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Hepatitis B Birth Dose Honor Roll
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Application for Enrollment

Hepatitis B Birth Dose Honor Roll

Apply for the Birth Dose Honor Roll

The Immunization Action Coalition's Hepatitis B Birth Dose Honor Roll recognizes U.S. birthing institutions that have attained a birth dose coverage rate of 90% or greater and have met specific additional criteria. These criteria help define the important elements of a birth dose policy that are needed to ensure newborns do not fall through the cracks when medical errors occur.
To be included in IAC's Hepatitis B Birth Dose Honor Roll, a birthing institution must have:
Achieved, over a 12-month period, a coverage rate of 90% or greater for administering hepatitis B vaccine before hospital discharge to all newborns (regardless of weight), including those whose parents refuse vaccination. (Newborns who are transferred to a different facility after birth due to medical problems do not need to be included in the denominator.)
Implemented written policies, procedures, and protocols to protect all newborns from hepatitis B virus infection prior to hospital discharge.
 
If you wish to apply by fax, mail, or email, please use our print-ready application form.
 
GLT
GRT
 
Application for Enrollment into the Hepatitis B Birth Dose Honor Roll
FIELDS MARKED WITH * ARE REQUIRED
 
  We are already a Hepatitis B Birth Dose Honor Roll honoree.
 
Please tell us about the person filling out this form
* First Name:
* Last Name:
* Job Title:
* Facility Name:
* Department:
* Address:
* City:
* State:
* Zip code:
* Phone:
* Email :
Please tell us about your hospital or birthing center
* Name of Institution:
* Address:
* City:
* State:
* Zip code:
* Identify the individual or committee responsible for adopting written policies, procedures, and protocols to administer the birth dose:
     
* Identify the healthcare professional responsible for ensuring implementation of all birth dose policies, procedures, and protocols:
     
* Indicate the type of facility:  
Hospital
Independent Birthing Center
Other:
     
* Which most closely describes the type of community your hospital or birthing center resides in?  
Urban
Suburban
Rural
     
* Approximately how many total beds are in your entire healthcare facility?  
     
* Approximately how many beds are in your birthing unit?  
     
* Approximately how many births occur per year in your healthcare facility?  
Qualifications for enrollment into IAC’s Hepatitis B Birth Dose Honor Roll
To be included in the Immunization Action Coalition’s Hepatitis B Birth Dose Honor Roll, a birthing institution must have:
1.  
Achieved, over a 12-month period, a coverage rate of 90% or greater for administering hepatitis B vaccine before hospital discharge to all newborns (regardless of weight), including those whose parents refuse vaccination. (Newborns who are transferred to a different facility after birth due to medical problems do not need to be included in the denominator.)
Please check this box if your birthing facility meets this qualification.
 
* What coverage rate did you achieve for administering hepatitis B vaccine to all newborns prior to hospital discharge?
*What is the starting date of the 12-month time period over which this rate was measured?
* What is the ending date?
* Please describe how the birth dose coverage level was measured:
 
Do you have an additional period you wish to apply for at this time? It is permissible to apply for multiple periods at once as long as 1) each period covers at least 12 months and 2) the periods do not overlap.
 
What coverage rate did you achieve for administering hepatitis B vaccine to all newborns prior to hospital discharge?
What is the starting date of the 12-month time period over which this rate was measured?
What is the ending date?
Please describe how the birth dose coverage level was measured:
If there are more than two eligible periods that you would like to include on your application, please list the coverage rate and the starting and ending dates for each period:
 
2.  
Implemented written policies, procedures, and protocols to administer the universal hepatitis B vaccine birth dose to all newborns prior to hospital discharge.
Please check this box if your birth dose policies are formally documented.
 
3.  
Generally, acceptance into the honor roll requires adoption of all the following policy components, but exceptions to that requirement may be granted.
Select "yes" if your written birth dose policies include the following policy items:
a.
Parents are informed about the importance of the hepatitis B vaccine birth dose and that it is recommended for all newborns.
Yes
No
 
b.
All newborns routinely receive hepatitis B vaccine within 24 hours of birth.
Yes
No
 
c.
A review is performed as to whether the correct screening test, hepatitis B surface antigen (HBsAg), was ordered for the mother during this pregnancy.
Yes
No
 
d.
The result of the mother's HBsAg screening test is reviewed.
Yes
No
(NOTE: It is best, if at all possible, that the policy calls for review of a copy of the original HBsAg test result, and not a transcribed or hand-entered report.)
 
e.
An HBsAg blood test is ordered ASAP if an incorrect test was ordered on the mother or if no test result is included on her chart.
Yes
No
 
f.
Infants born to HBsAg-positive mothers receive hepatitis B vaccine and hepatitis B immune globulin (HBIG) within 12 hours of birth.
Yes
No
 
g.
Infants born to mothers whose HBsAg status is unknown receive hepatitis B vaccine within 12 hours of birth.
Yes
No
 
h.
Infants who weigh less than 2,000 grams and are born to mothers whose HBsAg status is unknown receive HBIG (in addition to hepatitis B vaccine) within 12 hours of birth.
Yes
No
 
i.
Routine newborn admission orders include a standing order to administer hepatitis B vaccine to all infants (similar to standing orders to administer Vitamin K and ophthalmic antibiotic).
Yes
No
 
j.
Notification of the state or local health department’s perinatal hepatitis B prevention program is done prior to discharge (or as soon as known, if after discharge) for all mothers whose HBsAg test result is positive.
Yes
No
 
We welcome your comments about these policy items or about your birth dose policies and procedures in general:
 
Please tell us about your perinatal hepatitis B coordinator
* Name of State or Local Health Department:
     
* Name of Perinatal Hepatitis B Coordinator:
     
* Email:
     
* Phone:
     
Note: We notify the applicant and their perinatal hepatitis B coordinator upon acceptance into the honor roll. If you do not know the name of your state or local health department's perinatal hepatitis B coordinator, please visit the following CDC website: www.cdc.gov/vaccines/vpd/hepb/hcp/perinatal-contacts.html  to locate their contact information or email IAC at: birthdose@immunize.org
  
 
 
GLB
GRB
 
 
Learn more about the initiative: Give birth to the end of Hep B
 
Support for the Universal Hepatitis B Birth Dose
American Academy of Family Physicians
American Academy of Pediatrics
American College of Obstetricians and Gynecologists
Centers for Disease Control and Prevention
>> read letter of endorsement
 
Printable Application Form
If you wish to apply by fax, mail, or email, please use our print-ready application form.
This page was updated on July 13, 2020.
This page was reviewed on March 24, 2020.
 
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This website is supported in part by a cooperative agreement from the National Center for Immunization and Respiratory Diseases (Grant No. 6NH23IP22550) at the Centers for Disease Control and Prevention (CDC) in Atlanta, GA. The website content is the sole responsibility of IAC and does not necessarily represent the official views of CDC.