Recently, there has been a lot of media coverage about the “Hepatitis B vaccine may be linked to the death of newborns”, which has caused a lot of fear and anxiety. I think there is a very good word, do not “choke to waste food”! As we all know, China is a big hepatitis B country, and most hepatitis B is transmitted to newborns (mother-to-child transmission) before and after the birth of a mother carrying the hepatitis B virus, so the hepatitis B vaccine needs to be given to newborns as early as possible after birth (newborns whose mothers have hepatitis B also need to be given hepatitis B immunoglobulin) in order to minimize the rate of hepatitis B infection. Currently, hepatitis B vaccine is one of the most important vaccines in the newborn immunization program. Through extensive hepatitis B vaccination, the rate of hepatitis B virus infection in China has dropped significantly in recent years, with the rate of hepatitis B infection (HBsAg-positive rate) in the general population dropping from 9.09% (1996) to 7.18% (2006), and the rate of infection in children under 5 years of age being as low as 0.96%, for which the hepatitis B vaccine is credited. In general, the hepatitis B vaccine is very safe. First of all, the hepatitis B vaccine is a recombinant vaccine (which means that this vaccine only selects the surface protein of the hepatitis B virus as raw material and does not contain the complete virus), not a live attenuated vaccine (which may lead to the infection of the disease after vaccination because it contains live virus or live bacteria), so it is not infectious and vaccination will never lead you to hepatitis B infection. Secondly, China included the hepatitis B vaccine in the management of children’s immunization program in 1992, included it in children’s immunization program in 2002 to achieve free vaccine, and in 2005, achieved full free vaccination of newborns; data from the Chinese Center for Disease Control show that a total of 188 cases of suspected vaccine-related deaths were reported from 2000 to December 2013, and only 18 cases were finally determined to be abnormal reactions to the vaccine (Note that these are only abnormal reactions and may be non-vaccine-related co-morbidities as mentioned later; these 18 cases are cumulative for the past 13 years, not the 18 suspected deaths reported recently); if we calculate that about 16 million newborns are born each year, and the first dose of hepatitis B vaccine is given to about 75% of newborns nationwide in a timely manner (within 24 hours after birth) during these 13 years (50% gradually rising to 95%), then the vaccination rate is about 75%. The mortality rate related to abnormal vaccine reactions is 1.15/1 million if each person receives one dose, and 0.38/1 million if each person receives three doses, which is actually very low. Therefore, the hepatitis B vaccine is a very successful and safe vaccine. Newborns are a special stage of life, and once various health problems appear, they often show heavy manifestations, rapid progress and changes, and are extremely fragile and changeable. Regardless of whether vaccination is given or not and what kind of vaccine is given, it may very easily lead to various accidents or deaths due to its own reasons (such as premature birth, intrauterine asphyxia, congenital malformations or defects, congenital or postnatal infections, etc.), and data show that the mortality rate of newborns (0-28 days) in China is 10.7‰, and about 16 million children are born every year in the country; according to this projection, about 170,000 newborns According to this projection, about 170,000 newborns die each year, i.e., about 466 newborns die every day due to various reasons. Combined with the high safety of hepatitis B vaccine, it is very unlikely that the death of newborns after vaccination is related to the vaccine. Taking a step back, if it is indeed related to the hepatitis B vaccine, there are generally two factors: 1. the neonate itself, i.e. the neonate is extremely sensitive to the vaccine (some component/component), resulting in a severe adverse reaction; 2. the vaccine, i.e. the quality of the vaccine is faulty, such as impurities, contamination by some toxin (substance), poor storage, etc. No matter which of the above causes occurs, the presentation of death should be consistent, at least for the most part, and should not be different for each newborn. This reminds me of the 2006 “Qi Er Yao” incident (the solvent of leucovorin injection, a drug for hepatitis, was supposed to be non-toxic propylene glycol, but it was replaced by toxic diethylene glycol by criminals in pursuit of low cost), which is a typical drug quality problems, with almost all patients using the drug exhibiting mild to severe kidney failure, neurological damage and even death. The main causes of death in the 18 recently reported cases varied: they included severe pneumonia, asphyxia, renal failure, heavy pediatric diarrhea, necrotizing small intestinal colitis, meconium aspiration syndrome, sudden infant death, and congenital heart disease, and were not significantly different from the composition of causes of death in infants reported by the mortality surveillance system for children under 5 years of age in China. Therefore, this incident is most likely not vaccine-related. (This also makes me object to the “low price” policy adopted by the government in the procurement of drugs today to reduce the cost of medical care for patients.) Here I have to mention a term related to vaccination – coincidence: it means that the vaccinated person is in the incubation period of a certain disease or there is an undiscovered underlying disease that coincidentally develops (recurs or worsens) after vaccination, so the occurrence of coincidence is not related to the vaccine itself. The higher the vaccination rate and the greater the variety of vaccines, the greater the rate of coupling. What is the probability of coincidence during vaccination? Let’s take the example of coupled death of newborns with hepatitis B vaccination. According to what was mentioned earlier, about 466 newborns die every day in China due to various reasons, and the hepatitis B vaccination rate is calculated at 75%, then about 350 newborns die every day with hepatitis B vaccination, which means that there may be 350 incidental deaths of newborns with hepatitis B vaccination every day in the country, and this is actually not related to hepatitis B vaccination. Not to mention the 18 cases recently reported as “possibly related”. In other words, this hepatitis B vaccine incident is probably the result of its coincidence. If the vaccine is dismissed because of a “possible” problem with a certain company/lot number (in fact, the National Health and Family Planning Commission has already concluded that the hepatitis B vaccine involved is not of high quality and is not considered to be related to the death of newborns), or even by extension, that “no vaccine should be given. If you don’t even take the vaccine, then you are really “choking on your food”. Even measles, a nearly eradicated disease, has a tendency to resurface after vaccination rates have dropped, not to mention hepatitis B, which has an infection rate of 7.9% in our population. It is easy to imagine that if the hepatitis B vaccine is not administered as before, the incidence of hepatitis B will inevitably rise again, and the consequences will be something that no one wants to see. In fact, there are precedents for such incidents: a similar incident in Nigeria led to parents not vaccinating their children against polio, which not only led to a resurgence of polio in that country, but also to the spread of the disease to 19 countries that no longer have polio, resulting in a very painful lesson. Therefore, the hepatitis B vaccine will remain in need of mass scheduled vaccination for at least the last few decades, and it is safe! By extension, the vaccine should still be administered!