The following article is reproduced by permission of AAP News, November 1999, Vol. 15, Issue 11, p. 6. AAP News is a monthly publication of the American Academy of Pediatrics (AAP). Dr. Rennels is a pediatric infectious disease specialist and a member of the AAP Committee on Infectious Diseases.

Reinstitute hepatitis B vaccine for all infants
by Margaret B. Rennels, MD, FAAP

The Food and Drug Administration has approved the first thimerosal-free hepatitis B vaccine, Recombivax HB Pediatric, manufactured by Merck Vaccine Division. A second preservative-free hepatitis B vaccine made by Smith-Kline Beecham (Engerix-B Pediatric) currently is under evaluation by the FDA.

Resumption of hepatitis B vaccination of young infants is important because confusion about recommendations has resulted in some hospitals failing to immunize children delivered to hepatitis B surface antigen positive women. Additionally, data demonstrate that children who do not receive hepatitis B vaccine at birth are less likely to complete this series of immunizations. Therefore, hepatitis B immunization of all infants should be reinstituted immediately. The initial dose should be given optimally at birth, and no later than 2 months of age. This schedule may be accomplished by using either thimerosal-free single antigen hepatitis B vaccine, or for infants 6 weeks of age and older, the combination hepatitis B and Haemophilus influenzae type B vaccine (Comvax).

Since supplies of the thimerosal-free vaccine are currently limited, it should be used only for infants less than 6 months of age. Children 6 months of age and older can be given one of the thimerosal-containing hepatitis B vaccines until supplies of the preservative-free vaccine are sufficient to immunize all groups. When a thimerosal-free vaccine is not available for infants less than 6 months of age, the previous recommendations should be followed (AAP policy statement titled "Thimerosal in Vaccines -- An Interim Report to Clinicians" at www.aap.org/policy/re9935.html).

Dr. Rennels is a member of the AAP Committee on Infectious Diseases.