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Technically Speaking
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July/August 2018
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.
Check out a recent issue of Vaccine Update for Healthcare Providers. The VEC e-newsletter keeps providers up to date on vaccine-related issues and includes reviews of recently published journal articles, media recaps, announcements about new resources, and a regularly updated calendar of events.
TECHNICALLY SPEAKING
CDC Publishes Recommendations that Newborns Receive Hepatitis B Vaccine within 24 Hours of Birth — AAFP, AAP and ACOG Concur
Published July/August 2018

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

2018 ISSUES >> view all issues
DECEMBER 2018
Looking Back Over 2018 Can Help Ensure Optimal Vaccination Practices in 2019
NOVEMBER 2018
CDC's Vaccine Administration Training Materials – A Great Collection of 4-Minute Videos and Web-Based Training Programs
OCTOBER 2018
Let's Get It Right! How to Avoid Shoulder Injury with Deltoid Intramuscular Injections
SEPTEMBER 2018
What's New for Flu This Season?
JULY/AUGUST 2018
CDC Publishes Recommendations that Newborns Receive Hepatitis B Vaccine within 24 Hours of Birth — AAFP, AAP and ACOG Concur
JUNE 2018
History of Fever > 105 Degrees, Inconsolable Crying, and Hypotonic Episode Following a Previous DTaP Dose Are No Longer Precautions According to ACIP
MAY 2018
Immunize.org Provides a Wide Range of Practical Resources on Vaccine Administration, Storage and Handling, and More
APRIL 2018
New! 2018 Laminated U.S. Immunization Schedules and Updated Educational Materials
MARCH 2018
Subscribe to IAC Express from the Immunization Action Coalition
FEBRUARY 2018
CDC Publishes Updated Guidance on the Use of Zoster Vaccines
JANUARY 2018
CDC Issues New Requirements for VFC Vaccine Storage
 
This page was updated on August 8, 2018.
This page was reviewed on June 14, 2018.
 
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