Hepatitis B vaccine

Hepatitis B vaccine is a vaccine developed for the prevention of hepatitis B virus infection. These rely on the use of one of the viral envelope proteins (hepatitis B surface antigen or HBsAg). The vaccine was originally prepared from plasma obtained from patients who had long-standing hepatitis B virus infection. However, currently, these are more often made using recombinant DNA technology, though plasma-derived vaccines continue to be used; the two types of vaccines are equally effective and safe.

Many countries now routinely vaccinate infants against hepatitis B. Babies born to HBeAg positive mothers are strongly recommended to be vaccinated and injected with immune globulin immediately after birth, so as to prevent transmission of infection. In many areas, vaccination against hepatitis B is also required for all health-care workers. Some college campus housing units now require proof of vaccination as a prerequisite. Booster doses are not needed for low-risk general population. Some recommend such doses every five to ten years for health-care workers, though the evidence supporting such doses is quite limited.

The vaccine is highly effective. In endemic countries with high rates of hepatitis B infection, vaccination of newborns has not only reduced the risk of infection, but has also led to marked reduction in liver cancer. This was reported in Taiwan where the implementation of a nationwide hepatitis B vaccination program in 1984 was associated with a decline in the incidence of childhood hepatocellular carcinoma. In that sense, this vaccine can be thought of as an anti-cancer vaccine.

Patients with HIV appear to have inferior antibody responses to hepatitis B vaccination. This is not surprising, because some HIV-positive people have damaged immune systems: this may happen even before opportunistic infections take hold, thus justifying a diagnosis of AIDS.

It is not known whether vaccination with hepatitus B vaccine would cause rejection of a donor's blood by a blood bank that routinely tests blood for hepatitus B antibodies, as most now do—and have been doing since the mid-1980's. This is worth discussing with a doctor.

Another question has arisen: What is the value of vaccinating an infant against a sexually-transmitted disease, using a vaccine that confers immunity for only seven years? This point has been raised by Judith Reisman, whose credibility on other matters is suspect, but this point seems cogent. Unless the parents expected the child to be molested at an unusually early age, the vaccination would probably be wasted. Of course, the child might have consensual sex at 15 or 17, and the immunity might last longer than the guarantee, in which case it might help. (Is there a guarantee? In most jurisdictions, the statute of limitations for civil suits is one to three years, so a seven-year guarantee would be inherently unenforceable.) Alternatively, the parents might arrange for booster vaccinations every seven years: at 21 years, the booster might be needed, because most 21-year-olds have sex at least occasionally.