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Issue Number 97
July 16, 1999
CONTENTS OF THIS ISSUE
- Do you know which newborns need to
receive hepatitis B vaccine in the hospital despite thimerosal content? Read these new CDC
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July 15, 1999
DO YOU KNOW WHICH NEWBORNS NEED TO RECEIVE HEPATITIS B VACCINE IN THE HOSPITAL DESPITE
THIMEROSAL CONTENT? READ THESE NEW CDC GUIDELINES!
The Centers for Disease Control and Prevention released a document on July 15, 1999,
entitled "Implementation Guidance for Immunization Grantees During the Transition
Period to Vaccines Without Thimerosal."
These guidelines were written to assist health professionals through a transition period
during which vaccine manufacturers are working to reduce or eliminate thimerosal from
their products in accordance with recently released recommendations from the U.S. Public
Health Service (PHS) and the American Academy of Pediatrics (AAP).
(IAC Editors' note: September is
the anticipated month in which thimerosal-free single antigen hepatitis B vaccines will be
The information highlighted below on the use of hepatitis B vaccine at birth is excerpted
from CDC's July 15, 1999, document. The entire document which also contains information on
other thimerosal-containing vaccines can be obtained by clicking on its link at the end of
INFANTS WHO SHOULD HAVE HEPATITIS B VACCINE AT BIRTH!
The newly released guidelines stress the importance of continuing to vaccinate the
following infants against hepatitis B virus (HBV) infection at birth despite the
thimerosal content of hepatitis B vaccine because their risk of infection far outweighs
any theoretical risk of an adverse effect from mercury. These include:
- All infants born to hepatitis B surface antigen
(HBsAg) positive mothers need hepatitis B vaccine and hepatitis B immune globulin (HBIG)
within 12 hours of birth.
- All infants born to mothers whose HBsAg status is
still unknown 12 hours after birth need hepatitis B vaccine at that time. Draw the
mother's blood upon admission and send it to the lab ASAP. If the results cannot be
obtained by 12 hours after the infant's birth, the infant should be vaccinated at that
time. If the mother is found to be HBsAg positive, administer HBIG to the infant ASAP (no
later than 7 days after birth).
- All infants born to HBsAg negative mothers
belonging to populations or groups that have high risk of early childhood HBV infection
need hepatitis B vaccine prior to discharge. These high-risk groups include but are not
limited to Asian Pacific Islanders, immigrant populations from countries in which HBV is
of high or intermediate endemicity (see CDC's "Health Information for International
Travel, 1999"), and households with persons with chronic HBV infection (HBsAg
GUIDANCE FOR HOSPITALS WITH EXISTING UNIVERSAL
HEPATITIS B VACCINATION POLICIES
Many hospitals have instituted policies to vaccinate all children at birth regardless of
HBsAg status as a means of ensuring that all the infants of BsAg positive women and
infants of women with unknown HBsAg status are vaccinated at birth. These hospitals should
continue current policies until procedures are or can be put in place to guarantee the
proper management of all births to prevent perinatal HBV transmission.
Such procedures should ensure the following:
- The HBsAg status of every pregnant woman is
available and reviewed at delivery.
- Appropriate passive-active immunoprophylaxis (HBIG
and hepatitis B vaccine) is provided for infants of HBsAg positive women within 12 hours
- Appropriate active immunoprophylaxis (hepatitis B
vaccine) is provided for infants of women with unknown HBsAg status.
CDC PREFERS THAT LOW-RISK INFANTS GET HEPATITIS B
DOSE #1 BY 2 MONTHS OF AGE
CDC prefers that if a decision is made to delay the birth dose of hepatitis B vaccine for
infants not in a high-risk group, that you give the first dose of hepatitis B vaccine by
two months of age. This is not a new recommendation. It is a current recommendation of the
Advisory Committee on Immunization Practices.
MAKE SURE YOU READ THE ENTIRE CDC DOCUMENT!
This CDC document, "Implementation Guidance for Immunization Grantees During the
Transition Period to Vaccines Without Thimerosal," contains much more information
including information on other thimerosal-containing vaccines. Click here for a copy of
this document: http://www.immunize.org/news.d/guide7.htm
CDC ANSWERS SOME ADDITIONAL QUESTIONS ON THIMEROSAL AND VACCINES
The following questions were answered by CDC on July 15, 1999.
- Would delaying the hepatitis B first dose from
birth to 2 months impact completion rates of the hepatitis B series?
- Should state and local immunization programs or
VFC providers stop using hepatitis B vaccines that contain thimerosal?
- Can we get thimerosal free vaccine now?
For the answers to the above questions, click
HOW MUCH THIMEROSAL IS IN HEPATITIS B VACCINE?
Actually there is less thimerosal in single-antigen hepatitis B vaccines than in some of
the other vaccines. Click here for a table entitled "Thimerosal Content in Some U.S.
Licensed Vaccines." http://www.immunize.org/news.d/thimtabl.htm
IN CASE YOU MISSED IT, READ OUR PREVIOUSLY PUBLISHED INFORMATION ON THIMEROSAL!
IAC EXPRESS published three articles on thimerosal and vaccines on July 8, 1999, including
"Thimerosal in Vaccines: A Joint Statement of the American Academy of Pediatrics and
the Public Health Service," the U.S. Surgeon General's Statement on Vaccine Safety,
and CDC's "Thimerosal and Vaccines: Public Information Questions and Answers."
Click here to obtain this issue of IAC EXPRESS: http://www.immunize.org/genr.d/issue94.htm
"The large risks of not vaccinating children far outweigh the unknown and probably
much smaller risk, if any, of cumulative exposure to thimerosal-containing vaccines over
the first six months of life."
-Joint Statement of the American Academy of
Pediatrics and the United States Public Health Service, July 7, 1999