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Excerpted from "Immunization and Infectious Disease News"
Wisconsin Whisper
November 2000

Tom Saari, MD, FAAP
 

Hepatitis B Birthdosing: A major national campaign is unfolding to encourage a resumption of hepatitis B birthdosing before infants are discharged home from hospitals. A tragic, preventable death of a 3 month old Michigan infant who succumbed to acute hepatitis B liver failure occurred last December. The hospital had suspended HBV birthdosing during the thimerosal alert and elected not to resume routine immunization of all infants when thimerosal–free vaccine became available the end of September, 1999. The infant was born in October to a mother who was known by her physician to be a hepatitis B surface antigen carrier. Her lab report sent to the hospital was erroneously reported as negative and the state health department was not informed of her HBsAg (+) status as required by law.

WCIP (Wisconsin Council for Immunization Practices) followed up on the survey it conducted last Spring ( the results of which are expected to be published as a MMWR summary soon). Letters were sent to every birthing hospital in the state either congratulating them on resumption of their birthdose program (48 hospitals) or urging them to resume a birth- dosing program that, at the very least, provides for standing orders to immunize infants born to mothers with HBsAg (+) or UNKNOWN surface antigen status. As can be seen in the above fatal case, doing the bare minimum would not have saved this infant from a bureaucratic snafu. The most compliant hospital in our state has a HBV maternal testing batting average of 94%, ie: 6 out of every 100 women admitted for delivery have no record of a maternal hepatitis B test being done. Most hospitals range from 80-90% of mothers with HBV test results known at delivery. There are plenty of opportunities for infants to slip through the cracks in Wisconsin. As opposed to the rapid demise of the Michigan infant, most infants who acquire hepatitis B perinatally in Wisconsin are silently infected and 25% of them will succumb from cirrhosis or hepatocellular carcinoma 20 to 30 years from the time of their exposure. We have good data that predicts between 200 and 250 Wisconsin infants are born to HB surface antigen (+) mothers every year, most of whom live in the southeastern part of the state where HB birthdosing practices have fallen on hard times the most severely since the thimerosal alert.

The Wisconsin DHFS has gone the extra mile to make hepatitis B vaccine FREE to any Wisconsin birthing hospital who wishes to sign up through the VFC program and give hepatitis B vaccine to all their infants before discharge. This means that every infant, regardless of their insurance or HMO status, can receive hepatitis B vaccine prior to discharge at no cost to anyone but the DHFS. Several hospitals have already availed themselves of this offer but it takes pediatricians on hospital staffs to encourage their hospital administrators to look a gift horse in the mouth. If your use of combination vaccines has turned you away from birthdosing, there is no contraindication to giving a HBV birthdose and still complete your usual immunization schedule with the combo.

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