CDC Publishes Recommendations that Newborns Receive Hepatitis B Vaccine within 24 Hours of Birth — AAFP, AAP and ACOG Concur

What has changed for newborns?

The most significant change in these published recommendations is that medically stable newborns who weigh at least 2,000 gm and whose mothers’ hepatitis B surface antigen (HBsAg) test is documented to be negative, should receive hepatitis B vaccine within 24 hours of birth. Prior to this (since 2005), the recommendation was to administer the birth dose of hepatitis B vaccine at any time prior to hospital discharge. There was also language permitting a delay in administering the birth dose until after hospital discharge, but this was only during rare circumstances and on a case-by-case basis when certain specific criteria were met. However, this option is no longer included in the hepatitis B recommendations for newborns.

AAFP, AAP and ACOG agree

The American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), and American College of Obstetricians and Gynecologists (ACOG) are all in agreement with the recommendation to vaccinate newborns within 24 hours of birth. AAP included this in its recently published Red Book 2018–2021: Report of the Committee on Infectious Diseases (page 421, Table 3.24).

Administering the hepatitis B birth dose within 24 hours of birth was first published in 2017 in the Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger, United States, 2017, which was endorsed by AAFP, AAP and ACOG. It appears in the 2018 immunization schedule for children and adolescents as well.

ACIP-specific wording

The exact language regarding universal hepatitis B vaccination of infants in the ACIP recommendations on pages 16–17 is reprinted below:

Universal Vaccination of Infants

• All infants should receive the HepB vaccine series as part of the recommended childhood immunization schedule, beginning at birth as a safety net.
  
• For all medically stable infants weighing > 2,000 grams at birth and born to HBsAg-negative mothers, the first dose of vaccine should be administered within 24 hours of birth (new recommendation). Only single-antigen HepB vaccine should be used for the birth dose.

To access CDC guidance on hepatitis B-related topics such as the management of low birth weight infants, infants whose mothers are HBsAg positive or whose HBsAg status is unknown, and the management of HBsAg-positive mothers, consult the ACIP recommendations for hepatitis B.

Related resources

From the Immunization Action Coalition
(All IAC materials below have undergone technical review by CDC.)

• Guidance for Developing Admission Orders in Labor & Delivery and Newborn Units to Prevent Hepatitis B Virus Transmission
• Sample Text for Developing Admission Orders in Newborn Units for the Hepatitis B Vaccine Birth Dose
• Hepatitis B Shots Are Recommended for All New Babies: Hepatitis B Vaccine Helps Protect Your Baby’s Future
• States Report Hundreds of Medical Errors in Perinatal Hepatitis B Prevention (published in 2013 when older guidance was still in place)
• Unprotected Infant Dies of Fulminant Hepatitis B (published in 2013 when older guidance was still in place)
• IAC’s Hepatitis B birth dose initiative: Give Birth to the End of Hep B home page
• IAC’s guide for hospitals published in 2013: Hepatitis B: What Hospitals Need to Do to Protect Newborns (not fully up to date with recommendation to vaccinate newborns within 24 hours of birth)
• Slide set: Give Birth to the End of Hep B: What Hospitals Need to Do to Protect Newborns. To request the slide set to use “as is” or to modify to suit your needs, visit IAC’s PowerPoint Slide Set webpage. Scroll down to the slide set you want to order and click “Request the PowerPoint slide set.”

Vaccine Education Center at the Children’s Hospital of Philadelphia

• Q&A Hepatitis B: What you should know

Centers for Disease Control and Prevention

• Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP) in MMWR Recommendations and Reports (Vol.67, No.1)
• Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger, United States, 2018
• Hepatitis B Vaccine Information Statement (VIS): Hepatitis B Vaccine: What You Need to Know
• Hepatitis B VISs are available in many languages from IAC