Protecting Your Baby
Infants born to hepatitis B-positive women must receive the accurate doses of HBV vaccine and HBIG to ensure complete protection. In order to protect these infants, both medications should be given immediately after birth in the delivery room or within the first 12 hours of life.
Recommended Dosing Schedule for All Infants
First Dose: ACIP recommends all infants receive their first dose of the hepatitis B vaccine at birth. Infants born to hepatitis B positive mothers should receive hepatitis B vaccine and 0.5 milliliters of hepatitis B immune globulin (HBIG) at separate sites within 12 hours of birth.
Second Dose: Recommended at age 1-2 months
Third/Fourth Dose: The vaccination series should be completed at age 6 months. Poorer response rates are seen in infants who complete the vaccination series prior to age 24 weeks.
All doses must be completed in order for your infant to be fully protected against hepatitis B. It is also important that a baby born to an HBV-positive mother receive post-vaccination serologic testing at 9-12 months to confirm the baby is protected against HBV and is not infected. Tests include the HBsAg and anti-HBs titer test.
*Please Note: Although the CDC states that the medications can be given within the first 12 hours of life, there is no second chance to protect an infant once this window of opportunity is missed. Therefore, the Hepatitis B Foundation strongly recommends that health care professionals administer these medications immediately in the delivery room to avoid any delays or mistakes.
Vaccination Outside the United States
In developing countries the pentavalent vaccine, a combination 5-in-one vaccine that protects against five diseases, diphtheria, pertussis, tetanus, Hib and hepatitis B, may be given to babies more than 6 weeks of age, and can be given up to 1 year of age. The first dose is given at 6 weeks, and the second and third doses are given at 10 and 14 weeks of age. The pentavalent vaccine may be made available free of charge with the support of GAVI, the vaccine alliance. Check the GAVI country hub to see the resources and immunizations that may be available: http://www.gavi.org/country/
For babies born to mothers with hepatitis B, waiting for the first dose of the pentavalent vaccine is too late and will NOT protect the baby from vertical or horizontal transmission of hepatitis B. This means that a woman that is hepatitis B positive will likely pass the virus to her baby, who will then be chronically infected.
WHO recommends the hepatitis B vaccine within 24 hours of birth for ALL babies. Plan ahead and inquire about the availability and cost of the monovalent (single), birth dose of the vaccine, as it is not a GAVI provided immunization. This is particularly important to women who are positive for hepatitis B.
If you are unsure of your hepatitis B status, please be sure your doctor tests you for hepatitis B!
For babies NOT receiving the pentavalent vaccine, the first dose of the monovalent, HBV vaccine must be given within 12 hours of birth, followed by the remaining 2-3 doses of the hepatitis B vaccine according to schedule.
For babies receiving the pentavalent vaccine, the first, monovalent dose of the hepatitis B vaccine is given within 12 hours of birth, and the second and third doses of the HBV vaccine will be included in dose 1 and dose 2 of the pentavalent vaccine.
Making sure babies get the birth dose hepatitis B vaccine is critical to eliminating hepatitis B. The Center for Global Hepatitis Elimination published a review of strategies to improve implementation of hepatitis B vaccine birth dose worldwide, especially in limited-resource settings. This can be a useful resource to help organizations improve hepatitis B vaccine birth dose completion around the world.
*WHO does not recommend the birth dose of HBIG, and may not be available in all countries. Talk to your doctor if you have questions.