Physicians Group Recommend Hepatitis Vaccine Soon After Birth

Mother-to-child transmission of hepatitis B virus remains high, despite an effective vaccine.

The American Academy of Pediatrics (AAP) recommends that healthy infants receive the first dose of the hepatitis B virus (HBV) vaccine within 24 hours of birth. This updated policy seeks to improve protection against HBV infection.

HBV affects the liver and can result in chronic disease, liver damage, liver failure, liver cancer, or death. Newborns typically acquire HBV from mother-to-child transmission.

While the HBV vaccine is extremely effective when administered after birth, there are approximately 1000 cases in the United States each year, according to AAP.

The AAP’s previous policy statement featured an option to delay vaccination until the newborn’s first checkup; however, the physicians’ group now recommends that the first dose be administered within 24 hours of birth, as it maximizes the efficacy of the vaccine.

"This is the first vaccine a baby receives," said policy statement co-author Flor Munoz, MD, FAAP, a 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 statement recommends that healthy newborns with a minimum weight of 4 pounds 6 ounces receive the vaccine within 24 hours of birth. This guideline is also recommended by the Advisory Committee on Immunization Practices, a part of the CDC.

"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 statement co-author Elizabeth Barnett, MD, FAAP, a 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."

When given within the first 24 hours after birth, the HBV vaccine effectively prevents mother-to-child transmission. After completing the HBV vaccine series, 98% of healthy infants are immune to the virus and the vaccine is well-tolerated in this population, according to the AAP.

The AAP also recommends that pregnant women be tested for HBV and receive necessary treatment prior to delivery. Healthcare providers should also document the mother’s HBV status in the newborn’s medical records.

For infants who are born to HBV-positive mothers, the AAP statement advises that the child receive the HBV vaccine and hepatitis B immunoglobulin at birth, regardless of weight or other conditions.

Vaccination documentation should be included in birth records and in CDC Immunization Information Systems and state registries, according to the statement.

"The national opioid epidemic has led to an increase in new hepatitis B infections in some states," said co-author of the statement Karen Puopolo, MD, PhD, FAAP, a 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."