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Hepatitis B Birth Vaccine Recommendation Changes

Recently, the Advisory Committee on Immunization Practices met and voted to recommend a change to the dosing practice for Hepatitis B in infants.  Two different votes took place with slightly different changes.

The previous recommendation was that infants born to mothers who test negative for Hepatitis B surface antigen receive their 1st dose of Hepatitis B vaccine within 24 hours of birth. The 2nd dose will happen between 1 and 2 months. The 3rd dose is administered between 6 and 18 months.

The ACIP voted to change the authority for parents to decide when, or whether, their child receives the Hepatitis B vaccine. For those who don’t receive the birth dose, the initial dose should not be given before 2 months of age. (Only infants born to HbsAg-negative mothers)

Going forward, Hepatitis B will be given at birth only for infants born to women who test positive or for whom the status is unknown.

Women with a negative Hepatitis status are advised to speak with their doctors about vaccination.

They second vote was for testing children’s antibody levels after each Hepatitis shot to determine if additional shots are necessary. This means, post-vaccine serology should be offered to parents to determine whether additional vaccine doses are needed. Testing should be covered by insurance.

These new recommendations have been met with opposition.

The American Academy of Pediatrics (APP) issued a statement calling the new guidance “irresponsible” and ‘purposely misleading”.

The APP continues to recommend that all infants receive routine Hepatitis B. The current Hepatitis B vaccine program has been in place since 1991 and has reduced pediatric Hepatitis B infections by 99%.

“We know vaccines are safe,” said Dr. Cody Meissner, a professor of pediatrics at Dartmouth’s Geisel School of Medicine and the only current member who has served on the committee in previous years. “The hepatitis B vaccine recommendation is very well established. We know it is safe, and we know it is very effective.” Speaking Friday before the final vote, he said if the committee made the proposed change, “we will see more children and adolescents and adults infected with hepatitis B.”

In summary, the advisory committee believes these changes will provide flexibility for lower-risk infants, but strong recommendations remain in place for higher-risk infants. Some medical groups advocate a universal birth dose to maximize protection.