Saving Lives With the Universal Hepatitis B Birth Dose

Fact Sheets for Hospitals

On October 17, 2001, the Advisory Committee on Immunization Practices (ACIP) voted to recommend giving the birth dose of hepatitis B vaccine to all newborns prior to hospital discharge. This ACIP recommendation concurs with the American Academy of Pediatrics (AAP) policy that recommends a birth dose for all infants.The New York State Department of Health Immunization Program supports these recommendations and urges your hospital to adopt a universal hepatitis B birth dose policy if you have not already done so.

Why is such a policy necessary?

Approximately 19,000 women with chronic hepatitis B infection give birth in the United States each year. Ninety percent of perinatal infections can be prevented by postexposure prophylaxis given within 12 hours of birth. Tragically, many babies are exposed to HBV at birth but do not receive appropriate postexposure prophylaxis. Because thimerosal has been removed from all pediatric hepatitis B vaccines in the United States, concerns about thimerosal should no longer be an obstacle for practitioners in enacting a universal birth dose policy.

The following are some of the ways infants who are not vaccinated at birth become infected:

  • The mother is HBsAg negative but the infant is exposed to HBV infection postnatally from another family member or caregiver. This occurs in two-thirds of the cases of childhood transmission.
  • The woman is tested in early pregnancy for HBsAg and is found to be negative. She develops HBV infection later in pregnancy but it is not detected, even though it is recommended by CDC that high-risk women be retested later in pregnancy. The infection is not clinically detected by her health care provider so her infant does not receive hepatitis B vaccine or HBIG at birth.
  • A chronically infected pregnant woman is tested but with the wrong test, HBsAb (antibody to hepatitis B surface antigen), instead of HBsAg. This is a common mistake since these two test abbreviations differ by only one letter. Her incorrectly ordered test result is "negative," so her doctor believes her infant does not need postexposure prophylaxis.
  • The pregnant woman is tested and found to be hepatitis B surface antigen (HBsAg) positive, but her status is not communicated to the newborn nursery. The infant receives neither hepatitis B vaccine nor HBIG protection at birth.
  • The pregnant woman is not tested for HBsAg either prenatally or in the hospital at the time of delivery. Her infant does not receive hepatitis B vaccine in the hospital even though the vaccine is recommended within 12 hours of birth for infants whose mothers' test results are unknown.
  • The pregnant woman is HBsAg+ but her test results are misinterpreted or mistranscribed into her prenatal record or her infant's chart. Her infant does not receive HBIG or hepatitis B vaccine.

Your support for providing a birth dose of hepatitis B vaccine to all infants while still in the hospital will protect and save lives that are unnecessarily being put at risk!