Hepatitis B Vaccine. Hepatitis B is a virus which can cause mild symptoms, such as nausea and jaundice, or severe problems, including fatal hepatitis. Pregnant women are now tested for this virus routinely. Infection may be transmitted from a mother to a baby at birth. Among older persons, the most common modes of transmission include contact with infected blood products or sexual activity with someone already infected. A significant number of infected persons do not appear to have had any of these exposures. The illness is usually self-limited, but some persons develop chronic hepatitis B, which may lead to cirrhosis, liver failure, or liver cancer. This potential is the main concern about this illness. There is no drug available to cure the infection.
The American Academy of Pediatrics recommends that all children receive a series of three immunizations for hepatitis B Most health plans cover this immunization for children of all ages. Children receive the first shot, then the second shot one month later, and finally the third shot five months following the second. Side effects are minimal, limited to a brief period of soreness at the site of injection. The immunization is made of recombinant DNA and is not a live vaccine.
We believe that this recommendation is sound, and we are now administering the hepatitis B series to all infants and all children in our practice. Booster shots after the initial series of three shots are not currently necessary. Pennsylvania requires the hepatitis B series for school entry.
In July, 1999 a problem with a preservative used in producing the vaccine came to light. The production process used thimerosal, a mercury-containing substance, and while the amount of mercury present in each injection is quite miniscule, in the summer of 1999 the American Academy of Pediatrics recommended that babies begin the series at age six months, rather than at birth, which had been the practice since 1992. Since then the manufacturing process was improved, so a thimerosal-free vaccine became available. We have returned to the original schedule for the hepatitis B series, with the first injection in the newborn nursery.