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To the Editor: In their article on the impact of recommendations regarding the birth dose of hepatitis B virus (HBV) vaccine, Dr Daum and colleagues¹ concluded that "special efforts may be required to make at-birth administration of HBV vaccination universal." However, since HBV vaccination of newborns has never been shown to be better than vaccination after the maturation of the immune system, this worry about missing the birth dose seems misplaced.

There is no scientific evidence to justify HBV vaccination before the age when those risk factors associated with the HBV transmission (sex, needles, etc) become relevant. Recent risk-benefit analyses show HBV vaccination among children carries one of the largest unjustified risks and substantial financial costs, second only to the new controversial conjugate pneumococcal vaccine.^2-3 Specifically, HBV immunization has been associated with 53 deaths and 828 serious injuries, but for 38 million children younger than age 10 years, the total . . . [Full Text of this Article]