. (Especially when, in some people, the vaccine doesn't take to start with.) If people want to do it, great - but don't give folks heck who choose to postpone. If I have patients in the future whose parents deem it necessary, fine - that's their belief. I certainly won't push my opinion on them for that any more than I'd scream at a new mother for not breastfeeding. But any rugrat of mine won't get it until they're a bit older. Just my opinion.

JeanettePNP, MSN, RN, NP

1 Article; 1,863 Posts

Specializes in Pediatric Pulmonology and Allergy.

I'm just wondering - if antibodies are transferred through breastmilk, what's the rationale for vaxxing babies under 6 months (if nursing)? Does anyone know when the antibody levels in breastmilk start to fall?

prmenrs, RN

4,565 Posts

Specializes in NICU, Infection Control.

Many adults are not immunized against Hep B. Can't transfer immunity if you don't have it. Also, if Mom is [unknowingly] + for Hep B antigen, she may actually infect baby. If s/he's been immunized, there is at least some protection. (Most moms are tested for Hep B in prenatals, but if they haven't had prenatal care.....)


316 Posts

Specializes in Emergency.

Hep B vaccinations are fast becoming a school requirement. The State of Illinois began requiring the vaccine 5 years ago.


7 Posts

Hep B vaccinations are fast becoming a school requirement. The State of Illinois began requiring the vaccine 5 years ago.

But all states have exemptions.



1 Article; 6,683 Posts

But all states have exemptions.


All states allow a physician to certify that a vaccine would be detrimental to a kid's health, as in cases of immune compromise. Mississippi and West Virginia, however, are two states that do not even allow religious exemption. And only 19 states allow philosophical exemptions.


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