The use of vaccines has not been without controversy. Most recently, connections have been drawn between vaccinations and autism. Strong feelings lie on both sides of this heated debate. Unfortunately, these arguments have yet to result in answers to concerns regarding the safety of this precautionary measure. Another under review is the hepatitis B vaccine. A better understanding of how hepatitis B is spread, along with when to suggest this vaccine, could lead to substantially lower side effects and more appropriate protection for those who need it.
Hepatitis means inflammation of the liver. With this particular disease, the cause is a virus. The World Health Organization estimates that 600,000 people will die each year due to complications from hepatitis B [Source: WHO]. It is transmitted through contact with blood, semen and vaginal fluids [Source: WHO, Dawson]. This virus also has the hearty ability to live outside the body for several days, making it an even greater infectious risk. Hepatitis B occurs worldwide, but is most prevalent in China. Approximately 8-10 percent of the adult population chronically carries this virus, which means it has infected the body and the body has to keep it at bay. Since hepatitis B is such a serious infection, public health measures to keep it in check are very important. For this reason, the development of the hepatitis B vaccine is heralded by many as a huge success.
Others have not been so enthusiastic. It is one of many vaccines that contain thimerosal, a mercury based preservative that has been a big part of the vaccine/autism controversy. For many years, infants received several vaccines within their first 6 months that provided a sum total of mercury-based thimerosal that may have exceeded national safety guidelines [Source: Madaan]. The question many health advocates have is whether or not any level of mercury safe, especially in a newborn whose nerve structures will be very sensitive to toxins. The first round of the hepatitis B vaccine is given typically on the first or second day of life. If a child has a problem like colic or poor sleep from birth, the question becomes whether or not the child was born that way or did his or her first vaccination have anything to do with the problem. It becomes much harder to know what is a side effect of the vaccine and what is not. It is now requested, not mandated, that thimerosal be removed from vaccinations. One type of hepatitis B vaccine from the pharmaceutical company Merck is free of thimerosal, one from Merck is not, and a third vaccine from a different company contains trace amounts of thimerosal [Source: Madaan].
Another major problem in preventing hepatitis B, is having adequate protection during the probable times of exposure. In North America, the population most at risk for hepatitis B are intravenous drug users (due to potential needle sharing) and those engaging in promiscuous intercourse. These individuals will be at much higher risk for contracting hepatitis B than others. Health care workers will also share some risk due to the possible exposure to blood products. The hepatitis B vaccine might not offer protection for life, or even for several years. Unfortunately, vaccinating infants at 0-6 months of age might not offer sufficient protection when the child is 15 -25, a time when drug use and sex practices are a possibility.
Certainly, clinical sense should be used to determine when and if hepatitis B vaccinations should be used. Places where the hepatitis B virus is extremely prevalent, like China, might require a much more aggressive vaccination policy. In areas where the virus is much less common, vaccination at such a young age, years before potential exposure, might not provide as much benefit given that vaccine’s possible risks. It is true that any medicine can have risks, especially when given to a few million people. What might be a better option in areas of low risk is to ask whether or not a baby’s mother, father or primary caregiver are carriers of hepatitis B (mom is checked with each pregnancy and everyone else can be tested with a blood test), as well as does the child live in an area with a high volume of hepatitis B? If the answers are no, then perhaps the decision to vaccinate could be delayed until the child is older, giving the brain and nervous systems more time to develop. Then, if the risks are deemed worthy of vaccination, the series could be given and would proximate more of the time frame when the person is most at risk. Also, if a child does have developmental delays, the family would not be left wondering if it is because the child was vaccinated just after birth.
Vaccination policies will continue to be debated until the autism epidemic is finally under control. This debate does bring to light that current policies should constantly be reviewed and evaluated for both safety and rationale. The hepatitis B vaccine represents both the potential to help many and a one-size-fits-all approach to treatment. Parents should be encouraged to evaluate the pros and cons of the vaccine along with the time frame for which it will be most helpful. An educated discussion and decision with a doctor will help to produce confidence in treatment, a deeper understanding and better utilization of this vaccine leading to an improvement in overall safety.
