Hepatitis B vaccination is no longer given to all babies at birth in the US. What is happening in Romania? The explanations of the infectious disease doctor Adrian Marinescu

The topic of hepatitis B vaccination recently re-entered the public spotlight after, in the United States, the acting director of the Centers for Disease Control and Prevention (CDC) adopted a recommendation to delay the administration of the vaccine in newborns, in certain contexts. The decision is not supported, however, by major medical organizations such as the American Academy of Pediatrics (AAP) and the World Health Organization, which continue to recommend vaccination at birth as an essential public health measure.

Adrian Marinescu, primary infectious disease doctor at the “Matei Balș” National Institute of Infectious Diseases, explains how this discussion should be understood from a medical point of view and what is the situation in Romania regarding this immunization.

The change reverses a nearly 35-year-old practice of vaccinating newborns against hepatitis B within 24 hours of birth. Vaccination is now recommended as a priority for newborns of mothers infected with the hepatitis B virus, while for others the first dose could be delayed until two months of age.

The change is not supported by the AAP, however, which continues to recommend hepatitis B vaccination at birth as an essential public health measure. According to them, early vaccination reduces the risk of perinatal transmission and provides protection during a period when the infection can evolve silently, with long-term consequences.

Dr. Adrian Marinescu: “The postponement does not bring any clear benefit”

Adrian Marinescu, primary infectious disease doctor at the “Matei Balș” National Institute of Infectious Diseases, explains that the idea of ​​postponing the anti-hepatitis B vaccine until the age of two months starts from a risk assessment in the first weeks of life. During this period, the probability of infection is considered low, especially in the case of children who are not infected at birth and come from mothers without hepatitis B.

“The logic of those who discuss the postponement is that, in the first two months of life, the probability of infection is small, especially if we are talking about a child born to a mother without hepatitis B. Sure, theoretically anything can happen, including that the mother becomes infected later, but the risk is small. This does not mean, however, that the postponement brings a clear benefit. The vaccine will be administered anyway, and from a medical point of view there is no solid argument for changing the standard recommendation,” explains the doctor.

However, Dr. Adrian Marinescu emphasizes that this does not mean that the risk is non-existent. In the absence of the vaccine, the child has no protection, and in theory unforeseen situations may arise, including the mother becoming infected after birth and transmitting the virus. Even though such scenarios are rare, they cannot be completely ruled out.

According to the infectious disease specialist, protection becomes really important as the child grows and exposure to real risk factors occurs. This is precisely why vaccination remains essential, and the discussion of deferral should be understood as a nuance related to risk, not as a preferable alternative to the recommended vaccination schedule.

Hepatitis B and vaccination at birth in Romania: what the official recommendations provide

In Romania, vaccination against hepatitis B is part of the national vaccination scheme and is recommended for all newborns, in the first 24 hours of life, as a universal prevention measure. The strategy is aligned with international recommendations and has as its main objective the prevention of transmission of the virus from mother to child, but also the early protection of the newborn in a period when the risk cannot always be fully assessed.

The hepatitis B virus is transmitted through contact with infected blood or biological fluids, and transmission at birth is considered one of the most important routes of infection in the first years of life. Specialists point out that the infection acquired at birth or in early childhood has a much higher risk of becoming chronic, with possible long-term consequences, such as cirrhosis or liver cancer.

Vaccination of newborns at birth is also recommended because not all mothers infected with the hepatitis B virus know that they are carriers. Although screening in pregnancy is a standard practice, there may be situations where pregnancies are monitored late, regular prenatal checks are not respected, access to medical services is limited. In this context, universal vaccination works as a safety net for the child.

If the mother is known to have hepatitis B, the medical protocol provides for the administration of the anti-hepatitis B vaccine and specific immunoglobulin in the first hours after birth, to significantly reduce the risk of transmission of the virus. Afterwards, the vaccination schedule is continued according to the national calendar to ensure full protection.

The Romanian health authorities have not issued, until now, recommendations supporting the postponement of anti-hepatitis B vaccination in newborns. The current vaccination schedule remains based on early administration of the first dose as a public health measure.