Q: My pediatrician is recommending my baby get a shot for hepatitis. None of my other children ever got that shot and none of us have ever had hepatitis. Why should by baby get this shot?
A: We are certain the vaccine your pediatrician is recommending is one that prevents a type of hepatitis called hepatitis B. And you are quite right, the recommendation that all infants receive it is new. To understand its importance, we need to say more about the disease it will prevent.
The hepatitis B virus causes a kind of hepatitis (liver infection) which can be especially serious, and the number of cases has been increasing. About 300,000 Americans get the hepatitis B infection yearly. About one-third of those people don't know they have it; another third will be mildly ill; and a third will be quite ill. Some will die.
Unfortunately, the hepatitis B infection can cause scarring in the liver which leads to long-lasting liver problems and early death; and people who have had hepatitis B have a greatly increased risk of developing a very serious type of liver cancer called hepatocellular carcinoma. About 5,000 Americans die each year from these late effects of hepatitis B infection.
Some people who get hepatitis B are never able to clear the virus from their bodies, even though they seem to be perfectly well. They are carriers of the virus and can spread the infection to others who come in contact with their blood or body fluids. A baby can get hepatitis B from his mother, if she is carrying the virus when the baby is born. Older persons can get it from contaminated needles or other contact with blood that carries the virus or from sex with an infected person.
You are probably saying, so why immunize a baby who doesn't do drugs or have sex?
The Centers for Disease Control and the American Academy of Pediatrics have, this year, recommended that physicians begin to immunize all babies against hepatitis B. They cite very good reasons. For one thing, about a third of the people who get the disease don't appear to have any risk factors either. For another, the strategy of trying to immunize only those who appear to be at high risk hasn't worked. The number of cases is still increasing, which means the number of carriers is increasing and the risk that your baby will contract the disease during his lifetime is growing.
You were tested for hepatitis B during your pregnancy. If you had been carrying the hepatitis B virus, your baby would have received a shot of immunoglobulin rich in antibodies to hepatitis B and a first dose of vaccine before you left the hospital. Since you are not carrying the virus, the risk that your baby will get hepatitis B in early childhood is quite low, but then the risk grows. Giving the vaccine in infancy is the best way to be certain that everyone gets it. The vaccine is safe and protects for many years, probably for a lifetime. Vaccinating babies appears to be the best way to bring this very serious disease under control.
Many, but not all, doctors are now beginning the difficult task of building this new recommendation into their routine for infants. zTC There are two possible schedules for the three doses of vaccine: Dose 1, newborn nursery; Dose 2, 1 to 2 months; Dose 3, between 6 and 18 months; or Dose 1, 1 to 2 months; Dose 2, 4 months; and Dose 3, between 6 and 18 months.
We hope this discussion will help you to make an informed decision about your baby. We would also suggest that you consider hepatitis B vaccine for your older children as they become adolescents. Their risk will increase as they become sexually active.
Dr.Wilson is director of general pediatrics at the Johns Hopkins Children's Center; Dr. Joffe is director of adolescent medicine.