Newborn hepatitis B vaccines save lives, prevent cancer, and don't cause autism
RFK Jr and his anti-vaccine allies continue to cause preventable illness and death among our most vulnerable.
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I know you might have expected a newsletter last week, but I took some much-needed PTO to head to Colorado to 1) celebrate my bestie from college’s wedding (and see his mom for the first time in 18 years) and 2) visit my stepbrother and his partner after they moved to Colorado Springs a little over a year ago.
I also summited my first 14er while I was there! Garrett and I hiked Pike’s Peak, doing the northwest slope route from Crag’s Campground. It was intense — the air was super dry and thin for a girl living at sea level, but absolutely gorgeous and felt like a real accomplishment. Plus, we saw TONS of marmots and even a trio of mountain goats (including a baby).
If you’ve been here a while, you know this year has been pretty rough for me, even outside professional challenges (my career in life sciences biotech, the war on science and objective reality, etc). And science communication is a pastime for me, not the job that pays the bills. But I’m back at work, and writing, so buckle up because there is a LOT to cover!
Surprise! RFK Jr has been spouting off more deadly lies about vaccines.
This time he’s targeting the hepatitis B vaccine. The Hepatitis B vaccine has been demonized for decades, particularly among people who are opposed to vaccinating newborns for a deadly disease.
This time, RFK Jr. claimed on Tucker Carlson that children who received the hepatitis B vaccine within 30 days of birth had a 1,135% increased risk of autism, and the CDC “buried” the study, and the link.
This is a lie.
As usual, RFK Jr is blatantly showing his gaping absence of any scientific expertise, basic data analysis, and critical thinking. We will get back to this claim, but since I’ve already written on the decades of data demonstrating that no vaccines, hepatitis B or otherwise, have a link to autism, I would much rather focus on some education about hepatitis B and the vaccine.
There is a very specific reason we have universal newborn hepatitis B vaccination recommendations in the US — and we have data to show that it saves lives.
Hepatitis B infection causes acute illness, chronic hepatitis, cirrhosis, and liver cancer.
Hepatitis B virus is a DNA virus in the Hepadnaviridae family (hepa- for liver, dna- for DNA virus. Clever, right?). While you may also have heard of hepatitis C and hepatitis A viruses, these 3 viruses are unrelated—they just are all called hepatitis viruses because they lead to hepatitis: infection and inflammation of liver cells, called hepatocytes.
Hepatitis B virus (HBV) has a very complex replication cycle. This allows it to have multiple processes where its genome (because it is DNA) can get into the nucleus of human liver cells and exist indefinitely if it isn’t eliminated by our immune system.
As a result, HBV can cause persistent infection even after acute illness. This persistent infection can lead to chronic hepatitis which can progress to liver damage, cirrhosis (where the liver tissue becomes scar tissue), and liver cancer.
Hepatitis B is NOT just sexually transmitted.
Contrary to anti-vaccine activists who claim that infants don’t need a “vaccine for a sexually-transmitted infection,” HBV is not just sexually transmitted.
HBV is an incredibly contagious virus and is transmitted through contact with bodily fluids: blood, mucosal fluids, semen, and vaginal secretion. The virus spreads when there is a break in the skin or through mucous membranes (eyes, respiratory tract, vagina, etc). The virus can survive on inanimate objects and surfaces for 7 days, and is quite a hardy virus.
HBV is spread through sexual activity, perinatally (mother to child), unsafe medical practices, unsanitary needle practices (including piercing/tattooing), and other person-to-person fluid exchange. There is even evidence that while HBV is not transmitted by saliva, it can be transmitted through sharing of toothbrushes, drinkware, etc., when an infected person has a cut or small sore in the mouth — underscoring how much virus can be in a person’s system when they are infected.
So no, not just sexually transmitted, at all.
Children are infected primarily through two routes:
Perinatally (during birth), when during delivery the newborn is infected by the mother. This is also called vertical transmission.
Direct contact with an infected individual (family member, medical professional, etc)
When children are infected during the first year of life, they are at incredibly high risk of both acute hepatitis and chronic hepatitis. Adults are less likely to develop chronic hepatitis if they are infected with hepatitis B virus.
90% of infants (under 1 year old) will develop chronic hepatitis if they are infected with HBV.
What’s more?
58% of all liver cancers are linked to chronic hepatitis B.
So: if we could prevent infant hepatitis B infections, we could also prevent all the complications associated with chronic hepatitis (and obviously acute hepatitis which is no walk in the picnic either, especially for newborns), plus cancers.
Wouldn’t it be great if we could do something about that?
Enter, the hepatitis B vaccine.
The hepatitis B vaccine prevents infection with HBV, acute hepatitis, chronic hepatitis, and complications of chronic hepatitis.
The first hepatitis B vaccine was developed and approved in 1981 and was developed using serum of patients with chronic hepatitis, because blood of chronic hepatitis patients are filled with HBV virus particles (that’s how it gets spread to other people). A specific protein, HBsAg (hepatitis B surface antigen), was isolated, inactivated, purified, and used as the active ingredient in the vaccine because this protein serves as an antigen: it triggers that robust immune response that can lead to immune memory if administered to uninfected people.
The problem? This method of producing serum is very hard to scale, and with the extent of global prevalence of hepatitis B (including in the US), it was difficult to manufacture enough vaccine doses.
In 1986, a new vaccine was FDA-approved that used genetically engineered yeast cells to produce this same protein. Yeast cells can easily be turned into protein-production factories to make lots of this hepatitis B surface antigen. All current hepatitis B vaccines used this method and are called recombinant protein vaccines.
The HBV induces a very strong immune response and is incredibly protective against infection with the virus and the potential progression to chronic hepatitis (and all the resulting complications).
Starting in 1981 when the first FDA-approved vaccine was licensed, there was no universal vaccine recommendations. This was in part because making that plasma-based vaccine was incredibly difficult, expensive, and low-yield, and because the virology and epidemiology of hepatitis B wasn’t as well understood. Initially, vaccination was recommended for specific high-risk adult groups, like healthcare workers, dialysis patients, individuals who shared needles, and families with HBV-positive members.
In 1988, CDC’s ACIP started to recommend hepatitis B vaccination for infants born to mothers who tested positive for that HBV protein, the HBsAg. During this period, HBV testing during pregnancy (for those who had prenatal care) became semi-standard practice to try to identify infants who would be at risk.
But this still wasn’t leading to substantial reduction in HBV infections. The reason for this is multi-fold, and in large part is due to how the virus reproduces during infection and how we test for HBV infection by detecting HBsAg.
The big takeaway though? In the 1980s, 26,000 HBV infections were reported in the US every year, with an estimated of 200,000 new infections every year. So experts (legitimate ones, not wellness influencers) reviewed the data and updated policies.
In 1991, universal newborn HBV vaccination recommendations were implemented.
This was done because it was now understood that the vast majority of chronic hepatitis B cases were a result of infection early in life (not among high risk adults).
To minimize individual and public health impact, particularly among infants (extremely vulnerable humans), CDC’s ACIP (Advisory Committee on Immunization Practices) implemented universal newborn vaccination recommendations. This shift 5 years after the availability of a widespread preventive medicine had incredible impact.
What happened? Hepatitis B prevalence plummeted.
A quick rundown of all of the good things that happened following newborn vaccine recommendations:
By 2002, chronic hepatitis B prevalence in US children under the age of 5 dropped to less than 0.1%. Previously, 4.7% of children under 5 had hepatitis B infection.
There was an 89% reduction in infection rates, solely due to this change in newborn vaccine recommendations.
Perinatal HBV transmission declined by over 90%.
By 2010, acute HBV had declined by 82% among all age groups in US.
Among adolescents, HBV incidence dropped by 98%. (this is the demographic that was the first group to receive newborn vaccination)
What’s more? Newborn hepatitis B vaccine prevents liver cancers. 37 years of follow up in randomized controlled trials show that newborn hepatitis B vaccination prevents liver cancers by up to 72%. That’s huge.
Other countries have universal newborn hepatitis B recommendations too.
A common refrain is that the US is “over vaccinating” children compared to other countries. Well, that’s not true. In fact, many other countries implemented universal HBV newborn vaccination recommendations similar to the US.
These include Taiwan, Thailand, China, Australia, Japan, and nearly 190 other countries around the world. Taiwan actually adopted newborn vaccination in 1984, 7 years before the US did.
Just like the US, in countries who adopted universal infant vaccination, prevalence of HBV has dropped from ~5% in the 1980s to <1% by 2020. Vaccination programs have reduced new infections among kids by over 95% in areas with high vaccine uptake.
What’s more? Rates of liver cancers have also declined. Because remember, Hepatitis B infections cause cirrhosis, liver failure, and liver cancer, particularly when infection occurs during infancy.
No, “mom tested negative” isn’t a sufficient reason to avoid newborn hepatitis B vaccination: here’s why.
Our latest Surgeon General nominee, the grifter Casey Means (more on her here, but important to note she is neither a scientific expert nor a practicing physician), repeats the same anti-vaccine refrain, telling people that newborn hepatitis B vaccine should be questioned.
In fact, she went so far as to call it a “crime” — she thinks it’s a crime to protect vulnerable children against an incredibly contagious and dangerous disease? Got it. Obviously she is wholly unqualified to speak on this, and really any topics related to health and science, but let’s address this notion.
Many people who are opposed to universal hepatitis B vaccination in the US believe that if a pregnant woman tests negative for HBV, then there’s no risk to the infant and therefore, they don’t need vaccination.
This is wrong. And I would argue the crime here is undermining an incredibly important medicine that prevents acute AND chronic illness. Isn’t MAHA all about the “chronic illness” epidemic? (for more on that flawed logic, read the article below)
The “mom tested negative” isn’t a sufficient excuse to opt out of vaccinating.
In fact, experts saw that in the 1980s when only high-risk infants were being vaccinated following prenatal Hepatitis B testing. HBV infection rates and prevalence were not declining.
That’s why universal vaccination recommendations were implemented.
You can be infected with HBV and not test positive on the HBsAg test.
When someone is newly infected with HBV, there is a time called the window period. You can think of this as an extension of the incubation period. But the window period is the time interval between when someone is infected with HBV and when there is enough virus in their blood to detect that viral protein, the HBsAg, on the diagnostic tests.
The window period for HBV can be up to 10 weeks. That means someone could be infected and not test positive for hepatitis B for 2 1/2 months. I’m sure you can see where I’m going here, but if someone is tested in the early second trimester for HBV, tests negative, assumes they’re uninfected, that may not actually be the case. Even if someone tested negative late in pregnancy, that does not guarantee they are uninfected, if they are in the window period.
This idea that a negative test means your infant isn’t at risk creates a false sense of security. Universal vaccination at birth ensure we protect all newborns, even if early infection isn’t caught by testing during the window period.
The US has varied demographics and access to healthcare—universal newborn vaccinations minimize this negative impact to infant’s health.
A lot of anti-hepatitis B vaccine activists use European countries as examples of “why” newborn vaccination isn’t required. But they forget that the US, while also considered a developed nation, is wildly different demographically than European countries.
Our population is immense compared to any one European country. The US has roughly 341 million people compared to the most populous European country Germany, with 84 million. So the US has 4 times the number of people than the most populous European country.
The US does not have universal healthcare, and certainly not universal prenatal care. Comparing the US and the ability of pregnant women to seek and access HBV testing to any country with universal healthcare is apples to oranges and a completely flawed approach. By ensuring that even children born to individuals who did not have consistent pregnancy healthcare receive this incredibly effective medicine at birth ensures that all babies get protection.
The US had much higher hepatitis B prevalence compared to other developed countries. Similar to the previous point, people will compare the US vaccine recommendation to a European country, like the UK, which does not administer a birth dose of hepatitis B vaccine. Just because a country like the UK, with a population of 68 million, doesn’t do a birth dose of hepatitis B vaccine, isn’t an argument against it in the US, because the UK and the US are not the same.
The prevalence of chronic hepatitis B in the UK before the hepatitis B vaccine was developed was already quite low, less than 1%. In contrast, prevalence in the US was near 5%, with the majority of new chronic hepatitis cases occurring in children under 5.
Using the risk-based strategy of only vaccinating newborns whose mothers tested positive for HBsAg (which is the approach used in UK) was not reducing hepatitis B burden in the US because of the much higher circulation of virus in our population as well as the other factors above.
It was not until we implemented universal newborn vaccination here in the US that we were able to limit the transmission and infection of HBV.
The hepatitis B vaccine is one of the most studied and safest vaccines that exist—and it does NOT cause autism.
Hepatitis B vaccine has been studied for decades upon decades and has an incredibly high safety profile. Billions of doses have been administered globally.
Nothing is without risk. But vaccines, including the hepatitis B vaccine, are hundreds to thousands of time safer than things you do every single day, like getting in a car (or putting your infant in a car), eating food, taking Tylenol.
And vaccines are far safer than the infections they are preventing. That’s the whole point. Even serious adverse events like anaphylaxis occur at rates of 1 instance for every 1,100,000 doses of the hepatitis B vaccine administered.
It doesn’t cause multiple sclerosis or other neurological issues, either. The hepatitis B vaccine does not cause autism. No vaccines do. (For more, read below)
Undermining our ability to prevent acute and chronic viral hepatitis causes preventable illness and death.
Globally, hepatitis B causes around 1.1 million deaths due to cirrhosis, liver failure, and liver cancers. In the US, at least 5,000 deaths every year are a result of liver cancer and failure due to chronic hepatitis—and those infections are occurring primarily during infancy.
We can prevent even more of these deaths if we stop allowing anti-vaccine rhetoric to have a place in the public discourse. Vaccines are safe, they are incredibly well-studied, and they save lives. That’s true for all of them, but especially for hepatitis B vaccine, because this one also prevents cancers.
We cannot let charlatans like RFK Jr. further erode our public health safeguards. They are a clear and present danger to humanity.
We all must join in the fight for science.
Thank you for supporting evidence-based science communication. With outbreaks of preventable diseases, refusal of evidence-based medical interventions, propagation of pseudoscience by prominent public “personalities”, it’s needed now more than ever.
Stay skeptical,
Andrea
“ImmunoLogic” is written by Dr. Andrea Love, PhD - immunologist and microbiologist. She works full-time in life sciences biotech and has had a lifelong passion for closing the science literacy gap and combating pseudoscience and health misinformation as far back as her childhood. This newsletter and her science communication on her social media pages are born from that passion. Follow on Instagram, Threads, Twitter, and Facebook, or support the newsletter by subscribing below:
Absolutely excellent post. Thank you for laying out the science so clearly. It is infuriating to see RFK Jr. once again peddling lies that put children’s lives at risk. The data on the hepatitis B vaccine are overwhelming. It prevents lifelong infection, cirrhosis, and even liver cancer. Undermining it with fabricated statistics is beyond irresponsible.
And now, to make matters worse, we are watching the absurdity of Casey Means, someone with no relevant scientific expertise or clinical practice, being elevated as Surgeon General. Pairing her appointment with RFK Jr.’s ongoing disinformation is a perfect storm for public health. Thank you for continuing to shine a light on these dangerous falsehoods.
Great read. Is there an issue with maternal antibody interference and the HBV vaccine? I was one of the first immunized with the subunit vaccine. Had my first kid a couple years later who was also vaccinated for HBV. I think her primary vaccination was done in the delivery ward. Fast forward to adulthood and this kid goes to nursing school. She has titer done for HBV SAg and it is negative. She gets revaccinated with the series and produces a robust titer. Just wondering if vaccine status of mom needs to be considered so all kids are well protected as adults.