In Reply: Dr Cantekin and Mr Belkin question
the importance of initiating routine HBV vaccination at birth, a practice
whose benefits we described recently.1 They
are correct that some behaviors rendering people at high risk for HBV do not
begin until adolescence or adulthood. However, a lower but nevertheless substantial
incidence of HBV infection affects individuals, including adults and children,
who do not engage in these high-risk behaviors.2
Furthermore, there are at least 4 benefits to newborns of HBV-infected mothers.
First, it eliminates confusion in birthing units regarding the need for immediate
immunization of newborns of mothers whose hepatitis surface antigen status
is positive or unknown, thereby avoiding irretrievable missed opportunities
to interrupt vertical transmission, which can have tragic consequences.3,4 Second, rendering children immune
to HBV in early infancy provides protection against the small but measurable
incidence of HBV infection that is acquired horizontally during childhood.
Third, initiation of the 3-dose series at birth has been associated with a
higher likelihood of on-time receipt of the entire series of HBV vaccinations,5,6 and of unrelated immunizations,
such as diphtheria, tetanus, pertussis vaccine; inactivated poliovirus vaccine;
and measles, mumps, rubella vaccine.5 Fourth,
immunization during infancy with integration into a schedule with other vaccinations
has the best chance for high coverage and protection for most US children
when the burden of disease increases sharply beginning in adolescence. Such
a strategy has paid great dividend in the case of rubella immunization.