TABLE 4-2 Hepatitis B Immunization Management of Preterm Infants Who Weigh Less Than 2,000 g, by Maternal HBsAg Status—ACIP Recommendations

Maternal HBsAg Status

Recommendation

Positive

HBIG + hepatitis B vaccine (within 12 hours of birth) Continue vaccine series beginning at age of 1–2 months according to recommended schedule for infants born to HBsAg-positive mothers (see Table 4-1)

Do not count birth dose as part of vaccine series

Test for HBsAg and antibody to HBsAg after completion of vaccine series at age of 9–18 months (that is, next well-child visit)

Unknown

HBIG + hepatitis B vaccine (within 12 hours of birth)

Test mother for HBsAg

Continue vaccine series beginning at age of 1–2 months according to recommended schedule based on mother’s HBsAg result (see Table 4-1)

Do not count birth dose as part of vaccine series

Negative

Delay first dose of hepatitis B vaccine until age of 1 month or hospital discharge

Complete vaccine series (see Table 4-1)

Abbreviations: ACIP, Advisory Committee on Immunization Practices; HBIG, hepatitis B immune globulin; HBsAg, hepatitis B surface antigen.

SOURCE: Mast et al., 2005.

Recommendation 4-1. All infants weighing at least 2,000 grams and born to hepatitis B surface antigen-positive women should receive single-antigen hepatitis B vaccine and hepatitis B immune globulin in the delivery room as soon as they are stable and washed. The recommendations of the Advisory Committee on Immunization Practices should remain in effect for all other infants.

Administration of prophylaxis in the delivery room is not novel. In the United States, vitamin K prophylaxis for vitamin K–deficiency bleeding and tetracycline or erythromycin for prophylaxis of neonatal gonococcal infections are routinely given to infants in the delivery room (American Academy of Pediatrics, 1961, 1980; Workowski and Berman, 2006). The World Health Organization recommends that the birth dose of the hepatitis B vaccine be administered as soon after birth as possible (WHO, 2006). A pilot project in The Lao People’s Democratic Republic demonstrated almost 100% coverage when the hepatitis B vaccine was administered in



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement