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Hepatitis B vaccine: risks and benefits of universal neonatal vaccination
1National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Children's Hospital at Westmead, NSW, Australia. RainaM@chw.edu.au
Insights
Global eradication of hepatitis B is achievable with effective and safe vaccines. Universal childhood vaccination, including a neonatal dose, is the most practical strategy to prevent transmission and carriage, despite past concerns about vaccine safety.
Area of Science:
- Public Health
- Infectious Diseases
- Vaccinology
Background:
- Hepatitis B virus (HBV) infection affects over 2 billion people globally.
- HBV infection poses a significant public health challenge, with carriage being a primary transmission reservoir.
- Childhood vaccination schedules, including a neonatal dose, are recommended to combat HBV.
Purpose of the Study:
- To evaluate the effectiveness and safety of universal hepatitis B vaccination.
- To assess the impact of neonatal vaccination on HBV carriage and transmission.
- To address concerns regarding vaccine safety and cost-effectiveness in different endemicity settings.
Main Methods:
- Review of epidemiological studies on hepatitis B vaccine safety and efficacy.
- Analysis of the impact of neonatal versus selective vaccination strategies on disease transmission.
- Evaluation of cost-effectiveness data for universal vaccination programs.
Main Results:
- Hepatitis B vaccines are effective and safe, with no confirmed link to multiple sclerosis or fever.
- Neonatal vaccination significantly reduces HBV carriage due to age-related risk.
- Universal vaccination is cost-effective in high-endemicity regions and crucial for global eradication.
Conclusions:
- Universal hepatitis B vaccination, starting with a neonatal dose, is the most effective strategy for global eradication.
- Concerns regarding thiomersal preservative and rare adverse events have been addressed; current vaccines are thiomersal-free.
- Selective vaccination programs are less effective than universal programs in preventing childhood transmission.
Abstract:
Global eradication of hepatitis B, which has infected over 2000 million people worldwide, is an achievable goal. Hepatitis B vaccine is effective and safe, and is recommended in Australia as a four-dose childhood schedule commencing with a neonatal dose. A neonatal dose has a greater impact on carriage, the main reservoir of transmission, due to the inverse relationship of age and risk of chronic carriage. Universal vaccination is clearly cost-effective in countries of high hepatitis B endemicity but less so in countries of low endemicity. Other factors affecting the perceived benefits of universal vaccination in low-risk countries include the use of the preservative thiomersal in hepatitis B vaccines, and case reports of multiple sclerosis (MS) and unexplained fever in recipients. Careful epidemiological studies have failed to confirm any risk of MS or fever with the hepatitis B vaccine, which is now thiomersal-free. Other arguments against universal vaccination include 'unnecessary' vaccination of low-risk neonates. However, selective vaccination programmes targeting at-risk neonates are often poorly implemented and do not protect against horizontal transmission in early childhood. Universal vaccination, which is safe and effective, is the only practical means of achieving global eradication of hepatitis B.