What is Hepatitis B and Should I Vaccinate My Newborn Baby?

What is Hepatitis B?

• Hepatitis B is a viral infection that attacks the liver and can lead to chronic liver disease, cirrhosis (scarring of the liver), liver failure, or liver cancer.

How is it transmitted?

• Transmission of Hepatitis B requires blood to blood contact:
  • Unprotected Intercourse
  • Accidental blood exchanges such as using contaminated drug needles (drug addicts) or needle stick injuries (health care workers)
  • Childbirth: Usually, exposure is during delivery because of exposure to maternal blood. However, in utero exposure can happen as well

What has changed?

• In 2025, the CDC voted to change its recommendations from giving the hepatitis B vaccine right after birth to individual based decision making for moms who tested negative for hepatitis B during pregnancy.  The initial prenatal panel completed at the beginning of pregnancy tests for the following sexually transmitted diseases: hepatitis B, hepatitis C, syphilis, HIV, gonorrhea and chlamydia.  For moms who tested positive or were never tested, they recommended giving the dose within 12 hours after birth. 

To make this decision easier for new moms, lets talk about the risks and benefits of receiving the hepatitis b vaccine right after birth.

Benefits of newborns getting the vaccine:

1. The main advantage of receiving the vaccine after birth even if the mom tested negative during pregnancy is unpredictable exposures.  What if you were exposed to hepatitis B during pregnancy?  If you were exposed to dirty needles during pregnancy or had a needle stick (as a health care provider), I would strongly encourage you to get retested prior to giving birth and administer the hepatitis B vaccine to your newborn baby. 
2. Another benefit for large hospital systems is by administering it to all babies, it helps avoid errors and simplifies implementation.
3. Administration of the vaccine after birth improves overall compliance to the childhood vaccine schedule.

Concerns about Hepatitis B Vaccine administration to all newborns:

1. The prevalence of hepatitis B in American mothers is very low.  According to the CDC it is 0.2-0.5%.  Let’s compare this to certain areas in the world such as Africa and Southeast Asia where the prevalence is as high as 15%.  Such a low prevalence undermines the justification of mass vaccination. 
2. While the hepatitis B vaccine has reduced acute cases in high-risk demographics (IV drug users and prostitutes), there is no evidence vaccinating low risk infants (for an adult associated disease) has done the same in newborns or reduced chronic hepatitis cases. 
3. Serious side effects of the hepatitis B vaccine include infant death, seizures, autism, dysautonomia, autoimmune conditions like multiple sclerosis, rheumatoid arthritis, diabetes and rare cases of liver cancer.  These risks were extrapolated from VAERS (Vaccine Adverse Event Reporting Database).  Despite these risks, the licensing studies for the vaccines only monitored side effects for a very short period (typically 4-5 days).  There would be no way to detect some of these side effects during such a short period of time.  In addition, there are no randomized controlled trials that utilized a true placebo (saline or water), but instead they used aluminum or other vaccines.  Without using an inert placebo like saline, it is difficult to know if the side effects are caused by the hepatitis B vaccine or an adjuvant like aluminum or other vaccines. 
4. Another concern is not all vaccinated babies develop antibodies to hepatitis B following vaccination.  In a 2012 study, 11-84% of premature infants did not form antibodies to the vaccine.  In many cases, these antibodies decrease long before potential hepatitis B exposure can happen.  For example, one study found roughly 23% of babies vaccinated lost immunity by age 5 and 76% lost it by 13 years of age.  This is likely why many European countries vaccinate much later during adolescence when exposures like unprotected intercourse and needle exposure are more likely to occur.  Also, despite vaccinating during adolescence in many European countries, major outbreaks in children did not occur.

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Overall, parental choice and informed decision making between parents and the providers creates a more trustful relationship. You should have an extensive discussion with your baby’s doctor about the risks and benefits and what is best for your baby. 

​Dr. Pam Denson