Healthy newborns should receive their first dose of hepatitis B vaccine within the first 24 hours of birth to improve their protection against the enduring and potentially fatal disease, according to an updated policy statement from the American Academy of Pediatrics (AAP).
Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease. Chronic infection over the course of a lifetime can lead to liver damage, liver failure, liver cancer, or even death.
Newborns can acquire this infection at birth if a mother is infected with hepatitis B virus. Hepatitis B vaccine administered after birth is highly effective in preventing newborn infection. Yet, approximately 1,000 new cases in infants are identified annually in the United States.
The previous policy statement included an option to delay the first dose of hepatitis B vaccine until the first newborn pediatric checkup. In the updated statement, the AAP recommends the first dose be given within the first 24 hours because this timing maximizes the effectiveness of the vaccine in preventing newborn infection.
"This is the first vaccine a baby receives," said Flor Munoz, MD, FAAP, co-author of the statement and member of the AAP Committee on Infectious Diseases. "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 statement recommends that all medically stable newborns with a minimum birth weight of 2000 grams (about 4 lbs., 6 oz.) receive the vaccine within 24 hours of birth. This AAP statement follows the practice now recommended by the Advisory Committee on Immunization Practices (ACIP), part of the Centers for Disease Control and Prevention.
"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," said Elizabeth Barnett, MD, FAAP, a co-author of the statement and member of the AAP Committee on Infectious Disease. "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."
The first dose is highly effective in preventing mother-to-baby infection when given within the first 24 hours, the report states. After completing the full 3 to 4-dose hepatitis B vaccine series, 98% of healthy infants achieve full immunity to the virus. The vaccine is well tolerated in infants.
"The national opioid epidemic has led to an increase in new hepatitis B infections in some states," said Karen Puopolo, MD, PhD, FAAP, also co-author and member of the Academy's Committee on Fetus and Newborn. "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 recommendations include:
Identify and treat pregnant women who test positive for Hepatitis B infection before delivery.
Communicate the mother's status regarding hepatitis B at the time of birth, and document the maternal status in the newborn's medical records.
For infants born to hepatitis B negative mothers: administer the vaccine to all infants who weigh more than 2000 grams within the first 24 hours after birth. If birth weight is less than 2000 g, administer the vaccine at one month of age or at the time of discharge from the hospital – whichever comes first.
For infants born to hepatitis B positive mothers: administer the first dose of hepatitis B vaccine AND hepatitis B immunoglobulin at birth, regardless of birth weight or other co-morbidities.
Document infant vaccination accurately in birth hospital records and in the appropriate CDC Immunization Information Systems and state immunization registries.
All personnel involved in newborn care should receive up-to-date information on recommendations and procedures concerning the hepatitis B vaccine.
