OPINION: Evolving understandings: A physician’s perspective on hepatitis B
By Selika Sweet, MD
JA Guest Writer
There is growing discussion today about hepatitis B and the role of vaccination in preventing infection. My perspective is both deeply personal and profoundly professional, shaped by years of caring for individuals at heightened risk. These experiences have shaped how I understand hepatitis B – and reinforced the importance of thoughtful, evidence-based preventive medicine as a foundation of public health.
Training and Early Career
During my family medicine residency at Earl K. Long Hospital in Baton Rouge, Louisiana, I completed a month-long gastroenterology rotation with Dr. Bill Cassidy – then a respected liver disease specialist and now a U.S. senator. The rotation became one of the most formative chapters of my training.
Dr. Cassidy was known as the hospital’s hepatitis “guru” – deeply knowledgeable, patient, and dedicated to the care of some of the state’s sickest patients. As the only resident on the rotation, I had the benefit of learning directly at his side. Together, we cared for patients with hepatitis A, B, C, and delta virus; we managed cirrhosis, liver failure, and complex co-infections. He taught me to perform liver biopsies (“Insert the needle faster,” he coached) and to safely remove liters of ascitic fluid during paracentesis to relieve patients’ breathing.
Those experiences showed me how devastating liver disease can be – and why prevention must always come first.
After residency, I joined the Eden Park Community Health Center in Baton Rouge, where I cared for many patients with hepatitis B and C, including those co-infected with the delta virus, which accelerates liver damage dramatically. When cases became complicated, I would call Dr. Cassidy from the back room. Together, we reviewed labs, assessed cancer risk, and determined whether transplant referral was needed. Many of my patients benefited from expertise they never knew was guiding their care. Those early years deepened my clinical judgment and strengthened my respect for preventive strategies.
Dr. Cassidy also championed school-based hepatitis B vaccination long before it was widespread, recognizing early that population-level prevention must begin with children.
A Brief History of Hepatitis B Vaccination
The first hepatitis B vaccine was licensed in the United States in 1981, produced from purified plasma of chronically infected donors. In 1986, this product was replaced with a safer recombinant vaccine – an inactivated vaccine containing no live virus.
In 1991, the Centers for Disease Control and Prevention (CDC) recommended universal infant vaccination, shifting national strategy from risk-based vaccination toward comprehensive population protection. Before universal vaccination, the United States recorded an estimated 250,000 new hepatitis B infections per year. Since the introduction of routine childhood vaccination, new infections have declined by more than 80%, and by over 95% among children and adolescents – clear evidence of a successful public health intervention.
Understanding the Debate Over Newborn Vaccination
Despite these gains, some clinicians continue to question whether newborn vaccination is necessary when mothers have no identifiable risk factors. Such discussions reflect the natural evolution of medicine and the diverse ways clinicians interpret evidence.
Hepatitis B remains highly contagious – about 100 times more infectious than HIV – and spreads through blood or bodily fluids. The vaccine is inactivated and cannot cause infection. Side effects remain rare and generally mild.
While my perspective continues to evolve as I listen to colleagues and review emerging data, my clinical experience has consistently shown that hepatitis B can lead to lifelong, debilitating disease. Those at heightened risk – including healthcare providers, first responders, ancillary medical staff, individuals with multiple sexual partners, people who inject drugs, and household contacts of infected persons – benefit substantially from vaccination. Preventing liver disease will always be safer and more effective than treating cirrhosis or hepatocellular carcinoma.
Why Universal Newborn Vaccination Still Matters
Some infants may face a low risk. But many do not.
What about infants born to mothers struggling with addiction?
What about those whose mothers receive no prenatal care?
What about mothers who are never screened?
In these circumstances, risks are harder to identify – and sometimes impossible to detect in time.
Universal newborn vaccination does not label every infant as high risk. Rather, it ensures a public health safety net so that no child who is vulnerable is overlooked, while preserving the remarkable progress the United States has made in reducing hepatitis B transmission.
Where I Stand Today
I can discuss hepatitis A, B, C, the delta virus, and evolving vaccination practices throughout the United States. My journey continues to unfold, but I remain grounded in the lessons of my mentors, the trust of my patients, and a commitment to equitable, evidence-based care. As medicine evolves, I will continue advocating for prevention and protection – while respecting the diverse clinical perspectives that make our field dynamic and ever-progressing.
