All medically stable infants should be administered a hepatitis B vaccine as routine prophylaxis within the first 24 hours after birth, according to an updated AAP policy statement from the AAP Committee on Infectious Diseases and the AAP Committee on Fetus and Newborn.
Whereas the previous AAP policy statement on hepatitis B vaccination included permissive language to delay the first dose of the vaccine until the first pediatric checkup, the updated statement emphasizes that timely vaccination could significantly reduce the incidence of perinatal hepatitis B transmission.
“The national opioid epidemic has led to an increase in new hepatitis B infections in some states,” Karen Puopolo, MD, PhD, a member of the AAP Committee on Fetus and Newborn, said in a press release. “Infants are especially vulnerable to infection at the time of birth, and need the maximal protection provided by administering the first vaccine dose shortly after birth.”
The AAP now recommends that all healthy infants receive their first dose of the hepatitis B vaccine within the first 24 hours after birth to protect against perinatal transmission.
Despite the introduction of the hepatitis B vaccine in 1982, 1,000 new cases of perinatal hepatitis B infection are identified each year in the U.S. Without post-exposure prophylaxis at birth, there is significant risk of perinatal transmission for infants born to hepatitis B surface antigen-positive (HBsAg) mothers.
“Hepatitis B can lead to devastating lifelong illnesses or even death, so this vaccine is a critical safety net to protect babies from acquiring a potentially serious infection at the time of birth,” Elizabeth Barnett, MD, a member of the AAP Committee on Infectious Disease, said in the release. “Many adults with an infection do not feel or look sick and are not even aware that they carry the virus. It is contagious, and adults can transmit it while caring for an infant after birth.”
Recommended by the Advisory Committee on Immunization Practices, the hepatitis B vaccine is well-tolerated among infants and, when administered within 24 hours of birth, has demonstrated 75% to 95% efficacy in preventing perinatal hepatitis B transmission.
“This is the first vaccine a baby receives,” Flor Munoz, MD, a member of the AAP Committee on Infectious Diseases, said in the release. “It is important that no newborn leaves the birth hospital without it. We encourage pediatricians to advise expectant mothers about the need for their babies to receive the birth dose of the hepatitis B vaccine.”
The AAP recommends the following steps be taken to implement appropriate administration of the initial dose of the hepatitis B vaccine:
- Identify HBsAg-positive mothers before delivery and document maternal medical status in the infant records.
- Administer the hepatitis B vaccine and hepatitis B immune globulin to infants born to HBsAG-positive mothers within 12 hours of birth, regardless of birth weight or other comorbidities.
- Administer the hepatitis B vaccine to infants weighing more than 2,000 g born to HBsAG-negative mothers within 24 hours of birth. If the infant birth weight is less than 2,000 g, the hepatitis B vaccine should be administered as universal prophylaxis at either 1 month of age or at hospital discharge.
- Document infant vaccination accurately in birth hospital records, as well as the CDC Immunization Information Systems and state immunization registry.
- Develop protocols to educate personnel involved in infant care about AAP recommendations for hepatitis B vaccination, including personnel who participate in planned home births.
Disclosure: The researchers report no relevant financial disclosures.