The hepatitis B vaccine is widely promoted, even
mandated, based on the proposition that the hepatitis B virus is both
serious and widespread. Unfortunately, the statistics and "science"
used to promote this idea are of questionable validity.
The Centers for Disease Control and Prevention
(CDC) have made highly discrepant claims about the incidence of new
infections each year. In their "....Comprehensive
Strategy for Eliminating Transmission..." (of hepatitis B in
the United States), they claim that between 1980 and 1991 there were an
estimated 200,000 to 300,000 new cases of hepatitis B each year.
article the CDC estimates 323,462 were infected annually between
1976 and 1980, while 334,863 were infected annually from
1988-1994. However, in their
B Fact Sheet, the estimate rises to "an average of 450,000" new
cases in the 1980's.
Which is it, CDC?
They allegedly arrive at these numbers using "catalytic
modeling" based on serum sampling of hepatitis B markers employed
to derive the proportion of unreported and asymptomatic cases.
Were they not to do so, the
reported cases would be strikingly low, ranging from
18,003 (in 1991) to 26,611 (in 1985), hardly enough to get very excited
While the notion that one might want to determine missing cases is
certainly valid, in this case errant methodology appears to have been
used, since the particular markers upon which we are told the estimates
are based do not necessarily measure the things they are purported to
Using serum sampling of 14,488 people, the
found that "The
prevalence of serologic markers for HBV infection (HBsAg, anti-HBs,
or anti-HBc) in this population was 4.8%." In the CDC
study upon which their estimates are based, it was stated, "In NHANES
II, serologic evidence of present or past HBV infection was defined as
a positive test for
anti-HBs or HBsAg, while in NHANES III, a positive test for
anti-HBc was used to define infection". (Journal
of Infectious Diseases)
These methods of measurement, however, do not necessarily denote
either current or chronic infection. In fact, quite to the
represents immunity and is present in those cases where there has been recovery
from hepatitis B. Anti-HBc may indicate "resolved
infection". In addition, "Anti-HBc appears shortly after
HBsAg among people with acute disease and generally persists for life.
It is therefore not a good marker for people with acute disease."
Even the significance of HBsAg, a marker for acute or chronic HBV
infection, is not clear-cut: "In 95 percent of patients with
acute hepatitis B, HBsAg disappears from the serum within one year." (American
Family Physician) The mere finding via sampling of subclinical
cases also says nothing about the significance of such a finding.
"Most of these patients (with chronic persistent hepatitis) do not
progress to chronic active hepatitis or cirrhosis: however, those with
HBeAg in the serum are more likely to do so". (American
By lumping together acute, chronic and recovered hepatitis B cases,
an approach, which includes using contrary and ambiguous indicators,
and markers which haven't even been approved by the
the results become inflated and meaningless, particularly given that
most cases recover. In addition, by taking a slice in time and
treating it as if it is a constant, they are also disregarding the
overwhelming proportion of cases which eventually resolve. It is
usually only chronic, active infection that poses a long-term threat,
To bolster the appearance that the risk of getting hepatitis B was
rising, the CDC
stated that "reported incidence of acute hepatitis B increased by 37%
from 1979 to 1989".
The truth is, however, that reported cases actually DECLINED 12%
between 1985 and 1989. By the time the hepatitis B recombinant vaccine
in 1991 for all infants and children, the reported incidence of
hepatitis B was down to 18,003 (all ages), another 23% drop in two
years. (Put another way in
"In the United States, reports of acute hepatitis B increased by 37%
from 1979 to 1985, but since 1986 declined to 1979 levels.")
Topping it all off, the CDC
is now reporting that hepatitis B incidence dropped to around 80,000 in
1999, the implication being that vaccination has had a huge
impact. This, in spite of the fact that according to the
Journal of Public Health, as recently as 1994 there was no
significant decrease in prevalence, "despite the availability of
hepatitis B vaccine".
also has stated that "The estimated 1 million-1.25 million persons with
chronic HBV infection in the United States are potentially infectious
to others." "Potentially infectious" - now what's that supposed
to mean? Particularly given that hepatitis B is largely a
"lifestyle" disease, with transmission
dependent on either engaging in risky
behaviors or living in close contact with someone with infectious
hepatitis B virus (HBV) (the important exception, of course, being an
infant born to a hepatitis B positive mother, in which case the mother
can be screened).
The truth is, the United States, except for certain ethnic groups in
Alaska, is actually considered a
prevalence area for chronic hepatitis.
And what about long-term risk from chronic hepatitis B? According to
"It is not unusual for hepatitis B virus antigenemia to resolve after
20 to 30 years". Even the chronic carrier state will eventually
resolve, at least for some.
As for the alleged risk of acquiring liver damage or hepatocellular
carcinoma from hepatitis B, and implied to be quite large by the
according to American
Family Physician, "In the United States, alcoholic cirrhosis
more commonly leads to primary hepatic cancer than does chronic
hepatitis B infection". According to the journal
"Hepatocellular carcinoma (HCC) occurs more frequently in patients with
hepatitis C virus (HCV)-related chronic liver disease than those with
hepatitis B virus-related disease." And in the
American Journal of Epidemiology it was reported that "rather
than chronic hepatitis B virus infection, hepatitis C virus infection
and alcoholism were the two dominant risk factors that signaled the
risk of liver damage among these Taiwanese aborigines".
What is the true incidence of the chronic hepatitis B carrier
state in the U.S. and its significance?
How many chronic hepatitis B carriers in the U.S. go on to
develop chronic, active hepatitis?
How many of those with chronic, active hepatitis in the U.S. go
on to develop serious, long-term consequences?
What percent of hepatitis B cases in the U.S. end up eventually
resolving and how is this taken into account when estimating long-term
How much hepatocellular carcinoma in the U.S. is directly
attributable to hepatitis B?
Is Public Health over-stating the risk of cancer resulting from
What justification is there to recommend, not only universal
infant hepatitis B vaccine, but vaccine for those adolescents and
adults not participating in risky behaviors?
Even if there is what many would consider an arguably small risk
from hepatitis B vaccine, where is the justification for taking any
Are the CDC estimates of hepatitis B incidence, prevalence and
risk based on sound science?
How much coming out of the CDC can we believe?