In 1991, the Advisory Committee on Immunization Practices (ACIP) first recommended that all infants in the United States receive the hepatitis B vaccine at birth or within 1–2 months of age. The goal was to prevent maternal transmission of the hepatitis B virus (HBV) and reduce the incidence of infections in babies. Many healthy mothers without hepatitis B or risk factors such as IV drug abuse with normal infants ask what is the benefit in their babies?

The CDC recommends that children receive three doses of the hepatitis B vaccine as part of their routine childhood vaccine schedule:

• First dose: Within 24 hours of birth
• Second dose: Between 1–2 months of age
• Third dose: Between 6–18 months of age

What happens later in life when young people go into the medical field and are potentially exposed to hepatitis B in sick patients? Posuwan et al evaluated a prospective cohort of young people (mean age 18 years) going into medicine and evaluated their antibody titers as a proxy of enduring immunity to hepatitis B.

The investigators were disappointed to find that only 6.9% had long-lasting immunity to hepatitis B, and thus underwent booster doses upon entering medical school. It is unclear when immunity is lost in this cohort. The results are important for parents to understand that the hepatitis B shots given at birth are only applicable if the mother has hepatitis B or serious risks for carrying it including active IV drug abuse. Otherwise the vaccine schedule for this illness has little value at that age.