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Technically Speaking
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March 2017
Technically Speaking
Monthly Column by Deborah Wexler, MD
Deborah Wexler MD
Technically Speaking is a monthly column written by IAC’s Executive Director Deborah Wexler, MD. The column is featured in The Children's Hospital of Philadelphia Vaccine Education Center’s (VEC's) monthly e-newsletter for healthcare professionals. Technically Speaking columns cover practical topics in immunization delivery such as needle length, vaccine administration, cold chain, and immunization schedules.
Check out a recent issue of Vaccine Update for Healthcare Providers. The VEC e-newsletter keeps providers up to date on vaccine-related issues and includes reviews of recently published journal articles, media recaps, announcements about new resources, and a regularly updated calendar of events.
TECHNICALLY SPEAKING
ACIP Now Recommends Hepatitis B Vaccine within 24 Hours of Birth
Published March 2017
Each February, the U.S. Recommended Immunization Schedule for Children and Adolescents is published by the Advisory Committee on Immunization Practices (ACIP), American Academy of Family Physicians, American Academy of Pediatrics, and American College of Obstetricians and Gynecologists to reflect current recommendations for licensed vaccines.

This year, an "easy-to-miss" but significant change was made to the timing of the first dose of hepatitis B vaccine (HepB birth dose) when administered to infants born to women who are not infected with the hepatitis B virus (HBV), i.e., women who are hepatitis B surface antigen (HBsAg)-negative.

Here is the side-by-side comparison:

In the 2016 schedule (page 4), the first bullet in the footnote for hepatitis B vaccine read: "At birth: Administer monovalent HepB vaccine to all newborns before hospital discharge."

In the 2017 schedule (page 5), the first bullet in the same footnote section reads: "At birth: Administer monovalent HepB vaccine to all newborns within 24 hours of birth."

This modification was adopted during the October 2016 ACIP meeting, when the committee voted to recommend administration of the "birth dose" in the 24-hour window immediately after birth. This change re-emphasizes the importance of the timeliness of this dose as a safety net to protect newborns from becoming infected with hepatitis B at birth and developing chronic HBV disease later in life. Furthermore, the new guidance removed previous policy language that allowed for delays in administering the birth dose "on a case-by-case basis and only in rare circumstances" (see page 17, ACIP hepatitis B recommendations, December 2005).

On March 6, CDC posted additional information about the HepB birth dose guidance on its Child and Teen Immunization Schedule web page (see “Changes to the Schedule" section), which provides clarifications about the recommendations for infants whose mothers' HBsAg status is unknown or positive and for low birth weight infants:

  • Monovalent hepatitis B vaccine should be administered within 24 hours of birth for medically stable infants weighing = 2,000 grams born to hepatitis B surface antigen (HBsAg)-negative mothers. The recommendations for vaccination of infants < 2,000 grams (as well as infants born to HBsAg-positive mothers or mothers whose hepatitis B status is unknown) remain unchanged.
  • Preterm infants weighing < 2,000 g born to HBsAg-negative mothers should receive the first dose of vaccine one month after birth or at hospital discharge.

The clarification concludes by noting that “Additional detail regarding hepatitis B vaccination of infants born to HBsAg-positive mothers or mothers whose hepatitis B status is unknown can be found in the ACIP hepatitis B recommendations.”

CDC resource

Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger, U.S., 2017
2017 ISSUES >> view all issues
SEPTEMBER 2017
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AUGUST 2017
Standing Orders Protocols Can Improve Your Vaccination Rates
JULY 2017
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JUNE 2017
"General Best Practice Guidelines for Immunization" – Everything CDC Wants You to Know about the Practical Aspects of Vaccination
MAY 2017
ACIP Has Updated Its Recommendations on the Use of Tdap Vaccine in Pregnant Women and Children
APRIL 2017
Make Sure You Are Using VISs in Accordance with Federal Law
MARCH 2017
ACIP Now Recommends Hepatitis B Vaccine within 24 Hours of Birth
FEBRUARY 2017
New “16-year-old Vaccination Platform” Highlighted in 2017 U.S. Child/Teen Immunization Schedule
JANUARY 2017
Updated ACIP Recommendations on HPV Vaccine
 
This page was updated on April 11, 2017.
 
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