I have been a pharmacist that has been practicing for more than 20 years, and throughout this time, the US has alwways had an infant hepatitis B vaccine strategy in place. But this has not always been the case. Let’s look back in time to learn more. The first hepatitis B vaccine was introduced into the US in 1982. Initially, only those at high risk of hepatitis B disease were vaccinated, but cases remained high (10-13 per 100,000). In 1991 hepatitis B vaccination was changed to universal infant immunization and high-risk adolescent to vaccine and rates finally started coming down. This was followed in 1995 recommending routine catch-up vaccination for adolescents. Most recently in 2022 routine adult catch-up vaccination through age 59 years. By 2023 the rate dropped to 0.7 per 100,000 population. Universal infant vaccination, not selective high risk hepatitis B vaccination is what reduced hepatitis B incidence in the US.
Why Infant Vaccination Matters
When babies and young children acquire Hepatitis B the risk of developing chronic infection is very high (90% of infants that acquire hepatitis B go on to having chronic disease). Among newborns that acquire hepatitis B about one in four will eventually die as a result of chronic liver disease.
It is estimated that about 2.4 million individuals in the US are living with hepatitis B, but only about half are aware of their status. About 10% of children acquire hepatitis B through community or household exposures, which is known as their mother have tested negative. This is possible because Hepatitis B is one of the most contagious and viable bloodborne pathogens. It can survive in the environment for up to 7 days, making indirect transmission possible.
For these reasons, it is critically important to protect newborns as early as possible through vaccination.
Who Should Get Vaccinated
- All infants at birth begin 3 dose hepatitis B series (95% protection)
- Those who are born to hepatitis B infected mothers should get first hepatitis B vaccine dose and a dose of hepatitis B immune globulin within 12 hours (results in 94% protection)
- Catch-up of those who did not receive the protection through age 59 years
- Pediatrics – 2 hepatitis B only products, primarily 3 dose series although 2 dose option is available for teens
- Also included in multiple combination vaccines
- Adults 3 products currently available 2 are 3 dose series, 1 is available with a 2 dose series.
- Also included in one combination vaccine with hepatitis A
- Pediatrics – 2 hepatitis B only products, primarily 3 dose series although 2 dose option is available for teens
Vaccine Safety Profile
These vaccines are all inactivated, which as you know cannot cause disease. It is essential to remind our patients about that. I think it is also good to remind patients that every medication has side effects including vaccines. The side effects expected include pain and redness at the injection site as well as minor systemic adverse effects such as fever, headache, and gastrointestinal upset. It is possible, although rare that allergic reactions can occur. The CDC reports additional rare adverse reactions including Guillain-Barré syndrome, chronic fatigue syndrome, neurologic disorders, rheumatoid arthritis, type 1 diabetes, and autoimmune disease have been reported, but upon investigation no causal association have been found.
This post was written by Dr. Jennifer Girotto, the Assistant Department Head and Clinical Professor of Pharmacy Practice at the University of Connecticut School of Pharmacy. She specializes in pediatric infectious diseases and immunizations for all aged patients. Her goal is to provide timely, evidence-based insights that support pharmacists, other healthcare professionals, and trainees in improving patient care.