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Hepatitis B: Rare, and Not Very Contagious
So why are we mass-vaccinating newborns?
by Barbara Loe Fisher, co-founder and president, National Vaccine
Information Center
Excerpted with permission from "Shots in the Dark"
The hepatitis B vaccine is mandated for infants in the US and many
other countries. The Center for Disease Control (CDC) recommends a
series of hep B immunizations starting at birth, with the aim of
preventing mother-to-child transmission. But unlike other infectious
diseases for which vaccines have been mandated, hepatitis B is very
rare in childhood and is not even highly contagious. Hepatitis B is
primarily an adult disease usually transmitted by blood contact. It is
prevalent only in high-risk populations such as needle-sharing drug
addicts and sexually promiscuous adults. According to Harrison's
Principles of Internal Medicine (1994), mother to child transmission
of hepatitis B "is uncommon in North America and western Europe."
Although CDC officials have made statements that hepatitis B is easy
to catch through sharing toothbrushes or razors, Eric Mast, M.D.,
Chief of the Surveillance Section, Hepatitis Branch of the CDC, stated
in a 1997 public hearing that: "although [the hepatitis B virus] is
present in moderate concentrations in saliva, it's not transmitted
commonly by casual contact."
Not Even A Killer Disease For Most
According to Harrison's, in cases of acute hepatitis B "most patients
do not require hospital care" and "95 percent of patients have a
favorable course and recover completely" with the case-fatality ratio
being "very low (approximately 0.1 percent)." Those who recover
completely from hepatitis B infection acquire life-long immunity. Of
those who do not recover completely, fewer than 5 percent become
chronic carriers of the virus with just one quarter of these in danger
of developing life threatening liver disease later in life, according
to Robbins Pathologic Basis of Disease (1994), a medical textbook.
The Guide to Clinical Preventive Services (1996), written under the
supervision of the US Department of Health and Human Services (DHHS),
states that the risk of developing a chronic hepatitis B infection is
higher in infected infants than in infected older children and adults:
"Infections during infancy, while estimated to represent only 1-3
percent of cases, account for 20-30 percent of chronic infections."
Because infants born to infected mothers are at highest risk for
developing chronic hepatitis B infections, routine screening of
pregnant women for hepatitis B infection is one of the most important
public health measures that can be taken to prevent chronic hepatitis
B carriers. The Merck Manual (1992), a major medical reference used by
physicians, notes that "postexposure vaccination is recommended for
newborn infants of hepatitis B positive mothers."
Hepatitis B Low In US
North America and western Europe have always had among the lowest
rates of hepatitis B disease in the world (0.1 to 0.5 percent of the
general population) compared to countries in the Far East and Africa,
where the disease affects 5-20 percent or more of the population.
According to Guide to Clinical Preventive Services, in the US "the
greatest reported incidence [of hep B] occurs in adults aged 20-39"
and "the number of cases peaked in 1985 and has shown a continuous
gradual decline since that time." In 1991, there were 18,003 cases of
hepatitis B reported in the US out of a total US population of 248
million. According to the October 31, 1997 Morbidity and Mortality
Weekly Report published by the CDC, in 1996 there were 10,637 cases of
hepatitis B reported in the US with 279 cases reported in children
under the age of 14.
For further info, see the National Vaccine Information Center website
at www.909shot.com
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