AAP Endorses Updated HBV Vaccine Recommendation for Newborns

Although new infections of hepatitis B virus (HBV) were reduced by a whopping 90% upon the introduction of the HBV vaccine to United States in 1982, 1000 new cases of perinatal HBV infection still occur on an annual basis.

In order to cut back on perinatal HBV incidence, the American Academy of Pediatrics (AAP) has endorsed the Centers for Disease Control and Prevention (CDC)’s Advisory Committee on Immunization Practices recommendation that the hepatitis B vaccine be given to all newborns within the first 24 hours of birth, according to an updated policy statement released by the AAP and published in the journal Pediatrics. This action will “improve their protection against the enduring and potentially fatal disease.”

According to the CDC, if a pregnant mother is infected with HBV, it poses a serious risk for her child. In fact, without post-exposure immunoprophylaxis, the CDC estimates that a little less than half, or 40%, of infants born to mothers infected with the virus will go on to develop chronic infection; one-fourth of them will die.

Although the previous policy statement provided an option to delay the first vaccine dose until the newborn’s first pediatric checkup, the updated statement calls for the first dose to be given to all “medically stable newborns with a minimum birth weight of 2000 grams” within the first 24 hours of the infant’s life. According to the AAP’s press release, “this timing maximizes the effectiveness of the vaccine in preventing newborn infection.”

Co-author of the statement and member of the AAP Committee on Infectious Diseases, Flor Munoz, MD, FAAP, explained, “This is the first vaccine a baby receives. It’s important that no newborn leaves the birth hospital without it.” Dr. Munoz urges pediatricians “to advise expectant mothers about the need for their babies to receive the birth dose of the hepatitis B vaccine.”

According to the report, when it comes to preventing mother-to-child infection, giving the first dose of the vaccine within the newborn’s first 24 hours of life is “highly effective” and well-tolerated. Furthermore, completion of the full 3 to 4-dose regimen has led to a whopping 98% of infants achieving full immunity against the potentially deadly virus.

The AAP recommendations include the following, according to the press release:

• Identify and treat pregnant women who test positive for HBV infection prior to delivery
• Communicate the mother’s status of infection at time of birth and document the maternal status within the newborn’s medical records
• For infants born to HBV-negative mothers, administer the vaccine to all infants over 2000 grams within the first 24 hours after birth. If the infants weigh less than 2000 grams, delay administration of the vaccine until 1 month of age or at time of discharge from hospital (whichever comes first)
• For infants born to mothers who are positive with the virus, administer the first dose of the vaccine as well as hepatitis B immunoglobulin at birth, despite birth weight or any comorbidities
• Accurately document infant vaccination in birth hospital records as well as in the appropriate CDC Immunization Information Systems or state immunization registries

“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 time of birth,” co-author of the updated statement, Elizabeth Barnett, MD, FAAP, member of the AAP Committee on Infectious Disease concluded in the press release.