<<Disclaimer: Verify this information before applying it to your situation.>>

This is off topic, but a recent summary post on immunization of
children and Autism included a statement that some parent were not
immunizing the children against Hep B because they figured there was no
risk until the children were exposed to dirty needles or sexual contact.

The problem with this approach is that there is a lot of transmission
of hepatitis B.  Essentially all the transmission in children under 5
is in the absence of IV drug abuse and sexual contact.  Additionally,
in children infected before age 5 there is a very high risk of chronic
infection and 25% of those die of chronic liver disease as adults.
Immunizing adolescents is not of much benefit because 95% of
adolescents clear hepatitis B naturally.  The position paper that
discusses this is found at
http://www.cdc.gov/mmwr/preview/mmwrhtml/00033405.htm

By the way, the idea that infected needle exposure and sexual activity
are the only ways that Hep B is transmitted is incorrect.  Sexual
transmission and IV drug use do transmit hepatitis B, but only half of
hepatitis cases are explained by those routes.


The following two paragraphs from the position paper are relevant:

In the United States, children become infected with HBV through  a
variety of means. The risk of perinatal HBV infection among infants
born to HBV-infected mothers ranges from 10% to 85%, depending on each
mother's hepatitis B e antigen (HBeAg) status (3,7,8). Infants who
become  infected by perinatal transmission have a 90% risk of chronic
infection, and  up to 25% will die of chronic liver disease as adults
(9). Even when not  infected during the perinatal period, children of
HBV-infected mothers  remain at high risk of acquiring chronic HBV
infection by person-to-person (horizontal) transmission during the
first 5 years of life (10).  More than 90% of these infections can be
prevented if HBsAg-positive mothers  are identified so that their
infants can receive hepatitis B vaccine  and hepatitis B immune
globulin (HBIG) soon after birth (4,5).

Because screening selected pregnant women for HBsAg has failed  to
identify a high proportion of HBV-infected mothers (11,12),  prenatal
HBsAg testing of all pregnant women is now recommended (1,13,14).
Universal prenatal testing would identify an estimated 22,000
HBsAg-positive  women and could prevent at least 6,000 chronic HBV
infections annually  (3). Screening and vaccination programs for women
and infants receiving  care in the public sector have already been
initiated through state  immunization projects.

See the cited source for the references.

Stephen Holland, M.D.

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