Saving Lives With the Universal Hepatitis B Birth Dose - Fact Sheets for Hospitals

Since 2001, the Advisory Committee on Immunization Practices (ACIP) has recommend giving a birth dose of hepatitis B vaccine to all newborns prior to hospital discharge. This Advisory Committee on Immunization Practices recommendation aligns with the American Academy of Pediatrics policy that recommends a hepatitis b birth dose vaccine for all infants. The New York State Department of Health supports these recommendations and urges your hospital to adopt a universal hepatitis B birth dose policy if you have not already done so. For those eligible, the Vaccines for Children Program and New York State Department of Health provide hepatitis B vaccine at no cost.

Why is such a policy necessary?

The most common cause of perinatal hepatitis B virus infection is when a pregnant person with hepatitis B virus infection gives birth, and the infant does not receive postexposure immunoprophylaxis (hepatitis B birth dose and hepatitis B immune globulin [HBIG]) within 12 hours of birth.

An infant can also develop hepatitis B virus infection through contact with blood or other bodily fluids from a person with hepatitis B virus infection. In 2021, an estimated 17,827 infants were born to persons with a positive hepatitis B surface antigen (HBsAg) in the United States, representing nearly 0.5% of all births.

Ninety percent of perinatal infections can be prevented by postexposure immunoprophylaxis given within 12 hours of birth. Unfortunately, many babies are exposed to hepatitis B virus at birth but do not receive appropriate postexposure immunoprophylaxis.

The following are some of the ways infants who are not vaccinated at birth become infected:

  • The incorrect test is ordered OR is not communicated:
    • A chronically infected pregnant person is tested but with the wrong test, i.e., antibody to hepatitis B surface antigen (HBsAb) instead of hepatitis B surface antigen (HBsAg). This is a common mistake since these two test abbreviations differ by only one letter. The incorrectly ordered test result is "negative," so the medical provider believes the infant does not need postexposure immunoprophylaxis, though this is misinterpretation of the pregnant person's hepatitis B virus status.
    • The pregnant person is tested and found to be hepatitis B surface antigen (HBsAg) positive, but the status is not communicated to the newborn nursery. The infant does not receive their hepatitis B immunoglobulin along with their hepatitis B birth dose, missing the full immunoprophylaxis.
  • There is a missing test:
    • Pregnant person is not tested for hepatitis B surface antigen on admission. The infant does not receive their hepatitis B immunoglobulin along with their hepatitis B birth dose, missing the full immunoprophylaxis.
    • The birthing person is tested in early pregnancy for hepatitis B surface antigen and is found to be negative. They develop hepatitis B virus infection later in pregnancy but it is not detected, even though it is recommended by CDC that birthing persons with risk exposure be retested in the third trimester. The infection is not clinically detected by the health care provider, so the infant does not receive full immunoprophylaxis (hepatitis B vaccine and hepatitis B immunoglobulin) at birth.
    • The birthing person is hepatitis B surface antigen negative and does not receive a birth dose of hepatitis B vaccine. The infant is later exposed to HBV infection postnatally from another family member or caregiver. The infant missed the chance for protection by not receiving their birth dose. Vaccination produces seroprotection in 98% of healthy term infants.

Providing a birth dose of hepatitis B vaccine to all infants while still in the hospital will protect and save lives.