Summary
We encourage you to rely on guidance from national medical organizations who continue to recommend newborns receive hepatitis B vaccine. The Washington State Department of Health and the West Coast Health Alliance have also affirmed this recommendation.
Background
A national strategy of newborn vaccination launched in 1991 has reduced pediatric hepatitis B infections in the United States by 99%.
The Advisory Committee on Immunization Practices (ACIP) recently voted to end the universal recommendation for hepatitis B vaccination for all infants at birth. It also voted that parents should consult their provider regarding blood tests following each dose of the vaccine series.
National medical organizations have objected to these changes, as no credible evidence was presented to support either change. Delaying the birth dose of hepatitis B vaccine will likely lead to more children and adults developing preventable liver disease and liver cancer, with no evidence of a safety benefit from delaying vaccination.
Many people who have chronic hepatitis B do not know they are infected. Infants can be infected by household and other contacts as well as via vertical transmission during pregnancy or birth. Thus, even when the pregnant person has tested negative for hepatitis B, the newborn dose offers protection from infection. Infants and young children are especially vulnerable. Up to 90% of infants infected at birth develop chronic infection and 25% of infected children die prematurely from hepatitis-related disease.
Additionally, there is no established correlate for long-term protection for infants after a single vaccine dose; thus, healthcare providers do not have clear evidence or guidance to rely on if they were to pursue serologic testing after administering the first dose of hepatitis B vaccine. This approach would also result in unnecessary blood draws for infants and potentially decreased long-term protection against hepatitis B.
Vaccine recommendations
Going forward, we encourage you to rely on the American Academy of Pediatrics (AAP) vaccine schedule for pediatric vaccine recommendations. Please continue to recommend hepatitis B vaccination for all eligible newborns. You should give the first dose within 24 hours of birth for newborns weighing at least 2,000 grams (4 pounds, 7 ounces), followed by completion of the vaccine series.
In addition to the AAP, many other national medical groups also continue to recommend the newborn dose of hepatitis B, including the American Academy of Family Physicians (AAFP), the Infectious Diseases Society of America (IDSA), The American Association for the Study of Liver Diseases (AASLD), the American College of Gastroenterology (ACG), the American Gastroenterological Association (AGA), the American Society for Gastrointestinal Endoscopy (ASGE), and the North American Society for Pediatric Gastroenterology, Hepatology & Nutrition (NASPGHAN). The Washington State Department of Health and the West Coast Health Alliance have also affirmed this recommendation.