The hepatitis B shot is one of those vaccines that has a curious habit of showing up as a required vaccine for the most unlikely groups- like newborn babies and kindergarteners. Until a couple of years ago, the Church of Jesus Christ of Latter day Saints’ Missionary Department required that all of its missionaries receive the hep B vaccine. (Exactly what type of activities did they think missionaries would be participating in?) However, hepatitis B is primarily contracted through sexual transmission, contaminated needles, and contact with infected blood. It can also be passed from mother to baby during birth or the first few years of life. So how did a disease that was once feared mostly by drug addicts and participants in promiscuous sex end up on the vaccine schedule for young children?
Kids and Hepatitis B: The Real Story
The CDC’s information page for parents on Hepatitis B claims that “of the more than 1 million people in the United States living with lifelong Hepatitis B, most got the virus as a child” and that “When infants and young children are infected with Hepatitis B, they have 90% chance of developing a life-long, chronic infection”. The CDC says that Hepatitis B can be passed through more every day means such as chewing food to give to a baby, sharing toothbrushes and gum and touching open cuts or sores. Statements like these may give the impression that Hepatitis B is a disease that frequently affects children and that transmission outside of sexual contact, needle sharing and maternal transmission are also frequent phenomena.
However, reports of epidemiology presented at the National Institutes of Health Workshop on the Management of Hepatitis B show a different breakdown. Their statistics show that 45% of all new HBV infections in the United States are sexually transmitted, with injection drug use causing another 21% of cases and the remainder (33%) being cases of mother-to-child transmission occurring at birth or in the first few years of life. (pg. 20)
Overall, the CDC statistics show that rate of HBV infection is very low in the United States and Canada, averaging 0.1 to 0.5% for current or chronic infection, however the rate of infection is much higher among native populations and Asian emigres. About 5% of Americans have been infected with the hepatitis B, but 90-95% of the time these cases are cleared by the immune system on its own. (See page 19 under the heading “Canada and the United States”.)
Obviously, if a mother has hepatitis B, transmission to her baby is a grave concern. But a mother who is hepatitis B free poses no danger of transmission to her baby. Concerns have been raised over child-to-child transmission, and this is possible, though extremely rare.
Child-to-child transmission of hepatitis B (mostly through contact with open sores) has been well documented in developing countries. In the United States and other developed countries child-to-child transmission incidents have been extraordinarily rare, even in daycare and school. Urine and feces are not vehicles for transmission unless blood is present and oral transmission of hepatitis B is almost non-existent. (pg. 48 under heading “Risk of Hepatitis B Infection in Daycare Centers”.)
Risks vs. Benefits
Conscious objectors of the Hepatitis B vaccine have pointed out that the number of adverse events associated with this particular shot are far in excess of the number of children who actually have the disease. In Minnesota alone, there have been 240 reports of adverse events following hep B vaccination, including six deaths. A summary of these cases is available here. In 1999 Dr. Phillip Incao M.D. gave testimony before the Ohio House of Representatives protesting the requirement of hepatitis B vaccination for children starting school. He noted that between July 1990 and 1999, 17, 497 cases of hospitalizations, injuries and deaths had been reported in the United States after hepatitis B vaccination. Of these severe reactions, 146 of the deaths occurred in individuals who had received only a hepatitis B vaccine without any other vaccines. Of those 147 deaths, 73 were children under 14 years of age. How do these numbers measure up to the number of children who actually contract hepatitis B? In 1996, 279 cases of hepatitis B were reported in children under the age of 14 while 872 hep B vaccine related serious adverse events were reported to the Vaccine Adverse Events Reporting System. And this is likely only the tip of the iceberg. Fewer than 10% of doctors report adverse vaccine reactions. Read the full text of Dr. Incao’s testimony here. Statistically speaking, a child is more likely to suffer a serious reaction to the hepatitis B vaccine than to actually contract the disease.
Energix-B and Recombivax HB are the two most commonly used Hepatitis B vaccines for children. Energix-B does contain aluminum hydroxide. According to the Materials Safety Data sheet for aluminum hydroxide, information about carcinogenic, mutagenic, teratogenic developmental toxicity effects are not available, but it may affect the blood, bones, metabolism and liver. It also may affect behavior by causing spasms and muscle contractions. (23) Recombivax offers a preservative free pediatric and adult formulation, though these still contain a chemical called aluminum hydroxyphosphate.