News & Views: Why the Change in Recommendations Related to Hepatitis B Birth Dose?

Parents often balk at the idea of giving the hepatitis B vaccine to their newborn infants, citing the sexual nature of disease transmission and the low perceived risk to their new babies. This is also often the first in a string of vaccine-related conversations between parents and providers that will follow.

In response to parental hesitation around this first vaccine, some providers agree to delay it until the one week follow-up appointment. However, at its last meeting, the Advisory Committee on Immunization Practices (ACIP) voted to strengthen the language around the birth dose of hepatitis B vaccine. The revised language states that the dose should be administered within 24 hours of birth for medically stable infants weighing at least 2000 grams and born to HBsAg-negative mothers. The language around delay of the birth dose was removed.

So why did the ACIP opt to strengthen this language?

The simple answer is that they felt it is important for more babies to be protected against hepatitis B. Let’s take a look at some of the facts related to this disease:

• Infants primarily get infected from mothers infected with hepatitis B virus or from infected household contacts. While pregnant women are tested, these tests can be incorrect or overlooked. Likewise, women can be infected between the time of the test and delivery. For these reasons, this method of protecting infants is not foolproof.
• Infants and children infected with hepatitis B virus are often not symptomatic; therefore, they are often underdiagnosed and untreated.
• Additionally, people infected at a young age are more likely to be chronically infected. In fact, about 90 percent of infected infants will experience chronic infection. And, chronic infection is most often associated with liver cancer and cirrhosis.
• While hepatitis B virus is sexually transmitted, many people do not realize that hepatitis B is more infectious than HIV because of the quantity of viral proteins in the blood of someone who is infected.
• Because of the large quantity of hepatitis B virus in the bloodstream, it can be transmitted through quantities of blood so small that they are not visible with the naked eye. This means that personal items that may have minute quantities of blood, such as razors, toothbrushes and even washcloths, can transmit the virus if shared.
• Hepatitis B is also a hardy virus; it can live on surfaces (and remain infectious) for up to seven days.
• Finally, evidence suggests that babies who get the first dose of hepatitis B vaccine shortly after birth are more likely to complete the series on time and may also be associated with improved completion rates of other vaccines in some populations.

For these reasons, it makes sense to immunize newborn infants in the first 24 hours after birth.

Watch a new animation from the Vaccine Makers project that shows how Dr. Hilleman used the enormous quantities of hepatitis B surface protein in the blood to make the first hepatitis B vaccine.

The Immunization Action Coalition (IAC) has a hepatitis B birth dose honor roll program. Learn more about the program or access the guidebook for hospitals on the IAC website.