New recommendations from the American Academy of Pediatrics (AAP) say medically stable newborns weighing 2000 g or more should receive their first dose of the hepatitis B vaccine within the first 24 hours of life.
The AAP’s Committee on Infectious Diseases and Committee on Fetus and Newborn published the policy statement online August 28 in Pediatrics. It endorses October 2016 recommendations made by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP). The 2016 recommendation updated previous recommendations from 2005, which allowed clinicians to wait until the first well-baby visit to administer the first dose.
The new recommendation was made because “we have not eliminated perinatal transmission of hepatitis B in the United States, and up to 1000 new perinatal cases occur every year,” Karen Puopolo, MD, PhD, one of the statement authors, told Medscape Medical News.
The high rates of opioid addiction in many parts of the country added a sense of urgency, said Dr Puopolo, associate professor of clinical pediatrics at the Perelman School of Medicine, University of Pennsylvania, Philadelphia. “It was one of many reasons this change was recommended. The [Centers for Disease Control and Prevention] has documented that in a few states, there has been an increase in adult cases of hepatitis B coincident with opioid abuse, and that does raise the concern that more women of childbearing age will acquire the virus, increasing the risk of perinatal transmission.”
Vaccinating neonates against hepatitis B has been a standard recommendation “for years and years,” she added. “What is different in this statement is only that we are recommending it be administered before 24 hours of age.”
Also, “we really urge families to do it. Before, the recommendation was at 24 hours or on discharge from the birth hospital, which meant some infants did not get the vaccination until they were 2 or 3 days old. Now we are saying we really think you should get it before you are 24 hours old, as long as your birth weight is greater than 2000 g and you are medically stable.”
The recommendation states that if the mother is known to be positive for the hepatitis B surface antigen (HBsAg), the newborn should receive both the vaccine and the hepatitis B immune globulin within 12 hours of birth, regardless of birth weight. Infants born to women who are HBsAg-negative should receive the vaccine within 24 hours if their birth weight is 2000 g or more. If the mother is HBsAg-negative and her newborn weighs less than 2000 g at birth, the infant should be vaccinated at 1 month of age as part of universal routine prophylaxis or at hospital discharge, whichever comes first.
When the mother’s HBsAg status is unknown, the infant should receive the vaccination within 12 hours of birth, regardless of weight. That should be followed by hepatitis B immune globulin administration within 7 days or hospital discharge (whichever comes first) for children with a birth weight of at least 2000 g, or within 12 hours if they have a birth weight less than 2000 g.
With this immunization schedule, followed by completion of the infant hepatitis B immunization series, rates of perinatal infection range from 0.7% to 1.1%, the authors explain. The vaccine alone is 75% to 95% effective at preventing perinatal transmission if it is administered within 24 hours of birth.
Perinatal hepatitis B infection is associated with a 25% increase in the risk for premature death from illnesses such as cirrhosis or hepatocellular carcinoma, Dr Puopolo told Medscape Medical News. “So the child has a lifelong increased risk of very serious disease. And all of that can be prevented with timely administration of the hepatitis B vaccine.”
“What ACIP and the AAP are saying is that, for everybody, the best approach to eliminating all perinatally acquired hepatitis B in the United States is to routinely administer the vaccine to all infants before 24 hours of age. This gives us the advantage of dealing with cases where the mother’s hepatitis B status is not known at birth,” she added. “It also accounts for cases in which the mother has tested negative in error, or has acquired the virus after being tested.”
For infants born to women whose hepatitis B status is positive or unknown, the birth dose of the vaccine provides a “critical safety net,” the authors write.
The authors have disclosed no relevant financial relationships.
By Norra MacReady