Hepatitis B: Why do we vaccinate babies?

According to Dr Philip D. Minor, Head of the Division
of Virology at the National Institute for Biological
Standards and Control, in an article published in Microbiology Today:

“Hepatitis B is effectively a sexually transmitted disease in developed countries, but is endemic in other parts of the world such as Africa, or particularly China.”

“Hepatitis B vaccines were initially targeted at specific at risk groups, including healthcare workers and business travellers, and were made either from antigen from the plasma of infected donors or from antigen expressed in genetically modified organisms, such as yeast. They were (and remain) expensive, but have now been incorporated into global vaccination programmes, including universal usage in most developed countries as the impact on incidence following targeted use was not great. The usage in developed countries can therefore subsidize that in developing countries, but only if valid and recognizable uses in wealthy markets exist.”

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So what was considered a “valid and recognizable use” in 1991 when the CDC added it to the universal infant schedule?

Hepatitis B Virus: A Comprehensive Strategy for Eliminating Transmission in the United States Through Universal Childhood Vaccination: Recommendations of the Immunization Practices Advisory Committee (ACIP)
(selected quotes)
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In the United States, most infections occur among adults and adolescents (2,3). The recommended strategy for preventing these infections has been the selective vaccination of persons with identified risk factors (1,2). However, this strategy has not lowered the incidence of hepatitis B, primarily because vaccinating persons engaged in high-risk behaviors, life-styles, or occupations before they become infected generally has not been feasible.

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Efforts to vaccinate persons in the major risk groups have had limited success. For example, programs directed at injecting drug users failed to motivate them to receive three doses of vaccine.

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Educational programs to reduce parenteral drug use and unprotected sexual activity are important components of the strategy to prevent infection with the human immunodeficiency virus (HIV), which causes acquired immunodeficiency syndrome. These programs appear to have reduced the risk of HBV infections among homosexual men but have not had an impact on hepatitis B attributable to parenteral drug use or heterosexual trans- mission (2). Educational efforts alone are not likely to fully eliminate the high-risk behaviors responsible for HBV transmission.

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In the United States it has become evident that HBV transmission cannot be prevented through vaccinating only the groups at high risk of infection

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Vaccinating adolescents and adults is substantially more expensive because of the higher vaccine cost and the higher implementation costs of delivering vaccine to target populations. In the long term, universal infant vaccination would eliminate the need for vaccinating adolescents and high-risk adults.

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Hepatitis B vaccination is recommended for all infants, regardless of the HBsAg status of the mother.

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