Should You Give the Hepatitis B Vaccine to Your Child at Birth?

Here is a common scenario. I’m on the phone with an expecting parent and they are interviewing me to be their pediatrician or part of the healthcare team for their baby.

Inevitably one of us will bring up vaccines, and 90% of the time I can hear the stress rise in their voices as they grapple with yet another difficult decision as a new parent.

Vaccines. What is the best choice for your child?

My personal philosophy on vaccines is simple.

Vaccines work, there is no question that if you are looking to reduce or eliminate the risk of the disease most vaccines have been studied to show that they accomplish that. BUT, they do not come without their risks and the CDC schedule is based on vaccinating for those at the highest risk of developing complications from the disease.

In general, the risk of a scary side effect from a vaccine is lower than the risk of a complication from the disease you would be otherwise vaccinating against. The problem with vaccines is that there isn’t just the attenuated or inactive virus or bacteria in the vaccine, it also contains things like aluminum and formaldehyde.

It’s important to have these preservatives and additives in the vaccine because it ensures the vaccine provides a more robust immune response, and that their isn’t the chance that we inject something that has bacteria growing within it. BUT, here in lies the problem and the rub for myself and most parents when it comes to the traditional CDC schedule. None of us want our children, or others, getting sick when we could have otherwise prevented it, but we also worry about the risk of illness or developmental delays due to the additives or preservatives in the vaccines.

This is where the alternative vaccine schedule can offer a solution for parents. With the creation of an alternative vaccine schedule you slow down the vaccines given, to consider the individual child, the environment they live in, and the health of those around them. We keep in mind important factors like herd immunity, recent outbreaks, travel plans, exposure rates, and siblings to create INDIVUALIZED vaccine plans that make sense for families who are aware and diligent to stay on top of completing the vaccine schedule.

Plain and simple, for a parent willing to do the research, keep their child home when sick, and stay on top of their alternative vaccine schedule deviating from the CDC schedule may be a solution to ease concerns over the numerous number of vaccines we give today.

The decision to vaccinate or not should be made for each vaccine independent of the other.

So, let’s start with something relatively simple, Hepatitis B.

Since this is the first vaccine recommended by the CDC schedule. It is given at birth and is the only vaccine given prior to 2 months old.

I repeat, the only vaccine given prior to 2 months of age is Hepatitis B. Here is the CDC schedule for reference.

So here is how I help parents decide about Hepatitis B.

If you have any of the following risk factors, then you should vaccinate.

  1. The birth mother is Hepatitis B positive, does not know their Hepatitis B status, or has another chronic liver disease.
  2. The birth mother was negative for Hepatitis B, when screened initially during early pregnancy, but someone she was sexually active with during pregnancy does not know their Hepatitis B status.
  3. The birth mother does not know her Hepatitis B status.

The Hepatitis B vaccine given at birth reduces the risk of the infant contracting Hepatitis B from the birth mother, that’s it. Outside of this scenario the only way your child could contract Hepatitis B would be from the following scenarios, per the CDC (

  • Sex with an infected partner
  • Sharing needles, syringes, or other drug-injection equipment
  • Sharing items such as razors or toothbrushes with an infected person
  • Direct contact with the blood or open sores of an infected person
  • Exposure to blood from needlesticks or other sharp instruments

Can Hepatitis B be spread through food?

Unlike Hepatitis A, it is not spread routinely through food or water. However, there have been instances in which Hepatitis B has been spread to babies when they have received food pre-chewed by an infected person.

What are ways Hepatitis B is not spread?

Hepatitis B virus is not spread by sharing eating utensils, breastfeeding, hugging, kissing, holding hands, coughing, or sneezing.

In summary, the Hepatitis B vaccine should be given at some point in the child’s lifetime. The sooner you administer the vaccine the sooner the risk for Hepatitis B goes down, but if you are concerned about vaccine safety this is a vaccine you may choose to wait on. Most of my parents choose to start Hepatitis B sometime in the first 5 years of life, typically utilizing one of the combination vaccines.

I find that many of my MD pediatric colleagues in Los Angeles are okay with completing a delayed or alternative vaccine schedule but they won’t help create it. If you’re in this situation set up an appointment with me and we can discuss the safest, individualized alternative vaccine schedule for your child.

Be well.

– Dr. N