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On January 12, 2018, CDC published
“Prevention of Hepatitis B Virus Infection in the United States:
Recommendations of the Advisory Committee on Immunization
Practices (ACIP) in MMWR Recommendations and Reports,"
(Vol.67, No.1). This 36-page document contains full recommendations
for the use of hepatitis B vaccine in infants, children, teens and
adults, as well as guidance on many other related topics.
What has changed for newborns?
The most significant change in these published recommendations
is that medically stable newborns who weigh at least 2,000 gm and
whose mothers’ hepatitis B surface antigen (HBsAg) test is
documented to be negative, should receive hepatitis B vaccine
within 24 hours of birth. Prior to this (since 2005), the
recommendation was to administer the birth dose of hepatitis B
vaccine at any time prior to hospital discharge. There was also
language permitting a delay in administering the birth dose until
after hospital discharge, but this was only during rare
circumstances and on a case-by-case basis when certain specific
criteria were met. However, this option is no longer included
in the hepatitis B recommendations for newborns.
AAFP, AAP and ACOG agree
The American Academy of Family Physicians (AAFP), American Academy
of Pediatrics (AAP), and American College of Obstetricians and
Gynecologists (ACOG) are all in agreement with the recommendation
to vaccinate newborns within 24 hours of birth. AAP included this
in its recently published Red Book 2018–2021: Report of the
Committee on Infectious Diseases (page 421, Table 3.24). Administering the hepatitis B birth dose within 24 hours of birth
was first published in 2017 in the
Recommended Immunization
Schedule for Children and Adolescents Aged 18 Years or Younger,
United States, 2017,
which was endorsed by AAFP, AAP and ACOG. It appears in the
2018
immunization schedule for children and adolescents
as well. ACIP-specific wording
The exact language regarding universal hepatitis B vaccination
of infants in the
ACIP recommendations
on pages 16–17 is reprinted below:
Universal Vaccination of Infants
- All infants should receive the HepB vaccine series as part of the
recommended childhood immunization schedule, beginning at birth as
a safety net.
- For all medically stable infants weighing > 2,000 grams at birth
and born to HBsAg-negative mothers, the first dose of vaccine
should be administered within 24 hours of birth (new
recommendation). Only single-antigen HepB vaccine should be used
for the birth dose.
To access CDC guidance on hepatitis B-related topics such as the
management of low birth weight infants, infants whose mothers are HBsAg positive or whose HBsAg status is unknown, and the
management of HBsAg-positive mothers, consult the
ACIP recommendations for hepatitis B.
Related resources
From the Immunization Action Coalition
(All IAC materials below have undergone technical review by CDC.)
Vaccine Education Center at the Children’s Hospital of
Philadelphia
Centers for Disease Control and Prevention
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ACIP Recommendations
Vaccine Information Statements 
