Doctors Gun-Shy on Newborns' Hepatitis Shot
Temporary problem has long-term effect
By Edward Edelson
TUESDAY, April 10 (HealthScout) -- A large percentage of newborn
babies aren't getting the recommended hepatitis B vaccination
(HBV) because hospitals were thrown off their routine by a
precaution that was intended to be temporary, doctors say.
vaccination against hepatitis B, a viral liver infection that
can be fatal, was recommended for all newborns in 1991. That
recommendation was changed in 1999, when the American Academy
of Pediatrics (AAP) and the U.S. Public Health Service said
most infants should not get the shots until a few months after
birth. The change was based on concern that thimerosal, a
mercury-based component of the vaccine, might damage the
babies' nervous systems. The recommendation for routine
newborn vaccination was renewed in September 1999, when a
thimerosal-free vaccine became available.
when University of Chicago physicians surveyed 46 hospitals in
Ohio last year, they found widespread failure to observe the
July 1999, 74 percent of surveyed hospital nurseries offered
hepatitis B virus vaccine to all neonates. Only 39 percent did
so in August 2000," reports Dr. Ronda J. Oram and
colleagues in the April 11 Journal of the American Medical
problem has been that it is difficult to make sweeping
recommendations for a brief period and then revert to the old
rule. It is hard to make people change their ways and then go
back to the old way," says Dr. H. Cody Meissner, chief of
pediatric infectious diseases at the New England Medical
Center in Boston and a member of the AAP's committee on
Thomas N. Saari, professor of pediatrics at the University of
Wisconsin Medical School and a member of the AAP committee,
says his recent survey of Wisconsin hospitals found the same
lower rate of immunizing newborns. Saari says when the
thimerosal-based recommendation was made, many doctors
switched to a combination vaccine given at two months of age,
and they are reluctant to switch back to vaccinations in the
first days after birth.
two-month window of vulnerability can be important, Saari
says. "Hepatitis B is a silent disease. It is
asymptomatic until the child develops complications."
Chicago report says one problem of delaying vaccination is
that babies born to mothers carrying the hepatitis B virus are
not protected against maternal transmission of the virus. A
second problem is that "delay in the receipt of the first
HBV dose in the nursery is associated with delay in completion
of the on-time vaccine series."
doses of the vaccine, given in the first 18 months of life,
are recommended. The full series provides protection for at
least nine years, and possibly much longer.
says parents should be aware of the importance of early
hepatitis protection, but that awareness often doesn't come
easy. "When the hepatitis B program started, there was a
lot of concern on the part of parents as to whether a
brand-new baby should be given a vaccine when it is just
one-day old. It is the only vaccine given that early.
Overcoming this is not easy, because it is easier to sell
parents on protection against a disease that produces a rash
or a fever. Hepatitis B vaccination has always been a
difficult concept to get through to parents and to
physicians," he says.
says, "It is critical for parents to be informed and
understand the importance of the hepatitis B vaccine, as well
any other vaccine. It is an important element in the health of
you're pregnant, you should get tested for the hepatitis B
virus. Vaccines are frequently tough for parents to watch;
they hate to see a baby, especially a newborn, wince in pain,
but it's better than the alternative.