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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

Doctors Gun-Shy on Newborns' Hepatitis Shot

Temporary problem has long-term effect

By Edward Edelson
HealthScout Reporter

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.

Routine 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.


But when University of Chicago physicians surveyed 46 hospitals in Ohio last year, they found widespread failure to observe the renewed recommendation.

"Before 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 Association.

"The 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 infectious diseases.

Dr. 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.


That two-month window of vulnerability can be important, Saari says. "Hepatitis B is a silent disease. It is asymptomatic until the child develops complications."

The 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."

Three 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.

Saari 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.

What To Do

Meissner 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 the child."

If 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.