Birth dose index
October 9, 2001
Give the Birth Dose!
The Immunization Action Coalition (IAC) urges each of the organizations listed above to support the establishment of a national policy to protect ALL infants from hepatitis B virus (HBV) infection by requiring that the first dose of hepatitis B vaccine be administered to every infant at birth and no later than hospital discharge.
Approximately 19,000 women with chronic hepatitis B infection give birth in the United States each year. Ninety percent of perinatal infections can be prevented by postexposure prophylaxis given within 12 hours of birth. Tragically, many babies are exposed to HBV at birth but do not receive appropriate postexposure prophylaxis.
Because thimerosal has been removed from all pediatric hepatitis B vaccines in the United States, concerns about thimerosal should no longer be an obstacle for practitioners in enacting a universal birth dose policy.
Why is such a policy necessary? Following are some of the ways infants who are not vaccinated at birth become infected:
The following table summarizes the arguments for the birth dose vs. a two-month visit dose of hepatitis B vaccine. While there are advantages to giving the first dose at a later well-baby visit, these are advantages of administrative convenience. The primary advantage of giving the first dose at birth is that it saves lives.
Advantages of the Birth Dose vs. Two-Month Visit Dose
IAC recently asked hepatitis coordinators at every state health department as well as at many city/county CDC projects to express their views about providing hepatitis B vaccine in the hospital. Their responses contained many examples of children who were unprotected or inadequately protected due to not ordering, misordering, misinterpreting, mistranscribing, and miscommunicating the hepatitis B test results of their mothers. In order to overcome these failures, the states overwhelmingly endorse providing a birth dose.
These state coordinators’ reports tell us that no matter how well health care providers think they are doing with HBsAg screening of all pregnant women, serious mistakes continue to occur; children are unnecessarily being exposed without the benefit of postexposure prophylaxis, and at least one baby has died. (Survey results)
What is the answer? Vaccinate every baby in the hospital prior to discharge regardless of the HBsAg status of the mother. For those providers who choose to use hepatitis B-containing combination vaccine, i.e., Comvax, they may do so. However, since this vaccine cannot be given at birth, monovalent hepatitis B vaccine must be given at birth and then the hepatitis B vaccine series can be completed with three doses of the combination vaccine. Giving four doses of hepatitis B vaccine has been shown to be safe in several clinical studies.
Hepatitis B vaccine is one of the most effective vaccines available. Studies have shown that infants of the most highly infectious mothers ( HBsAg+ and HBeAg+) who receive postexposure prophylaxis with hepatitis B vaccine alone (without HBIG) at birth are protected in 90-95% of cases, essentially the same level of protection afforded by administering hepatitis B vaccine in addition to HBIG. Even higher rates of protection with postexposure prophylaxis have been demonstrated in infants born to less infectious mothers (HBsAg+ and HBeAg –).
Please read the enclosed examples from statements we have received from hepatitis coordinators describing their experiences with failures of the current system, failures that can be largely prevented by administering hepatitis B vaccine to infants before they go home from the hospital.
Your support for providing a birth dose of hepatitis B vaccine to infants while still in the hospital will protect and save lives that are now being put at risk.
Deborah L. Wexler, MD
Birth dose index
Immunization Action Coalition1573 Selby AvenueSt. Paul MN 55104
E-mail: firstname.lastname@example.org Web: http://www.immunize.org/
Tel: (651) 647-9009Fax: (651) 647-9131