Hepatitis B, immunization

Academy endorses CDC's hepatitis B recommendation

The Academy has endorsed the Centers for Disease Control and Prevention (CDC) recommendation for hepatitis B vaccine, A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States. The CDC recommends that all newborns receive a birth dose of hepatitis B vaccine before leaving the hospital unless a physician provides a written order to defer the birth dose. CDC also recommends that all children age 19 and younger receive the vaccine series.

Delay in 'rare circumstances'". 'On a case-by-case basis and only in rare circumstances," the birth dose may be delayed until after hospital discharge, according to the new recommendation. This exception applies only to infants who weigh at least 2,000 grams and whose mothers are known to be HBsAg negative during the current pregnancy. When a decision is made to delay the birth dose, a physician's order to withhold the birth dose and a copy of the original laboratory report indicating that the mother was HBsAg negative during this pregnancy must be placed in the infant's medical record.

In infants who do not receive a first dose before hospital discharge, the first dose should be administered no later than 2 months of age.

CDC recommendations also state that the birth dose should not be delayed if the infant's mother engaged in high-risk sexual or drug-using practices during pregnancy (e.g., having had more than one sex partner during the previous six months or an HBsAg-positive sex partner, evaluation or treatment for an STD, or recent or current injection-drug use) or in situations of expected poor compliance with follow-up to initiate the vaccine series.

Preterm infants weighing less than 2,000 grams and born to HBsAg-negative mothers should have their first vaccine dose delayed until one month after birth or hospital discharge, whichever comes first. For these infants, a copy of the original laboratory report indicating that the mother was HBsAg negative during this pregnancy should be placed in the infant's medical record.

The recommendations call for physician follow-up in infants whose birth dose is delayed.

Catch-up. Hepatitis B vaccination is recommended for all children and adolescents 19 years of age and under. Children and adolescents who have not previously received hepatitis B vaccine should be vaccinated routinely at any age with an appropriate dose and schedule, but all children aged 11-12 years should have a review of their immunization records and should complete the vaccine series if they were not previously vaccinated or were incompletely vaccinated.

© 2006 American Academy of Pediatrics