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Issue Number 198            October 5, 2000



By Deborah L. Wexler, MD
Executive Director, Immunization Action Coalition


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If you haven't done so already, it's time to resume administration of the first dose of hepatitis B vaccine at 0-2 months of age. Ample supplies of pediatric hepatitis B vaccines that do not contain thimerosal as a preservative are available from both Merck & Co. (Recombivax HB and Comvax) and SmithKline Beecham (Engerix-B).

According to Bob Snyder, vaccine contract project officer at the Centers for Disease Control and Prevention (CDC), "As of April 2000, the National Immunization Program has contracts with both Merck & Co. and SmithKline Beecham that will provide sufficient preservative-free hepatitis B vaccine for all age cohorts 0 through 18 years of age."

Some states have reported that infants born to women who tested positive for hepatitis B surface antigen (HBsAg) did not receive the birth dose of hepatitis B vaccine. The infants were not vaccinated because of hospital policy changes based on "Thimerosal in Vaccines: A Joint Statement of the American Academy of Pediatrics and the United States Public Health Service." In Michigan, a baby girl recently born to an HBsAg-positive mother did not receive hepatitis B immune globulin (HBIG) or hepatitis B vaccine at birth. The infant died at three months of age from liver failure caused by fulminant (overwhelming) HBV infection. This death most likely would have been prevented if the birth hospital had not stopped its policy of routinely vaccinating infants before hospital discharge. This illustrates the importance of establishing AND implementing hospital policies to ensure that the HBsAg status of all pregnant women is known and clearly documented before delivery and that infants are vaccinated against hepatitis B at birth.

The following problems continue to occur:

  1. Some hospitals and clinicians have been incorrectly deferring hepatitis B vaccination for ALL infants, even those whose mothers are HBsAg positive.
    NOTE: According to recommendations of CDC, the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American College of Obstetrics and Gynecology (ACOG), when a mother is HBsAg positive, her infant should receive HBIG and hepatitis B vaccine within 12 hours of birth.
  2. Some hospitals and clinicians have been incorrectly delaying vaccination for infants born to mothers whose HBsAg status is unknown at the time of delivery.
    NOTE: According to the recommendations of CDC, AAP, AAFP, and ACOG, when the mother's HBsAg status is unknown, hepatitis B vaccine should be administered to the infant within 12 hours of birth and the mother's blood should be tested as soon as possible for HBsAg to determine if the baby also needs HBIG prophylaxis and subsequent evaluation during well child visits.
  3. Many hospitals and clinicians have been incorrectly deferring the birth dose of hepatitis B vaccine for infants whose mothers are HBsAg negative but may have other factors that continue to place the infants at risk for HBV infection after they leave the hospital. Postponing hepatitis B vaccination for these infants leaves them at risk for exposure in their households and communities.
    NOTE: According to CDC, infants who live in households or communities at high risk for early childhood HBV infection should be vaccinated at birth to protect them from potential exposures within their households or communities. Infants at risk include Alaskan Natives, Asian Pacific Islanders, immigrant populations from countries in which HBV is of high or intermediate endemicity, and households with persons with chronic HBV infection.

The administration of hepatitis B vaccine at birth serves as a broad safety net to protect infants whose risk factors for HBV infection have not been identified or whose prenatal care records may be missing, incomplete, or incorrect (containing transcription or lab test misinterpretation errors).


  1. Please resume administration of the birth dose of hepatitis B vaccine for all infants who are at risk for HBV infection to be sure that these babies are protected from this potentially deadly liver disease.
  2. Hospitals that previously administered the birth dose of hepatitis B vaccine to ALL infants should reinstate their policies to assure that every baby is protected.
  3. If your hospital doesn't have this policy, consider adoption of a policy to vaccinate every infant beginning at birth. When hospitals institute this important policy, every infant will receive protection.
  4. Be sure your hospital's labor and delivery unit and its newborn nursery have hepatitis B prevention protocols in place. For a sample hospital policy that has been reviewed by CDC, go to:
    For this same sample policy in PDF format, go to:


Labor and delivery units should be sent a copy of their patients' HBsAg laboratory reports along with prenatal records. A handwritten lab value on a patient's chart DOES NOT GUARANTEE that the result has been accurately interpreted or correctly transcribed. Send a copy of the original laboratory report to the hospital to assure that the hospital has the correct information. Hospital staff should make sure to review the lab report as well as the prenatal chart information. 

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IZ Express is supported in part by Grant No. 1NH23IP922654 from CDC’s National Center for Immunization and Respiratory Diseases. Its contents are solely the responsibility of and do not necessarily represent the official views of CDC.

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