Do Teens Need Hepatitis B
Vaccine?
Approximately 1.2 million people in
the US are infected by the hepatitis B virus (HBV), which attacks the liver
and causes it to become inflamed. While most make a full recovery, some
5 to 10 percent progress to chronic liver disease, cirrhosis, and sometimes
liver cancer.
According to the CDC, the biggest increase in new HBV infections is among teenagers. Though HBV is preventable through a vaccine, many adolescents have not been immunized-despite recommendations from CDC and the American Academy of Pediatrics.
"Adolescents are at high risk for contracting hepatitis B, but there is no sense of urgency about protecting them from infection," says Robert L. Johnson, MD, director of the Division of Adolescent and Young Adult Medicine at UMDNJ-University Hospital. "We need to immunize all 11- and 12-year-olds before they become sexually active. Older teens should be immunized too."
HBV is transmitted through infected blood and body fluids, including semen, vaginal secretions, saliva, breast milk and tears. Those at risk include intravenous drug users and people with multiple sex partners (although transmission can occur through a single sexual encounter). Intranasal drug use (snorting a drug through a straw), tattooing and body piercing are also believed to be modes of transmission. Other risk factors include exposure to infected saliva, through deep kissing or bites that break the skin.
Transmission can also occur through exposure to open wounds or nosebleeds (common occurrences in classrooms, playgrounds and schoolyards) or by sharing nail clippers, razors, or toothbrushes. The hepatitis B virus is extremely hardy. It can survive in a drop of blood or body fluid or even on a dry surface for weeks.
The virus is readily transmitted at birth from mothers to their newborns, who then have a 90 percent risk of being chronically infected. For this reason, in 1991 the CDC recommended immunization of all newborns. "We're protecting babies, but adolescents are falling through the cracks," says Johnson.
The HBV vaccine was developed in 1982, making it a newcomer to the vaccine world. Its relative newness may be the reason why it's not included as one of the childhood vaccines.
In 1994, the Advisory Committee on Immunization Practices recommended HBV vaccination for all 11- and 12-year-olds who have not been immunized. Many states have begun school-wide programs to vaccinate this group as well as older teens. Some public health officials advocate making immunization a mandatory part of college health physicals.
"In a few years, this problem will go away, since all the babies
currently being immunized will be adolescents," Johnson says. "But
in the meantime, thousands of teenagers will be infected."