PETALING JAYA: While the United States has dropped its long-standing policy of a universal Hepatitis B birth-dose for newborns, Malaysian health experts say the vaccine for infants is crucial in preventing liver cancer and cirrhosis later in life.
The US Centers for Disease Control and Prevention (CDC) now recommends that the birth- dose should only be given to infants whose mothers test positive for Hepatitis B or whose status is unknown.
It also advised parents to consult a healthcare provider to decide whether infants born to Hepatitis B-negative mothers should get the vaccine, including at birth.
However, there is no change in policy in Malaysia, where the Health Ministry has said that the Hepatitis B vaccine will remain in the National Immunisation Programme, in line with the recommendations of the World Health Organisation (WHO).
Malaysia recorded 49,992 Hepatitis B cases between 2013 and 2023.
Consultant obstetrician and gynaecologist Datuk Dr NKS Tharmaseelan said administering the Hepatitis B vaccine within 24 hours of birth is a globally accepted practice and is highly effective in preventing infection in newborns.
“Hepatitis B can be transmitted from mother to baby during childbirth, and the birth-dose is the most reliable way to ensure immediate protection,” he said when contacted.
He said the virus can infect infants even through routine care after birth.
Dr Tharmaseelan said Hepatitis B is highly contagious and can spread through infected blood and bodily fluids, adding that many adults carrying the virus are unaware that they are infected.
The virus, he said, can survive outside the body for several days and enter through tiny cuts or mucous membranes.
“If an infant develops Hepatitis B, there is a significant risk of chronic infection, which can later progress to liver cirrhosis or liver cancer – conditions that are difficult to treat and often life-threatening,” he said.
Health Ministry statistics show that Hepatitis B infection rates among children have fallen sharply over the decades, a trend Dr Tharmaseelan attributed to universal birth-dose vaccination.
“Making the vaccine optional would mean many infants missing vital protection,” he warned, adding that long-term public health gains could be reversed.
The move to maintain the birth-doses is adequate, according to Datuk Dr Zainal Ariffin Omar.
He said universal birth-dose vaccination is the single most effective strategy to break the cycle of mother-to-child (vertical) transmission, which leads to a very high risk of chronic infection.
“The first dose within 24 hours is critical as it provides a ‘safety net’ for infants born to mothers with unknown or incorrectly recorded Hepatitis B status,” he said.
Making the vaccines optional has its cons, Dr Zainal said, stating that it could break herd immunity which has already been achieved through universal vaccination.
The public health expert added that it will also cause a long-term burden of chronic Hepatitis B cases as any policy changes would create a cohort at risk for severe liver disease in 30 to 50 years.
This will impose a significant future burden on the healthcare system.
“Malaysia has introduced universal Hepatitis B vaccination in 1989, including the birth-dose.
“Studies have shown a dramatic decline in Hepatitis B surface antigen (HBsAg) carriage among children and adolescents,” he said.
Echoing the same sentiment, director at International Islamic University Malaysia’s Kuantan campus Prof Dr Jamalludin Ab Rahman said the government’s decision to maintain the Hepatitis B birth-dose is justified because immunisation policy should be tailored to local epidemiology, health system realities and population risk.
The professor of Epidemiology and Biostatistics said that even if the US shifts towards individual-based decision-making, that does not invalidate Malaysia’s policy because countries can legitimately make different decisions based on different baseline risks and programme considerations.
