Issue Number 98
July 20, 1999
CONTENTS OF THIS ISSUE
- Urgent message! Some hospitals have
changed their newborn hepatitis B vaccination policies and are not following new CDC
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July 20, 1999
URGENT MESSAGE! SOME HOSPITALS HAVE CHANGED THEIR NEWBORN HEPATITIS B VACCINATION POLICIES
AND ARE NOT FOLLOWING NEW CDC GUIDELINES
IAC EXPRESS has received news that some hospitals have changed their hepatitis B
vaccination policies because of the new American Academy of Pediatrics (AAP) guidelines on
the use of thimerosal-containing vaccines. The new AAP guidelines do not address the issue
of vaccination of infants born to hepatitis B surface antigen (HBsAg) negative mothers who
belong to populations and groups that have high risk of early childhood hepatitis B virus
infection. As a result, some hospitals have rewritten their policies and are
recommending that these high-risk infants not receive hepatitis B vaccine until they are
six months of age.
While the AAP guidelines have no specific
recommendations for these high-risk infants, the new CDC guidelines stress the importance
of vaccinating these infants in the hospital.
When asked by IAC staff to clarify the difference between the United States Public Health
Service recommendation and the AAP recommendation, Dr. Harold S. Margolis, Chief of the
Hepatitis Branch of the Centers of Disease Control and Prevention, made the following
"CDC recommends that infants born to HBsAg negative women who belong to populations
and groups that have high risk of early childhood hepatitis B virus infection be
vaccinated as newborns. Although routine newborn vaccination is not the current
recommendation of the AAP, it is still a recommendation of the Advisory Committee on
Immunization Practices. However, if a hospital chooses to follow the AAP recommendation
and delay vaccination of these high-risk infants until two to six months, they should make
sure these infants receive their first dose by two months of age, even if COMVAX is not
available. This is definitely a situation in which the larger risk of not vaccinating
children far outweighs the much smaller theoretical risk of cumulative exposure to
thimerosal-containing vaccines over the first six months of life."
IAC EDITORS' NOTE: COMVAX is a thimerosal-free hepatitis B vaccine that also contains a
Hib component. It is licensed for use beginning at six weeks of age. It is also
anticipated that thimerosal-free, single-antigen hepatitis B vaccines will be available
during the month of September.
The new CDC guidelines, which were released on July 15, 1999, and appear today on the
National Immunization Program's website, stress the importance of continuing to vaccinate
infants born to HBsAg negative women who belong to populations and groups that have high
risk of hepatitis B virus infection as well as infants born to HBsAg positive mothers and
to mothers whose status is not known.
CDC GUIDELINES SAY TO VACCINATE THESE GROUPS OF INFANTS AT BIRTH:
- INFANTS BORN TO HBsAg POSITIVE MOTHERS
All infants born to HBsAg positive mothers need hepatitis B vaccine and hepatitis B immune
globulin (HBIG) within 12 hours of birth.
- INFANTS BORN TO MOTHERS WHOSE HBsAg STATUS IS
All infants born to mothers whose HBsAg status is still unknown 12 hours after birth need
hepatitis B vaccine at that time. Draw the mother's blood upon admission and send it to
the lab ASAP. If the results cannot be obtained by 12 hours after the infant's birth, the
infant should be vaccinated at that time. If the mother is found to be HBsAg positive,
administer HBIG to the infant ASAP (no later than 7 days after birth).
- INFANTS BORN TO HBsAg NEGATIVE MOTHERS BELONGING
TO POPULATIONS OR GROUPS THAT HAVE HIGH RISK OF EARLY CHILDHOOD HBV INFECTION
All infants born to HBsAg negative mothers belonging to populations or groups that have
high risk of early childhood HBV infection need hepatitis B vaccine prior to discharge.
These high-risk groups include, but are not limited to, Asian Pacific Islanders, immigrant
populations from countries in which HBV is of high or intermediate endemicity (see CDC's
"Health Information for International Travel, 1999"), and households with
persons with chronic HBV.
NOTE: The AAP has no specific recommendation for
infants who are born to women belonging to groups or populations at high risk of early
childhood hepatitis B virus infection. Because of this, some hospitals are treating these
high-risk infants no differently from infants with low risk of infection and have written
policies to delay these infants' hepatitis B vaccination until 6 months of age.
CDC recommends that if your hospital chooses to follow the recommendation of the AAP, you
should vaccinate all children who are born to HBsAg negative women in high-risk
communities at two months of age with thimerosal-free vaccine (COMVAX). However, if
thimerosal-free vaccine is not available, you should make sure that these high-risk
infants receive hepatitis B vaccine no later than two months of age, even if only
thimerosal-containing vaccine is available to you (Recombivax HB and Engerix-B).
Do not wait until these at-risk children are six months old to give dose #1. The need for
these infants to receive hepatitis B vaccine by two months of age far outweighs the much
smaller theoretical risk of cumulative exposure to thimerosal-containing vaccines.
The complete guidelines, "Implementation Guidance for Immunization Grantees During
the Transition Period to Vaccines Without Thimerosal," can be downloaded from CDC's
website at http://www.cdc.gov/nip/vacsafe/concerns/thimerosal/thimerosal-guidance.htm
If you are unable to download these guidelines, call the immunization program manager at
your state health department. Your state health department received these guidelines on
July 15, 1999.
CDC also has other important information on thimerosal and vaccines on its website at http://www.cdc.gov/nip/Q&A/clinqa/Thimerosal-p.htm