Immunization and the hepatitis B virus: A view from the ESPGHAN Hepatology Committee

Hepatitis B virus (HBV) infection remains a global health challenge, with more than 250 million people chronically infected worldwide and >2000 daily deaths from HBV-related disease. Early-life acquisition is the primary driver of chronic infection; up to 90% of infants infected perinatally progress to chronic HBV infection compared with markedly lower rates in older children and adults. Universal infant immunization, including the birth-dose, has been central to global elimination, resulting in a substantial reduction in chronic HBV infection, cirrhosis, and hepatocellular carcinoma. Recent statements from the Centers for Disease Control and Prevention question the evidence-base for early-life vaccination and recommend deferring HBV immunization until later in childhood. These claims reflect misconceptions about HBV epidemiology and reference a perceived association between infant vaccination and autism. This communication summarizes evidence demonstrating the risks of early-life HBV transmission leading to chronic infection. We argue that delaying or foregoing immunization would leave infants at unnecessary risk. We reference two decades of research in which large-scale studies have not identified an association between vaccination, including HBV vaccination, and autism.