By Amanda Lindsey, Pediatric Nurse Practitioner, Grace Cottage Family Health
There has been a lot of public attention surrounding pediatric hepatitis B vaccines recently. Are they safe? Are they necessary? Here is some information to help you decide.
First, what is Hepatitis B? Hepatitis B is a liver infection caused by the hepatitis B virus, which can lead to chronic liver problems, liver failure, liver cancer, or death. The hepatitis B vaccine prevents this.
The most common way hepatitis B is transmitted to young children is during childbirth, when the infant is in contact with the mother’s blood and other body fluids. About 90% of infants infected at birth will develop chronic hepatitis B infection. Among those with chronic infection, 25% will die prematurely from the disease, according to the American Academy of Pediatrics (AAP).
While most young children who contract the virus do so from an infected mother at birth, it can also be spread through blood or other infected body fluids in any close contact setting, such between a parent and young child, between siblings, and at hospital and childcare facilities. Adults and older individuals with hepatitis B are often asymptomatic and do not know they are infected.
Because infants and young children are at such a high risk for chronic liver issues from hepatitis B, there is currently a universal screening recommendation for expectant mothers. However, some women do not receive routine prenatal care or are not offered testing. Also, the mother may become infected in between testing and childbirth. And, to complicate matters, there is also a risk for false negative test results.
This is why, since 1991, the CDC’s Advisory Committee on Immunization Practices (ACIP) has recommended a dose of the hepatitis B vaccine within the first 12 hours after birth.
This practice has proven to be highly effective. Since the practice began, annual hepatitis B infections among infants and children have dropped dramatically, from 16,000 to less than 20 per year.
Unfortunately, the current vaccine schedule is under scrutiny and ACIP guidelines are evolving. Some have expressed concerns about a link between vaccines and autism, even though there is no scientific evidence to link these two. There is also new misinformation surrounding the amount of aluminum in vaccines.
Aluminum is the most abundant metal in the earth’s crust. It is found naturally in plants, soil, water, and air. The aluminum contained in vaccines has been studied extensively. Infants who maintain the routine vaccine schedule (long recommended by the CDC) receive about 4.4 mg of aluminum total in the first 6 months of life, compared to 7 mg of aluminum ingested by breast-fed babies in the first 6 months, 38 mg of aluminum ingested by formula-fed babies, or 117 mg of aluminum ingested by soy-based formula-fed babies in the same time period.
A study published in 2025 evaluating the health records of 1.2 million children born between 1997 and 2018 in Denmark did not find any association between the cumulative aluminum exposure through recommended vaccines during the first two years of life and the development of specific health conditions such as asthma, environmental or food allergies, autoimmune disorders, and neurodevelopmental diagnoses such as autism and ADHD.
The Vaccine Integrity Project, based at the University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP), reviewed more than 400 studies and reports and concluded that delaying the birth dose of hepatitis B vaccine would lead to increased infections with no benefit to the vaccine’s safety or effectiveness.
“After extensive review, we did not discover safety or effectiveness data that support delaying the choice parents have to vaccinate their newborns against hepatitis B,” CIDRAP Director Michael T. Osterholm, Ph.D., M.P.H., said in a press release. “Instead, it showed that a delay will needlessly endanger the health of America’s children, putting more of them at risk of HBV infection.”
AAP President Susan J. Kressly, M.D., FAAP, has said that the hepatitis B vaccine “has one of the most well-established safety records of any vaccine. Switching to a non-universal recommendation will result in many children contracting hepatitis B infection, with devastating results for their health.”
Based on these and other peer-reviewed, scientific studies, several leading health organizations, including the AAP and the Vermont Department of Health, continue to recommend hepatitis B vaccine be administered at birth, given the highly transmissible nature of hepatitis B, and the low risk of harm from vaccines.
If you have specific vaccine concerns, I encourage you to reach out to your child’s health care provider to discuss further.
