Hepatitis B remains a significant public health concern in the United States, despite progress made through vaccination programs. According to healthcare providers, there has been an increase in families delaying or refusing the birth dose of the hepatitis B vaccine for their infants. This trend is occurring even as the Advisory Committee on Immunization Practices (ACIP) considers reviewing the current hepatitis B schedule, which includes the birth dose.
Before vaccines were introduced, between 200,000 and 300,000 new hepatitis B infections occurred annually in the U.S. With vaccination efforts, that number has dropped to about 22,000 new cases each year. Of these cases, approximately 2,000 people die from complications related to their infection.
Recommendations for hepatitis B vaccination have changed since first being published in 1982. They now include universal infant vaccination and catch-up strategies for older children and adults. The addition of a birth dose has played a crucial role in controlling hepatitis B nationwide. This approach is also recommended by the World Health Organization (WHO) and implemented by many countries globally.
Hepatitis B virus targets the liver and can cause both acute and chronic infections. Symptoms may include fatigue, jaundice, abdominal pain, and elevated liver enzymes; however, many young children do not show symptoms initially. Chronic infection increases risks of long-term liver damage such as cirrhosis and cancer. People infected at birth or early childhood face higher risks of these complications compared to those infected later in life.
Certain groups are more likely to be exposed to hepatitis B:
– Individuals born in regions with high prevalence (Asia, Africa, Pacific Islands)
– People who use injection drugs
– Men who have sex with men
– People living with HIV
– Household or sexual contacts of individuals with hepatitis B
– Those undergoing immunosuppressive therapy or dialysis
– People with diabetes
Infants born to mothers with hepatitis B are particularly at risk during delivery or shortly after due to exposure to blood or body fluids. For this reason, prenatal screening is standard practice across obstetric care settings.
Testing for hepatitis B relies on blood tests that detect specific viral markers:
– HBsAg shows active infection.
– Anti-HBs indicates immunity from past infection or successful vaccination.
– Anti-HBc signals past or present infection.
Screening is recommended universally for adults at least once in their lifetime regardless of risk factors; all pregnant women should be screened during each pregnancy; high-risk groups should be screened periodically; anyone requesting screening should also be evaluated.
Treatment depends on whether infection is acute or chronic:
– Most people with acute infection require only supportive care.
– Chronic cases may need long-term antiviral therapy under specialist supervision.
Pregnant women with high viral loads may receive antivirals during late pregnancy to reduce transmission risk; all infants born to mothers with hepatitis B should receive vaccine and immune globulin within 12 hours of birth.
More than two million people are estimated to live with chronic hepatitis B in the U.S., but about 80% do not know they have it. Over time, up to one-third develop serious complications like cirrhosis or liver cancer if left untreated.
The virus spreads easily—about 100 times more infectious than HIV—and can remain viable on surfaces for up to seven days. Transmission occurs through contact with blood or certain body fluids but not through casual contact like hugging or coughing. Globally, perinatal transmission is most common; without proper intervention at birth (vaccine plus immune globulin), up to 90% of infants born to infected mothers become chronically infected.
Infection can also occur from contaminated needles—an issue exacerbated by rising opioid use—or from shared personal items such as razors and toothbrushes that may contain traces of blood invisible to the naked eye.
Universal prevention approaches remain critical because exposures can happen unexpectedly—from sports injuries involving bleeding wounds to household accidents involving contaminated objects.
If someone is exposed—especially via needlestick injury or contact between broken skin/mucous membranes and infected fluids—prompt action within 24 hours improves chances of preventing infection according to Centers for Disease Control and Prevention guidance (https://www.cdc.gov/mmwr/volumes/67/rr/pdfs/rr6701a1-H.pdf).
Experts emphasize: “Hepatitis B is a highly contagious virus with often insidious methods of transmission. When children are exposed, they often lack symptoms and are more likely to be chronically infected. For this reason, on-time vaccination is critical.” As fewer children become chronically infected due to robust vaccination programs, there will be greater opportunity for eliminating hepatitis B virus nationally.
