By Eva Briggs, MD
Recently the ACIP (Advisory Committee on Immune Practices) recommended altering the childhood vaccine schedule to delay the first dose of hepatitis B vaccine.
Currently given to newborns in the first day of life, the ACIP recommended delaying the first dose until 2 months of age.
This is a change which disturbs many physicians who care for infants and children. The New York State Department of Health issued a recommendation that infants continue to receive this vaccine as newborns.
Hepatitis B is virus that causes liver inflammation. Acute infection can cause abdominal pain, fever, dark urine, jaundice (yellowing of the skin and eyes), vomiting, weakness and fatigue.
Some people have only mild symptoms or none at all. Fifty percent of people don’t even know they’ve been infected. Fortunately, most people recover completely from the initial infection.
But a small proportion don’t clear the virus and go on to become chronically infected with hepatitis B.
Chronically infected people can go for years without symptoms, shedding virus and potentially unwittingly infecting others.
Eventually chronic hepatitis B carriers can develop cirrhosis, liver failure or liver cancer. Those infected as children are more likely to become chronically infected than those infected as adults.
Liver failure is a pretty miserable disease. Symptoms can include swelling — of the legs but also, when severe, of the scrotum and abdomen. The abdomen can fill with fluid called ascites. This is not only painful but can compress the stomach (making eating hard) and the lungs (compromising breathing.)
The ascites fluid can become infected making patients dangerously ill. Patients can develop jaundice with yellow skin and eyes. Anemia contributes to generalized weakness. The liver is no longer manufacture blood clotting factors so patients can bleed excessively, such as from wounds (even small cuts) and the gastrointestinal tract. Toxic metabolites accumulate leading to confusion and drowsiness.
How do people acquire hepatitis B?
Many people are aware that it is spread sexually, from needles or contact with blood, and from an infected mother to her baby.
The ACIP apparently assumed that this was the only way babies can acquire hepatitis B, and mistakenly assumed that children whose mothers test negative for hepatitis B don’t need the vaccine at birth. But the virus can also be spread by saliva and other secretions. Many people infected as children have no idea where it came from.
It could come from anyone who might contact the child: a nanny, daycare provider, a grandparent, an uncle, a father, a sibling.
I belong to a Facebook group of physicians, and I’d like to share some edited stories members shared on this topic.
A liver specialist wrote: “I trained in the southeast for hepatology. In total those four years I think I saw a total of 20 cases of HBV.
But I now practice in California. I see 15 or more cases A WEEK.
“If people are not around the condition, they simply don’t believe in it. Or they assume it’s only a disease associated with high-risk sexual behavior or IV drug use. Could not be further from the truth. I see patients with cirrhosis, some of whom required transplants, some with liver cancer, some who unfortunately succumbed to their disease. Not one person questions the vaccine for their children. They know the price.”
Another shared this heartrending story: “I am a chronic hepatitis B carrier who became infected as a young child. [She added that all her family tested negative and does not know how she became infected]. I was diagnosed with hepatocellular carcinoma at a prime age when my children were very young. I later underwent a liver transplant which has saved my life.
“The pain and anguish of possibly leaving my children while they’re so young and the thought that my toddler may never remember me are experiences that I wish no one will ever have to go through. I had hoped that my generation would be the last that had to deal with this vaccine- preventable cancer.
A third doctor wrote: I was diagnosed with Hepatitis B in an underdeveloped country while I was in medical school. My own classmates, including the friends I lived with, no longer wanted to share a home with me. Random people from school, healthcare workers, and others bullied me because everyone assumed Hep B was an STD. By the time I was diagnosed, I had already developed cirrhosis.”
A fourth doctor weighed in on why delaying the vaccine is a bad idea: “Prenatal screening misses some with false negatives. Not 100% of moms are screened prior to delivery, and some infants will go home to households where someone is a carrier. I just had a family whose mom is a nurse who unknowingly became infected. Thank goodness her kids were vaccinated so none are infected. For a safe and effective vaccine like hep B that is well tolerated even by newborns, the risk benefit ratio still falls out on the side of universal vaccination IMO.”
That’s why the vast majority of physicians continue to recommend the hepatitis B vaccine for newborns. Since it was instituted, it has reduced childhood hepatitis B infections by 95%.
Eva Briggs is a retired medical doctor who practiced in Central New York for several decades. She lives in Marcellus.