Issue Number
198
October 5,
2000
CONTENTS OF THIS ISSUE
RESUME THE BIRTH DOSE OF HEPATITIS B VACCINE!
By Deborah L. Wexler, MD
Executive Director, Immunization Action Coalition
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If you haven't done so already, it's time to resume
administration of the first dose of hepatitis B vaccine at 0-2 months of age. Ample supplies of pediatric
hepatitis B vaccines that do not contain thimerosal as a preservative are available from both Merck & Co. (Recombivax HB and
Comvax) and SmithKline Beecham (Engerix-B).
According to Bob Snyder, vaccine contract project officer at the Centers for
Disease Control and Prevention (CDC), "As of April 2000, the National Immunization Program has
contracts with both Merck & Co. and SmithKline Beecham that will provide sufficient preservative-free hepatitis B
vaccine for all age cohorts 0 through 18 years of age."
Some states have reported that infants born to women who tested positive for
hepatitis B surface antigen (HBsAg) did not receive the birth dose of hepatitis
B vaccine. The infants were not vaccinated because of hospital policy changes based on "Thimerosal in Vaccines: A Joint Statement
of the American Academy of Pediatrics and the United States Public Health Service." In Michigan, a baby girl recently
born to an HBsAg-positive mother did not receive hepatitis B immune globulin (HBIG) or hepatitis B vaccine at
birth. The infant died at three months of age from liver failure caused by fulminant (overwhelming) HBV infection. This death
most likely would have been prevented if the birth hospital had not stopped its policy of routinely
vaccinating infants before hospital discharge. This illustrates the importance
of establishing AND implementing hospital policies to ensure that the HBsAg status of all pregnant women is known
and clearly documented before delivery and that infants are vaccinated against hepatitis B at birth.
The following problems continue to occur:
- Some hospitals and clinicians have been incorrectly
deferring hepatitis B vaccination for ALL infants, even those whose mothers are HBsAg
positive.
NOTE: According to recommendations of CDC, the American Academy
of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American College of Obstetrics
and Gynecology (ACOG), when a mother is HBsAg positive, her infant should receive
HBIG and hepatitis B vaccine within 12 hours of birth.
- Some hospitals and clinicians have been incorrectly
delaying vaccination for infants born to mothers whose HBsAg status is unknown
at the time of delivery.
NOTE: According to the recommendations of CDC, AAP, AAFP, and
ACOG, when the mother's HBsAg status is unknown, hepatitis B vaccine should be administered to the infant
within 12 hours of birth and the mother's blood should be tested as soon as possible for HBsAg to
determine if the baby also needs HBIG prophylaxis and subsequent evaluation
during well child visits.
- Many hospitals and clinicians have been incorrectly
deferring the birth dose of hepatitis B vaccine for infants whose mothers are HBsAg
negative but may have other factors that continue to place the infants at
risk for HBV infection after they leave the hospital. Postponing hepatitis
B vaccination for these infants leaves them at risk for exposure in their
households and communities.
NOTE: According to CDC, infants who live in households or communities
at high risk for early childhood HBV infection should be vaccinated at
birth to protect them from potential exposures within their households or
communities. Infants at risk include Alaskan Natives, Asian Pacific Islanders, immigrant populations from countries in which
HBV is of high or intermediate endemicity, and households with persons with chronic
HBV infection.
The administration of hepatitis B vaccine at birth serves
as a broad safety net to protect infants whose risk factors for HBV infection have not been identified
or whose prenatal care records may be missing, incomplete, or incorrect (containing transcription or lab test
misinterpretation errors).
HOW TO PREVENT HEPATITIS B TRANSMISSION AT BIRTH
- Please resume administration of the birth dose of
hepatitis B vaccine for all infants who are at risk for HBV infection to be sure that these babies
are protected from this potentially deadly liver disease.
- Hospitals that previously administered the birth dose of
hepatitis B vaccine to ALL infants should reinstate their policies to assure that every
baby is protected.
- If your hospital doesn't have this policy, consider
adoption of a policy to vaccinate every infant beginning at birth. When hospitals institute this
important policy, every infant will receive protection.
- Be sure your hospital's labor and delivery unit and its
newborn nursery have hepatitis B prevention protocols in place. For a sample hospital
policy that has been reviewed by CDC, go to: http://www.immunize.org/catg.d/p2130.htm
For this same sample policy in PDF format, go to:
http://www.immunize.org/catg.d/p2130per.pdf
ANOTHER IMPORTANT WAY TO PREVENT PERINATAL HBV INFECTION
Labor and delivery units should be sent a copy of their patients' HBsAg laboratory reports along with prenatal
records. A handwritten lab value on a patient's chart DOES NOT GUARANTEE that the result has been accurately
interpreted or correctly transcribed. Send a copy of the original laboratory
report to the hospital to assure that the hospital has the correct information.
Hospital staff should make sure to review the lab report as well as the prenatal
chart information.
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