<<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. * Send administrative questions to [log in to unmask] *