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Why we need to vaccinate newborns against hepatitis B

The recent decision in the US regarding routine vaccinations for newborns against the hepatitis B virus has raised concerns and fears of a resurgence of the disease.

Here in Australia, hepatitis B vaccinations are given to all babies at birth, as part of the National Immunisation Program Schedule.

In this month’s blog, we take a closer look at the disease and why it’s important to continue to vaccinate newborns against the virus.

What is hepatitis B?

Hepatitis B is a viral infection that attacks the liver. It can be acute, only affecting people for a short amount of time, or chronic, with long-term effects that can potentially lead to liver cancer, cirrhosis, and death.

According to the World Health Organization (WHO), there are approximately 254 million people currently living with chronic infections, with around 1.2 million new infections detected every year.

While treatment is available to help reduce the progress of liver damage and loss of liver function, people with chronic hepatitis B will still need to be monitored every 6-12 months by their GP for signs and symptoms of liver disease.

It is spread through contact with infected bodily fluids, including blood, saliva, vaginal fluids, and semen. It can also spread through needlestick injury, tattooing and piercing.

The most common forms of transmission, however come via mother to child at birth. Children are also at risk of transmission from household contacts or through contact with other children who are infected, particularly during the first five years of life. As the disease can survive for a week on household surfaces, the disease can pass on through something as simple as sharing the same toothbrush as an infected person.

A child who contracts chronic hepatitis B has an increased risk of developing chronic liver disease and cancer later in life. In fact, a 2018 report from the U.S. Centres for Disease Control and Prevention suggests that 70% to 90% of unvaccinated infants born to infected mothers will become infected themselves, and 90% of those infections will become chronic.

It is for this reason that the World Health Organization recommends that children receive the first dose of the hepatitis B vaccine at birth.

Why do we vaccinate newborns against hepatitis B?

Vaccinating babies at birth remains one of the best ways to keep children protected from this lifelong, deadly disease.

Globally, 117 countries have introduced a dose of hepatitis B vaccine to newborns within the first 24 hours of life.

In Australia, every baby born since 2000 has been eligible to receive a free vaccine at birth, with further doses given at 2, 4 and 6 months of age. Full protection against hepatitis B requires a three-dose vaccine series, given at specific intervals in infancy. Anything short of this can leave children vulnerable to the virus for life.

This vaccination program has been a great success, with newborn vaccination rates remaining steady at between 92%-95% every year and newly acquired infections reducing by two thirds between 2000 and 2019.

From 2014 to 2023, the program also led to a 60% decline in cases for those aged under 20.

In America, it is a similar story, with a 95% reduction in hepatitis B infection rates resulting in less than 1,000 children or adolescents contracting the virus each year. In fact, America’s vaccination program has seen it come within reach of eliminating infections all together. So why have recommendations changed in the US?

Recent changes in the US

A newly appointed committee who advises on immunisation practices in the US recently changed the recommendation on hepatitis B vaccine at birth to apply only to those newborns whose mothers test positive for the virus. For those who test negative, it is now recommended that they consult their health care provider to make individualised decisions on whether or not to administer the vaccine to their newborn.

This change is not based on any new evidence and causes some concern, particularly as we know that delaying the first dose of the vaccine puts children at greater risk of chronic infection.

Almost one-third of people with hepatitis B do not know that they are infected. While screening is recommended for all pregnant women, not all mothers are tested during pregnancy.

Even if mothers are tested, there is still the risk that they can become infected after testing has occurred. There is also the risk that newborns can be exposed to the disease through contact with other family members who haven’t been tested and/or are unaware that they have the virus. That’s why the newborn vaccination dose is so important to help prevent newborns developing the infection at birth.

The good news for Australia is that there are no changes to our vaccination program and the hepatitis B vaccination remains in place for all Australian newborns.

Is the newborn vaccine safe?

Yes. The hepatitis vaccine has been safely given to millions of newborns across the world within the first 24 hours of life.

Like any vaccine, some newborns may experience a reaction but the risk of serious harm is very low. Infants are more likely to experience mild side effects, if any, including pain, redness, or swelling at the injection site, which will usually last no more than a day or two.

Vaccination remains one of the most successful and cost-effective public health measures worldwide and has helped protect many people from many serious infectious diseases.

Over the past 50 years, childhood vaccines alone have prevented 154 million deaths globally – the vast majority in children under five.

In Australia, all vaccines must pass strict safety testing before being approved for use by the TGA. We also have a national program – AusVaxSafety – that monitors the type and rate of reactions to all vaccines on the National Immunisation Program.

You can find out more about the safety of vaccines given in Australia here>>

At Illawarra Medical Centre, we also utilise the SmartVax system as an additional vaccine safety measure for our patients. SmartVax uses SMS and smartphone technology to actively monitor vaccine safety in real time and feeds that information into the AusVaxSafety program.

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