Andy S Yu MDa Ramsey C Cheung MDbc Emmet B Keeffe MDc

The Revised Authoritative Guide To Vaccine Legal Exemptions

Vaccines Have Serious Side Effects

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aPacific Gastroenterology, 2101 Forest Avenue, Suite 106, San Jose, CA 95128, USA hDepartment of Hepatology. VA Palo Alto Health Care System, 3801 Miranda Avenue,

Palo Alto, CA 94304, USA cDivision of Gastroenterology and Hepatology, Stanford University School of Medicine, 750 Welch Road, Suite 210, Palo Alto, CA 94304, USA

More than 350 million people worldwide are infected with the hepatitis B virus (HBV), and more than 1 million of them die each year of liver failure or hepatocellular carcinoma (HCC) [1]. The HBV prevalence varies widely from 0.1% to 20% in different geographic regions in the world, depending on the predominant age of infection and major mode of transmission [2]. There are currently 1.25 million HBV carriers in the United States, contributing to 17,000 hospitalizations and 5000 deaths annually [3]. As HBV is transmitted by body fluids, infection can be minimized by proper infection control practices, risk-reduction counseling, virus deactivation of plasma-derived products, and screening donors of blood, solid organs, and semen [4]. However the most effective way to prevent transmission of HBV is by immunization [5].


The national strategy to eliminate HBV transmission in the United States focuses on four major categories of subjects, including: (1) neonates, (2) infants, (3) adolescents, and (4) adults who are at increased risks for infection [6]. Identification of pregnant women who test positive for hepatitis B surface antigen (HBsAg) and timely postexposure prophylaxis of their newborns with hepatitis B vaccine can prevent most perinatal transmission

A version of this article originally appeared in the 8:2 issue of Clinics in Liver Disease.

* Corresponding authors. Liver Transplant Program, Stanford University Medical Center, 750 Welch Road, Suite 210, Palo Alto, CA 94304-1509. E-mail address: [email protected] (E.B. Keeffe).

0891-5520/06/$ - see front matter © 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.idc.2006.01.004

[7]. Hepatitis B vaccine is now recommended for all newborns before hospital discharge, regardless of maternal HBsAg status. Neonates born to mothers who are chronic HBsAg carriers should receive the first dose of vaccine within 12 hours of birth, accompanied by hepatitis B immune globulin (HBIG) at a different injection site. To further prevent transmission of HBV, both universal vaccination of infants and catch-up vaccination of all adolescents are now recommended in the United States (Box 1) [8]. It is required by 33 states for entry to middle school or seventh grade, three states for college entry, and by some colleges for matriculation. Juvenile correctional vaccination programs can also prevent infections among detainees

Hepatitis B vaccine should be administered to adult populations at high risk for infection. High-risk ethnic groups include those who live in or emigrated from endemic areas, such as Asia and sub-Saharan Africa. Travelers to endemic regions for a prolonged period, defined arbitrarily as 6 months, should also be vaccinated. High-risk occupational groups include people who may be in contact with blood or body fluids. Workers in health care

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