The End of Hepatitis B Transmission Begins At Birth

July 2013

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.
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The End of Hepatitis B Transmission Begins At Birth
Published July 2013
Information presented in this article may have changed since the original publication date. For the most current immunization recommendations from the Advisory Committee on Immunization Practices, visit
Universal hepatitis B vaccination at birth is a major part of CDC’s Advisory Committee on Immunization Practices’ (ACIP) 2005 strategy to eliminate hepatitis B virus (HBV) transmission in the United States.
In 2011, the U.S. Department of Health & Human Services (HHS) echoed ACIP’s recommendations in its Action Plan for the Prevention, Care and Treatment of Viral Hepatitis. HHS further recommended birth dose coverage as a standard of care and a national quality measure.
In 2012, the National Quality Forum endorsed a new standard that calls for reporting “Hepatitis B Coverage Among All Live Newborn Infants Prior to Hospital or Birthing Facility Discharge.”
Yet, despite expert consensus on the importance of a hepatitis B vaccine birth dose, nearly 1 in 3 U.S. newborns leaves the hospital unprotected. As a result, approximately 800 U.S. newborns become chronically infected each year because of perinatal exposure. These newborns would be afforded a “safety net” if a birth dose was universally administered before hospital discharge.
That’s why this July the Immunization Action Coalition (IAC) launched a major campaign aimed at urging the nation’s birthing institutions to adopt or strengthen their hepatitis B vaccine birth dose policies. The centerpiece of the campaign is a new, comprehensive guidebook, “Hepatitis B: What Hospitals Need to Do to Protect Newborns.” Endorsed by the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the Centers for Disease Control and Prevention, the guide contains a wide range of resources to help birthing institutions establish, implement and optimize their hepatitis B birth dose policies.
The guidebook explains that universal hepatitis B vaccination is needed at birth because it:
Prevents 70 percent to 95 percent of transmission to infants born to HBsAg-positive women
Prevents household transmission to infants from infected family members and other caregivers
Provides a safety net to prevent perinatal transmission when medical errors occur
Medical errors in perinatal settings that can lead to newborn HBV transmission include the following:
Ordering the wrong hepatitis B screening test
Misinterpreting or mis-transcribing hepatitis B test results
Failing to communicate test results to or within the hospital
Failing to vaccinate infants born to mothers of unknown HBsAg status within 12 hours of birth
Failing to provide prophylaxis to newborns when the mother is known to be HBsAg positive
Administering the hepatitis B vaccine birth dose can circumvent potentially tragic outcomes and save lives.
With the launch of its new guidebook and corresponding Hepatitis B Birth Dose Honor Roll, which recognizes birthing institutions that have attained high birth dose coverage rates, IAC urges hospitals and birthing centers to Give birth to the end of Hep B. What better time than now to join the cause?
For more information and to download the guidebook, visit


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