Don't minimize the importance of the Hepatitis B Vaccine

As all of my patients know and any readers of this blog can tell, I strongly believe in the importance of sticking to the AAP-endorsed pediatric vaccine schedule.

Occasionally, I have parents who wish to delay the Hepatitis B virus (HBV) vaccine.  The typical rationale is that they know that mom doesn't have Hep B disease (therefore there is/was no risk of vertical transmission during the birthing process) and they are not concerned about their infant and/or young child exhibiting the types of high-risk behaviors that can expose humans to blood and bodily fluids.

Unfortunately, this strategy is not supported by the evidence.  Take a look at the following link on the HBV vaccine from the Children's Hospital of Philadelphia Vaccine Education Center (bit.ly/ynJrve).  

Before the HBV vaccine was available, 50% of the 18,000 annual pediatric cases of HBV under 10 yrs old did not come from mother-to-newborn vertical transmission during birth. 

The most likely causes of non-vertical transmission are incidental exposures to microscopic amounts of infected blood from asymptomatic (but still infected and contagious) close contacts.  This could happen innocently via toothbrushes, razors and washcloths or towels.  

The bottom line is that "being careful" is not enough to prevent these kinds of cases, the best protection is infant HBV vaccination starting at birth.