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Give The Birth Dose

Give the birth dose ● ● ●
Healthcare professionals!
Hepatitis B vaccine at birth saves lives!
Urge your patients to protect their
newborns with hepatitis B vaccine
By Deborah L. Wexler, MD, Executive Director, Immunization Action Coalition
before hospital discharge.
In December 2005, CDC issued updated recommendations on hepatitis B vaccination (HepB) for infants.
Your recommendation to vaccinate
The recommendations strongly support (1) giving the HepB birth dose to every newborn prior to hospital
is a strong patient motivator!
discharge and (2) using standardized admission orders for administering the birth dose. In addition, it is
recommended that a copy of the original maternal hepatitis B lab report be sent to the hospital—not a
The HepB birthdose saves lives!
transcribed result. The recommendations also state that the HepB birth dose may be delayed until after
hospital discharge only “in rare circumstances.” When doing so, a physician’s order to withhold the
To obtain CDC’s recommendations for
birth dose and a copy of the original lab report indicating that the mother was HBsAg negative during
hepatitis B immunization of infants,
this pregnancy should be placed in the infant’s medical record. The latest CDC estimates indicate only
children, and adolescents, go to:
55% of newborns receive the HepB birth dose by 3 days of age. Clearly, there is much work left to do to
www.cdc.gov/mmwr/pdf/rr/rr5416.pdf
fully protect newborns.
Leading health organizations—CDC, AAP, AAFP, • The pregnant woman is not tested for HBsAg HBsAg, mistakes continue to occur. Newborns
and ACOG—recommend that all hospitals and
either prenatally or in the hospital at the time of are are unnecessarily being exposed without the
healthcare professionals protect newborns from
delivery. In one study, women who didn’t receive benefit of postexposure prophylaxis. At least one
hepatitis B virus (HBV) infection by administering
prenatal care were eight times more likely to be baby has died of fulminant hepatitis B; hundreds
the first dose of hepatitis B vaccine (HepB) to every
HBsAg positive than women who received prena-
have become chronically infected and are doomed
baby at birth, no later than hospital discharge.
tal care. When a woman does not receive prenatal to preventable hepatocellular carcinoma or cirrhosis
Approximately 24,000 women with chronic
care and is not tested at the time of delivery, her later in life. To overcome these failures, perinatal
HBV infection give birth in the U.S. each year,
infant is in danger of being infected with HBV at hepatitis B coordinators overwhelmingly endorse
and many do not know they are infected. Up to
birth—unless he or she is born in a hospital that providing a HepB birth dose as the first step in de-
95% of perinatal infections can be prevented by
adheres to a policy of administering HepB within veloping a safety net to protect all infants from HBV
postexposure prophylaxis given within 12 hours of
12–24 hours of birth to every newborn without infection, regardless of the circumstances.
birth. Tragically, many babies are exposed to HBV
fail. This provides the greatest effectiveness in
To maximally protect every newborn, CDC, AAP,
at birth and do not receive appropriate postexposure
preventing HBV infection.
AAFP, and ACOG recommend all infants be vac-
prophylaxis. Infants infected at birth have a greater • She develops HBV infection later in pregnancy, cinated with a HepB birth dose prior to hospital
than 90% chance of becoming chronically infected
but it is not clinically detected. Because her initial discharge. Delaying hepatitis B vaccination until
with HBV. Chronic HBV infection in infants leads
HBsAg test result is negative, she is not retested a follow-up office visit will be too late to prevent
to liver cancer, cirrhosis, and liver failure in 25% of
later in pregnancy as CDC recommends for high-
perinatal HBV transmission.*
these infants when they become adults.
risk women, and her infant does not receive HepB
Why is a universal birth dose policy necessary
or HBIG at birth.
in hospitals?
• The mother is HBsAg negative, but the infant is
State perinatal hepatitis B coordinators
Following are some of the ways newborns can be
exposed to HBV postnatally from another family
surveyed overwhelmingly endorsed
infected if they do not receive a dose of hepatitis B
member or caregiver. This occurs in two-thirds
providing the birth dose.
vaccine, ideally within 12 hours of birth:
of the cases of childhood transmission.
• The pregnant woman is tested and found to be
HepB is a highly effective vaccine. Studies have
hepatitis B surface antigen (HBsAg) positive,
shown that infants of the most highly infectious
but her “infected” status is not communicated to
State perinatal hepatitis B coordinators
mothers (women who are both HBsAg and HBeAg
the newborn nursery. The infant receives neither
provided hundreds of reports of newborns
positive) who receive postexposure prophylaxis
HepB nor HBIG protection at birth.
who were unprotected or inadequately
with HepB alone (without HBIG) at birth are pro-
•
protected because of medical errors.
A chronically infected pregnant woman receives
tected in 70%–95% of cases. Please read the hepa-
the wrong test. For example, antibody to hepatitis
titis coordinators’ survey results (www.immunize.
B surface antigen (antiHBs) is ordered in error,
In 2001, 2002, and 2008, the Immunization Ac-
org/birthdose), including descriptions of their ex-
instead of HBsAg. This can happen because some tion Coalition surveyed perinatal hepatitis B coor-
periences with failures of the system —failures that
labs use the confusing abbreviation HBsAb in-
dinators at every state health department, as well largely will be prevented by administering HepB
stead of anti-HBs. This misordering of a test is as at city and county CDC projects to assess their to infants before they go home from the hospital,
relatively common since the two abbreviations views about providing hepatitis B vaccine in the ideally within 12 hours of birth.
(HBsAg and HBsAb) differ by only one letter. hospital. Their responses contained hundreds of
Your support for providing a birth dose to new-
However, when her incorrectly ordered test reports of newborns who were unprotected or inad-
borns while they are still in the hospital will protect
comes back “negative,” the woman may actu-
equately protected because healthcare profession-
and save lives that are now being put at risk. ♦
ally be HBsAg positive and her infant would not als failed to order or misordered hepatitis B blood
receive appropriate postexposure prophylaxis.
tests or misinterpreted, mistranscribed, or miscom-
*For subsequent doses of hepatitis B vaccine (HepB) in infants, use
•
monovalent HepB or hepatitis B-containing combination vaccines. If
The pregnant woman is HBsAg positive, but her municated the test results of the children’s mothers using hepatitis B-containing combination vaccines, you will be giving
test results are misinterpreted or mistranscribed (see www.immunize.org/catg.d/p2062.pdf).
3 more doses of HepB. Giving a total of 4 doses of HepB to infants
is acceptable practice to CDC, AAP, and AAFP. These vaccine doses
into her prenatal record or her infant’s chart.
These state coordinators’ reports tell us that no are covered under the Vaccines For Children (VFC) program for VFC-
As a result, her infant does not receive HBIG matter how well healthcare providers think they eligible children.
or HepB.
are doing in screening all pregnant women for
www.immunize.org/catg.d/p2125.pdf • Item #P2125 (9/09)
Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org