Important: This is intended as general information only. It may not apply to your specific situation. It is not a substitute for medical advice. If you have a question or concern, please raise it with me at your next appointment or contact me sooner if it's urgent.
Hepatitis B Vaccination for Newborns
It is recommended that all children receive a series of vaccines over the first few years of their lives to protect them from serious infections. One of these is infection with the Hepatitis B virus (Hep B). Unlike most vaccinations, which start when the baby is six weeks old, the first dose of the Hep B vaccination is given within a few days of birth.
Why is the Vaccination Given So Early?
When babies and children are infected with Hep B, the infection usually occurs in the first few days to weeks of life. The infection is usually transmitted from the mother or a close household contact. Although there are several ways to get Hep B, the most common way that people are infected is as babies or young children. If we were to wait until 6 weeks of age or later, we would miss the chance to prevent this infection in the bulk of people who are affected.
Why is This Vaccination So Important?
When an adult contracts Hep B, they may become unwell (sometimes seriously unwell) but in most cases their immune systems eventually get rid of the virus. In infants, the reverse is true. While it is uncommon for infected babies to become unwell in the short term, they usually (in 90% of cases) become chronic carriers of the infection. This means that they never clear the virus from their bodies. Being a chronic carrier has some important health consequences. About a quarter (25%) of people who are chronic carriers develop cirrhosis of the liver which may result in liver failure, cancer of the liver and death. Currently, in Australia, the most common reason for needing a liver transplant is cirrhosis or cancer caused by viral hepatitis.
In addition, people who are chronic carriers may pass the infection on to someone else, including any children they may have.
Does My Child Need a Vaccination Even if I’ve Been Tested?
Hepatitis B testing is one of the standard blood tests performed on women in early pregnancy (see First Trimester Tests for more information). This is because it is very important to identify women who carry the virus - their babies (and sometimes they themselves) need extra treatment. However, it is still recommended that the babies of women who don’t carry the virus are vaccinated. This is because the test may take some time to become positive so we may not detect an infection in a pregnant woman if it has occurred recently. Also, while we can test all pregnant women, we can’t test everyone else that the baby will come into contact with in the first few days to weeks of it’s life. It’s possible that one of your relatives of close friends is carrier of the Hep B virus without knowing it and could, unintentionally, place you baby at risk.
Does The Vaccination Work?
The vaccine has been shown to be very effective in preventing Hep B infection in newborn babies. However, the baby will still need 3 further doses of the vaccination (from your GP or a vaccination clinic) over the first year of his or her life in order to have lifelong immunity to Hep B.
Is the Vaccination Safe?
Yes. As with all treatments, there is the possibility of side effects. These are uncommon and usually mild such as bruising at the injection site. Serious reactions such as allergic reactions are extremely rare. The vaccine does not contain any live virus so it is not possible for anyone to ‘catch’ Hep B from having a vaccination. The vaccination does not affect breastfeeding.
If you do a bit of googling about vaccinations, you’ll find lots of websites telling you that vaccines are responsible for all sorts of problems, in particular autism. While the people pushing this information are often quite compelling and emotive, their science is wrong. There is extensive evidence proving that autism is not related to vaccination and that it is much safer for your child to be vaccinated than not vaccinated. Try not to be sucked in by these people and stick to information provided by reputable scientists such as information on university and hospital websites.
What If I am Hep B Positive?
The recommendations for women who are Hep B positive are slightly different. It’s worth mentioning that most of the women I see who are Hep B positive, both in my private practice and my work in a public hospital, are women who contracted the infection as babies and are now chronic carriers. In the first instance, it is important that these women see someone who specializes in the treatment of viral hepatitis (such as a hepatologist or an infectious diseases physician) who can provide longterm monitoring of their liver function and treatment if required.
Secondly, as well as receiving the Hep B vaccine within 12 hours of birth, babies of these women also receive a further injection of Hep B immunoglobulin (antibodies directed against the the Hep B virus) to further reduce the risk that they will prick up the infection. This has been shown to be very effective in preventing transmission – it works in up to 95% of cases. These babies will then be followed up by a paediatrician to make sure that they have not contracted the virus.
Women who are Hep B positive can still have a vaginal delivery and are still able to breastfeed. Studies have shown that, providing the vaccination and immunoglobulin are given, neither of these things increase the risk of transmission.