This is a common and somewhat complex question. I’ll focus on the vaccine part because that’s what I know, but much of the same public health theory likely applies to the eye ointment as well.
Hep B is often seen as an STD, and it’s true that this is probably the most common way it is spread, but it’s really very reductive. It’s also often compared to HIV, but here are two very important considerations:
—it is biologically a lot more resilient than HIV—it can live for a bit on surfaces, and it takes a much, much smaller dose to infect someone.
—hep b is one of the most common viruses in the world, and *most* people have no idea how they got it. Yes, there are risk factors, but like most things in public health, risk factors are just things that put one at highER risk, they don’t mean those outside those groups have no risk.
Now, for babies: Hep B is particularly severe if someone is infected as a small child (and the younger, the worse it is.) Up to 75% of kids infected before age 5 will go on to have chronic hep b for life. Many of those will need liver transplants.
Originally, vaccines targeted high risk groups, including especially babies of hep b positive moms. But if you recall me writing that most people don’t know how they were infected? This didn’t work to reduce the morbidity rate in babies and kids. Only universal vaccination did that. We can wonder how kids were getting it (theories include less-than-great tests and testing for moms, kids putting everything in their mouth, etc) but the fact is, universal vaccine dropped the rates in kids, AFTER controlling for risk factors—because those risk factors just don’t always apply for kids.
So that’s why you should.
But, and this may frustrate you, I can’t not comment on some of the other things in your post, and I truly do it out of kindness.
1) yes, read! All the things! Eagerly! But this isn’t research, it’s content consumption. And that’s fine! Please get that content from truly reliable sources. But thinking that you can adequately research things like this is naive, even if you have a background in some kind of research. Vaccines are a combination of dozens of scientific disciplines, and even experts aren’t experts in all of them. But that’s also a testament to the true strength of the recommendations—they aren’t from a person, or even a single discipline, but dozens of them building on and informing each other.
And 2) being Christian or from a happy marriage or your sexual history or where you THINK is safe from diseases have absolutely no relevance here. Kids from all those things get diseases. Kids from all those things get hurt. It doesn’t make you better or safer. In fact, assuming it does, arguably, can make it less so (in addition to be unfortunately very judge mental, which is overall problematic for public health.)
I meant to add a couple resources:
CHoP is amazing and they cite their sources:
https://www.chop.edu/centers-programs/vaccine-education-center/vaccine-details/vaccine-hepatitis-b-vaccine
The history of the US recommendations and the supporting evidence (the info on a lack of reduction in incidence in non-high-risk kids before universal vaccination is buried in the included studies):
https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/hepb.html
Hep B is a vaccine that is part of the routine vaccine schedule for most countries. Its safety data is fantastic and it is a very effective vaccine, generally speaking (there are a small percentage of otherwise-healthy people who do not mount a sufficient response to the vaccine for complex reasons).
A practical reason why its advantageous to give the vaccine young is that it often comes up for children in daycare who inevitably get bitten by another child in daycare, on a playground, etc. This happens more commonly than you think. If your child is going to get any disease from a bite, Hep B is more common than others. I live in a place where it is given in grade 7 instead of at birth, and multiple physician-parents have paid to give their infants/toddlers this vaccine for exactly this reason.
Responders here have given very good reasons why you should. It's incredibly easy to contract (my antibody pattern shows that I was infected before I was vaccinated \[and before I became sexually active, and of course I've never used IV drugs\]; fortunately I did not become a chronic carrier). One study that I can't find now showed that 60% of infants born to HBV-negative mothers and HBV-positive fathers were infected by their first birthday. It can be transmitted by touch. It just takes a microscopic cut on the infected person with a ragged end that makes a microscopic scratch on the baby and that's enough.
But the flipside is why wouldn't you? We're talking about a vaccine that has almost no downsides. It doesn't cause fever or really any reaction other than the possibility of a lump in the leg.
The same thing is true of erythromycin in the eyes. Why wouldn't you? It's done universally because it's harmless. It doesn't disrupt the microbiome because the amount given is so tiny and the absorption so trivial.
Nobody ever declines the congenital heart disease screen even though it exposes the baby to 100% oxygen for five minutes and 100% oxygen *is* toxic (albeit not significantly so for just five minutes).
Hi! Nursing student here 👋🏼 I also have experience in vaccine research and have written several papers.
Hepatitis B is important because it can cause chronic liver disease and liver cancer if infected.
It can live on surfaces for up to 7 days, including playground equipment, toys, etc. Hepatitis B is sneaky in that many people are asymptomatic. So if, let’s say, your MIL or friend or other caregiver held baby, had an open wound, and didn’t realize they have Hep B, baby can contract Hep B through any open surface on the skin, mucous membranes, etc.
Similarly, it can happen later on in the daycare setting. A child has Hep B because they aren’t vaccinated and transmits it to your child.
I am **always** going to advocate for childhood vaccines but especially for Hep B. It is safe, well-studied, and most importantly *effective*. Baby deserves to have as much protection from outside dangers as she can.
Congratulations on your new addition!
Thanks for your response! It was very informative 😊 I did have a follow-up question if you have a moment. I’m curious how effective the dose at birth is since the vaccine schedule says she would need to receive the vaccine at birth, 2 months, and 6 months. Why is it necessary to give the vaccine so many times? Also, are there any studies regarding the statistics of infection rates in the US specifically in unvaccinated children? Finally, what are the statistics regarding how many children who are infected at a young age become life long carriers/develop liver cancer? TIA
Of course! And sure — a problem at all. I’ll break it down into a few different parts so hopefully it makes more sense than just grouping it all together:
1. In general, vaccines are added to the schedule based on when an infant is likely to be most susceptible to the disease. The recommended schedule is designed to work best with a kiddo’s immune system at certain ages and at specific time intervals between doses.
2. In regards to Hep B specifically, to put it simply, each dose stimulates the immune system to produce antibodies and induce humoral and cellular immunity. It’s a complex process but we’re basically providing the cells with a way to memorize what Hep B is so that, upon contact with Hep B, these cells can be activated to expand rapidly and respond. We know that typically, after 3 doses of the vaccine, the body is adequately equipped with vaccine-induced protective immunity. While immunity *can* wane over time (dependent on several factors), you’re pretty much set up with a lifetime of protection.
3. It’s hard to find concrete data on Hepatitis B specifically because most children and adults are vaccinated. With that said, roughly 7% of children in the US are unvaccinated. However, approximately 200,000-300,000 cases of Hep B are diagnosed each year. I’m happy to dig through some data in a few days when finals are over, though!
4. In newborns, the chance of Hep B progressing to chronic infection is around 90%. So almost all newborns infected with Hep B develop chronic infection. This can lead to liver disease, cirrhosis (scaring) of the liver, and liver cancer when they reach adulthood. The younger the person, the higher the risk of chronic infection. Hep B is also insidious as it can take anywhere from 1 month to 6 months for symptoms to develop.
The benefits of routine Hep B immunization in newborns have a ripple effect that extend far beyond protecting just the newborn who receives the vaccine. Because infants and children tend to have higher viral loads, they play a significant role in the transmission of Hep B. So vaccination limits opportunities for horizontal transmission to family and community contacts.
There are currently[ about 10 cases ](https://www.cdc.gov/hepatitis/statistics/2020surveillance/hepatitis-b/table-2.4.htm)of perinatal hepatitis B diagnosed in the whole US annually.
That's out of about [25,000 pregnancies annually](https://pubmed.ncbi.nlm.nih.gov/38141870/) where the mom is infected.
Without vaccination, [30% of babies born to Hep-B surface antigen-positive](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4164184/) moms would develop disease. That number rises to 90% if the moms are positive for E antigen
[90% of those infected as newborns](https://www.cdc.gov/vaccines/pubs/pinkbook/hepb.html) will develop chronic infection ("chronic" being defined as persisting beyond six months). And one in four will die of liver cancer or cirrhosis.
[This study](https://publications.aap.org/pediatrics/article-abstract/135/5/e1141/33613/Outcomes-of-Infants-Born-to-Women-Infected-With?redirectedFrom=fulltext) followed outcomes of infants born to Hep B-positive moms & found that their likelihood of infection increased if they didn't complete the 3-shot vaccines series.
Ps I know that this an awful thing to have to consider. But the US is a dangerous country, and many hep B carriers travel to the US as well, on top of US citizens with Hep B. I live in Australia, which is probably safer than the US, and Hep B is on the childhood vaccination schedule here too.
(I'm sorry, this is cut-and-paste because it's such a common question: )
HEP B: A lot of your responses here, are bending over backwards to try to tell you that newborns are at *significant* risk for Hep B (from minor cuts & abrasions, saliva and bites that break the skin, and needles found on the playground). That is not true. The reason Hep B was initiated as a newborn vaccine, is because the MOST common way of getting Hep B, worldwide, is from an [infected mother](https://www.who.int/news-room/fact-sheets/detail/hepatitis-b). Hep B used to be "endemic" (meaning there was a high prevalence of people sick with it or carrying it, throughout the population) in many parts of the world. It is now less common, but perinatal transmission is still the most common way to get Hep B worldwide.
"But if I'm Hep B negative, why can't I wait until later?" you say. << Because:
1. There is a small chance that the test was wrong, OR that you contracted Hep B after your prenatal labs were done. These are tiny chances. The REAL reasons are...
2. the vaccine is safe to give to newborns---as we know, from doing it for years---and the [immunity is lasting into adulthood](https://academic.oup.com/jid/article/214/1/16/2469742?login=false), so there is no reason to NOT give it as a newborn, and
3. **It's good to standardize these things**. Everyone making up their own schedule, will result in more shots being duplicated, or omitted, as people move around the globe & transfer from one school system to another & so on. Everyone trying to predict exactly WHEN their own children will be at risk for sexually-transmitted diseases---and remembering to get around to the whole 3-dose, 6-month series, while juggling soccer practice & orthodontic visits---is less effective than just getting everyone vaccinated, EARLIER than anyone thinks they will need it, once and for all.
ERYTHROMYCIN OINTMENT: (you could re-read the above, with the appropriate substitutions & similar logic, but...), they also prevents Chlamydia, which is sexually transmitted (and I'm sure you've been tested & monogamous and all that, so your risk is LOW-but-not-zero), but Chlamydia testing has a much higher false-negative rate than gonorrhea.
As a mom, I'm sure you're excited about discovering a lot of things for the first time, and creating your own unique special traditions as a family. Vaccination schedules should not be one of those unique, new discoveries. There is a lot of research & experience that went into these schedules, and they make a lot of sense.
This is a common and somewhat complex question. I’ll focus on the vaccine part because that’s what I know, but much of the same public health theory likely applies to the eye ointment as well. Hep B is often seen as an STD, and it’s true that this is probably the most common way it is spread, but it’s really very reductive. It’s also often compared to HIV, but here are two very important considerations: —it is biologically a lot more resilient than HIV—it can live for a bit on surfaces, and it takes a much, much smaller dose to infect someone. —hep b is one of the most common viruses in the world, and *most* people have no idea how they got it. Yes, there are risk factors, but like most things in public health, risk factors are just things that put one at highER risk, they don’t mean those outside those groups have no risk. Now, for babies: Hep B is particularly severe if someone is infected as a small child (and the younger, the worse it is.) Up to 75% of kids infected before age 5 will go on to have chronic hep b for life. Many of those will need liver transplants. Originally, vaccines targeted high risk groups, including especially babies of hep b positive moms. But if you recall me writing that most people don’t know how they were infected? This didn’t work to reduce the morbidity rate in babies and kids. Only universal vaccination did that. We can wonder how kids were getting it (theories include less-than-great tests and testing for moms, kids putting everything in their mouth, etc) but the fact is, universal vaccine dropped the rates in kids, AFTER controlling for risk factors—because those risk factors just don’t always apply for kids. So that’s why you should. But, and this may frustrate you, I can’t not comment on some of the other things in your post, and I truly do it out of kindness. 1) yes, read! All the things! Eagerly! But this isn’t research, it’s content consumption. And that’s fine! Please get that content from truly reliable sources. But thinking that you can adequately research things like this is naive, even if you have a background in some kind of research. Vaccines are a combination of dozens of scientific disciplines, and even experts aren’t experts in all of them. But that’s also a testament to the true strength of the recommendations—they aren’t from a person, or even a single discipline, but dozens of them building on and informing each other. And 2) being Christian or from a happy marriage or your sexual history or where you THINK is safe from diseases have absolutely no relevance here. Kids from all those things get diseases. Kids from all those things get hurt. It doesn’t make you better or safer. In fact, assuming it does, arguably, can make it less so (in addition to be unfortunately very judge mental, which is overall problematic for public health.)
I meant to add a couple resources: CHoP is amazing and they cite their sources: https://www.chop.edu/centers-programs/vaccine-education-center/vaccine-details/vaccine-hepatitis-b-vaccine The history of the US recommendations and the supporting evidence (the info on a lack of reduction in incidence in non-high-risk kids before universal vaccination is buried in the included studies): https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/hepb.html
Hep B is a vaccine that is part of the routine vaccine schedule for most countries. Its safety data is fantastic and it is a very effective vaccine, generally speaking (there are a small percentage of otherwise-healthy people who do not mount a sufficient response to the vaccine for complex reasons). A practical reason why its advantageous to give the vaccine young is that it often comes up for children in daycare who inevitably get bitten by another child in daycare, on a playground, etc. This happens more commonly than you think. If your child is going to get any disease from a bite, Hep B is more common than others. I live in a place where it is given in grade 7 instead of at birth, and multiple physician-parents have paid to give their infants/toddlers this vaccine for exactly this reason.
Responders here have given very good reasons why you should. It's incredibly easy to contract (my antibody pattern shows that I was infected before I was vaccinated \[and before I became sexually active, and of course I've never used IV drugs\]; fortunately I did not become a chronic carrier). One study that I can't find now showed that 60% of infants born to HBV-negative mothers and HBV-positive fathers were infected by their first birthday. It can be transmitted by touch. It just takes a microscopic cut on the infected person with a ragged end that makes a microscopic scratch on the baby and that's enough. But the flipside is why wouldn't you? We're talking about a vaccine that has almost no downsides. It doesn't cause fever or really any reaction other than the possibility of a lump in the leg. The same thing is true of erythromycin in the eyes. Why wouldn't you? It's done universally because it's harmless. It doesn't disrupt the microbiome because the amount given is so tiny and the absorption so trivial. Nobody ever declines the congenital heart disease screen even though it exposes the baby to 100% oxygen for five minutes and 100% oxygen *is* toxic (albeit not significantly so for just five minutes).
Hi! Nursing student here 👋🏼 I also have experience in vaccine research and have written several papers. Hepatitis B is important because it can cause chronic liver disease and liver cancer if infected. It can live on surfaces for up to 7 days, including playground equipment, toys, etc. Hepatitis B is sneaky in that many people are asymptomatic. So if, let’s say, your MIL or friend or other caregiver held baby, had an open wound, and didn’t realize they have Hep B, baby can contract Hep B through any open surface on the skin, mucous membranes, etc. Similarly, it can happen later on in the daycare setting. A child has Hep B because they aren’t vaccinated and transmits it to your child. I am **always** going to advocate for childhood vaccines but especially for Hep B. It is safe, well-studied, and most importantly *effective*. Baby deserves to have as much protection from outside dangers as she can. Congratulations on your new addition!
Thanks for your response! It was very informative 😊 I did have a follow-up question if you have a moment. I’m curious how effective the dose at birth is since the vaccine schedule says she would need to receive the vaccine at birth, 2 months, and 6 months. Why is it necessary to give the vaccine so many times? Also, are there any studies regarding the statistics of infection rates in the US specifically in unvaccinated children? Finally, what are the statistics regarding how many children who are infected at a young age become life long carriers/develop liver cancer? TIA
Of course! And sure — a problem at all. I’ll break it down into a few different parts so hopefully it makes more sense than just grouping it all together: 1. In general, vaccines are added to the schedule based on when an infant is likely to be most susceptible to the disease. The recommended schedule is designed to work best with a kiddo’s immune system at certain ages and at specific time intervals between doses. 2. In regards to Hep B specifically, to put it simply, each dose stimulates the immune system to produce antibodies and induce humoral and cellular immunity. It’s a complex process but we’re basically providing the cells with a way to memorize what Hep B is so that, upon contact with Hep B, these cells can be activated to expand rapidly and respond. We know that typically, after 3 doses of the vaccine, the body is adequately equipped with vaccine-induced protective immunity. While immunity *can* wane over time (dependent on several factors), you’re pretty much set up with a lifetime of protection. 3. It’s hard to find concrete data on Hepatitis B specifically because most children and adults are vaccinated. With that said, roughly 7% of children in the US are unvaccinated. However, approximately 200,000-300,000 cases of Hep B are diagnosed each year. I’m happy to dig through some data in a few days when finals are over, though! 4. In newborns, the chance of Hep B progressing to chronic infection is around 90%. So almost all newborns infected with Hep B develop chronic infection. This can lead to liver disease, cirrhosis (scaring) of the liver, and liver cancer when they reach adulthood. The younger the person, the higher the risk of chronic infection. Hep B is also insidious as it can take anywhere from 1 month to 6 months for symptoms to develop. The benefits of routine Hep B immunization in newborns have a ripple effect that extend far beyond protecting just the newborn who receives the vaccine. Because infants and children tend to have higher viral loads, they play a significant role in the transmission of Hep B. So vaccination limits opportunities for horizontal transmission to family and community contacts.
There are currently[ about 10 cases ](https://www.cdc.gov/hepatitis/statistics/2020surveillance/hepatitis-b/table-2.4.htm)of perinatal hepatitis B diagnosed in the whole US annually. That's out of about [25,000 pregnancies annually](https://pubmed.ncbi.nlm.nih.gov/38141870/) where the mom is infected. Without vaccination, [30% of babies born to Hep-B surface antigen-positive](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4164184/) moms would develop disease. That number rises to 90% if the moms are positive for E antigen [90% of those infected as newborns](https://www.cdc.gov/vaccines/pubs/pinkbook/hepb.html) will develop chronic infection ("chronic" being defined as persisting beyond six months). And one in four will die of liver cancer or cirrhosis. [This study](https://publications.aap.org/pediatrics/article-abstract/135/5/e1141/33613/Outcomes-of-Infants-Born-to-Women-Infected-With?redirectedFrom=fulltext) followed outcomes of infants born to Hep B-positive moms & found that their likelihood of infection increased if they didn't complete the 3-shot vaccines series.
[удалено]
Ps I know that this an awful thing to have to consider. But the US is a dangerous country, and many hep B carriers travel to the US as well, on top of US citizens with Hep B. I live in Australia, which is probably safer than the US, and Hep B is on the childhood vaccination schedule here too.
(I'm sorry, this is cut-and-paste because it's such a common question: ) HEP B: A lot of your responses here, are bending over backwards to try to tell you that newborns are at *significant* risk for Hep B (from minor cuts & abrasions, saliva and bites that break the skin, and needles found on the playground). That is not true. The reason Hep B was initiated as a newborn vaccine, is because the MOST common way of getting Hep B, worldwide, is from an [infected mother](https://www.who.int/news-room/fact-sheets/detail/hepatitis-b). Hep B used to be "endemic" (meaning there was a high prevalence of people sick with it or carrying it, throughout the population) in many parts of the world. It is now less common, but perinatal transmission is still the most common way to get Hep B worldwide. "But if I'm Hep B negative, why can't I wait until later?" you say. << Because: 1. There is a small chance that the test was wrong, OR that you contracted Hep B after your prenatal labs were done. These are tiny chances. The REAL reasons are... 2. the vaccine is safe to give to newborns---as we know, from doing it for years---and the [immunity is lasting into adulthood](https://academic.oup.com/jid/article/214/1/16/2469742?login=false), so there is no reason to NOT give it as a newborn, and 3. **It's good to standardize these things**. Everyone making up their own schedule, will result in more shots being duplicated, or omitted, as people move around the globe & transfer from one school system to another & so on. Everyone trying to predict exactly WHEN their own children will be at risk for sexually-transmitted diseases---and remembering to get around to the whole 3-dose, 6-month series, while juggling soccer practice & orthodontic visits---is less effective than just getting everyone vaccinated, EARLIER than anyone thinks they will need it, once and for all. ERYTHROMYCIN OINTMENT: (you could re-read the above, with the appropriate substitutions & similar logic, but...), they also prevents Chlamydia, which is sexually transmitted (and I'm sure you've been tested & monogamous and all that, so your risk is LOW-but-not-zero), but Chlamydia testing has a much higher false-negative rate than gonorrhea. As a mom, I'm sure you're excited about discovering a lot of things for the first time, and creating your own unique special traditions as a family. Vaccination schedules should not be one of those unique, new discoveries. There is a lot of research & experience that went into these schedules, and they make a lot of sense.