This article is from the Childhood Vaccinations FAQ, by Lynn Gazis-Sax firstname.lastname@example.org with numerous contributions by others.
Up until 1992, the recommendation was that hepatitis B vaccine be
given only to people in high risk groups for hepatitis B: people whose
professions exposed them to blood, people at extra risk due to their
sexual practices or intravenous drug use, and certain populations
(such as Southeast Asian immigrants) with a high incidence of the
disease. The chief reason was cost; it was felt to be not
cost-effective to vaccinate low-risk groups.
Unfortunately, this policy was not successful in checking the spread
of hepatitis B. It proved difficult to identify high-risk people, and
high-risk people did not volunteer in large numbers to be
vaccinated. For this reason, in 1992, the ACIP recommendation was
switched to vaccination of teens and adults in high-risk groups and
universal vaccination of infants. The AAP made a similar
recommendation but would also like to extend hepatitis B vaccination
to all adolescents, if possible.
The American Liver Foundation also supports hepatitis B vaccination of
infants, and their pamphlet on the subject suggests a variety of ways
in which even young children could come in contact with the virus
(through contact with blood, etc.). Though young children are at low
risk of catching hepatitis B, their risk of developing the chronic
form of the disease if they do catch it is higher than for adults.
The new policy was well-received internationally, and 30 countries now
have universal infant HBV vaccination programs. Many physicians
remain skeptical, however, and a survey in North Carolina showed one
third of pediatricians and <20% of family physicians supporting the
new guidelines (Journal Watch, 9-1-93). (Update: Journal Watch for Jan
15, 1995/Feb 7, 1995 reports that this vaccine is gaining physician
acceptance, citing Arch Pediatr Adolesc Med Sep 1994, p. 936)
Why the resistance? One reason is a reluctance to give low-risk
infants yet another vaccination. Another is doubt about the duration
of HBV vaccine. There is evidence that it lasts up to 10 years, but we
do not know yet whether it wears off beyond that point. There is
concern that infants vaccinated for HBV may lose immunity during
adolescence, when the risk of catching the disease is greatest. An
alternative would be to vaccinate all children at age 10 and give a
booster at age 20. But compliance would likely be lower at age 10 than
in infancy. Hepatitis B vaccine is administered in three shots over
the course of six months, and it would be difficult to get preteens to
all come in for the full series. Also, 8% of hepatitis B infections
occur before age 10, and the deadly form is three times greater in
children (NY Times, 3/3/93:B8). Boosters could be given later to
infants vaccinated for HBV if immunity proves to lapse.
Hepatitis B vaccine is also often recommended for travel purposes.