United States President Donald Trump recently stirred controversy by suggesting that children should not be vaccinated against hepatitis B until they are 12 years old. He also described the viral liver infection as a sexually transmitted disease. This statement, part of a broader commentary on vaccines, autism, and medications, has been criticized by medical experts for lacking evidence-based support.
The announcement comes as health professionals emphasize the critical importance of administering the hepatitis B vaccine to newborns. But what does the scientific evidence say about hepatitis B, and why is it crucial to vaccinate infants from birth?
Understanding Hepatitis B
Hepatitis B is a liver infection caused by the hepatitis B virus, which can become chronic and significantly increase the risk of liver cirrhosis, liver cancer, and even death. The virus spreads through contact with infected body fluids, including blood, saliva, vaginal fluids, and semen. While it can be sexually transmitted, this is not the sole mode of transmission.
Crucially, the virus can pass from a mother to her baby during childbirth. If exposed at birth, a newborn faces a 90% chance of developing a chronic infection. Over time, approximately one in four of those with a chronic infection will succumb to liver disease or cancer. In regions where hepatitis B is prevalent, transmission often occurs from mother to child at birth or from child to child in early childhood.
Currently, there is no cure for hepatitis B, making vaccination a vital preventive measure. Fortunately, a highly effective vaccine is available, significantly reducing the risk of infection.
The Case for Early Vaccination
The World Health Organization (WHO) recommends that children receive their first dose of the hepatitis B vaccine at birth. This has been standard practice in Australia since 2000, with the vaccine ideally administered within 24 hours of birth as part of the National Immunisation Program.
For infants born to mothers with a chronic hepatitis B infection, the first vaccine dose should be given within four hours of birth, alongside hepatitis B immunoglobulin, which contains antibodies to the virus. The vaccine alone is 75% effective in preventing infection during childbirth, while the combination with immunoglobulin boosts efficacy to 95%.
This initial dose, followed by three additional doses at two, four, and six months, ensures long-term protection for at least 20 years. This protection extends into adolescence and adulthood, when behaviors such as sexual activity or drug use may increase hepatitis B exposure risks.
Global Vaccination Efforts
Globally, 117 countries have implemented a policy to administer the hepatitis B vaccine to newborns within the first 24 hours of life. This widespread adoption has resulted in millions of infants safely receiving the vaccine at birth.
In Australia, vaccination rates are high, with 92% of babies in New South Wales receiving the birth dose in 2023. Since the introduction of free infant hepatitis B immunization, newly acquired infections have decreased by two-thirds between 2000 and 2019. From 2014 to 2023, there has been a 60% decline in hepatitis B cases among individuals under 20.
The impact of universal vaccination has been striking, bringing the US closer to eliminating hepatitis B infections, a goal Australia also aims to achieve by 2030.
Safety and Risks of Delaying Vaccination
The hepatitis B vaccine is safe, with minor side effects such as pain, redness, or swelling at the injection site, which typically resolve within a few days. Occasionally, a small lump may form, lasting a few weeks.
Delaying the first dose of the vaccine is not recommended. The virus is prevalent and often silent, with about 0.9% of Australians living with chronic hepatitis B, many unaware of their infection. Transmission can occur during childbirth or later through household contact, known as horizontal transmission. Vaccination at birth and during infancy provides crucial protection against these transmission routes.
Screening all pregnant women for hepatitis B is advised to prevent newborn infections. However, not all mothers undergo testing, and infections can occur post-testing or be missed entirely. The birth dose serves as an essential safety net in such cases.
Conclusion
In summary, vaccinating babies at birth is one of the safest, most effective, and accessible methods to protect against a lifetime of hepatitis B infection and its potentially fatal complications. The evidence strongly supports early vaccination as a key public health strategy to prevent disease transmission and improve long-term health outcomes.
