Protecting Your Baby Through Vaccination
Infants born to women with hepatitis B must receive accurate doses of hepatitis B vaccine and hepatitis B immune globulin (if recommended and available) to ensure complete protection. In order to protect these infants, medications should be given immediately after birth in the delivery room or within the first 12-24 hours of life*.
* See Testing and Treatment During Pregnancy section for details. Please note that testing of all pregnant women for hepatitis B is a global recommendation.
Infants Born to Mothers Who Have Hepatitis B: Hepatitis B Vaccine Schedules
*Please note that the first dose of the hepatitis B vaccine (birth dose) should be given as soon as possible. Additional doses require minimum time intervals between doses in order for the vaccine to be effective.
Protecting Your Baby
Infants born to women who have hepatitis B must receive accurate doses of the hepatitis B vaccine and hepatitis B immune globulin (HBIG) at separate injection sites (opposite limbs) to ensure complete protection. In order to protect these infants, at least the hepatitis B vaccine birth dose should be given immediately after birth in the delivery room or within the first 12-24 hours of life. If recommended and available, HBIG should also be given at that time.
*U.S. CDC recommends both the hepatitis B vaccine and HBIG within 12 hours of birth to babies born to mothers that are HBsAg positive and within 24 hours for all other babies. WHO recommends the hepatitis B vaccine within 24 hours of birth for ALL babies and does not recommend HBIG for babies born to mothers with hepatitis B.
3-Dose Vaccine Series for Infants (Including the "Birth Dose")
The World Health Organization (WHO) recommends that infants born to women who have hepatitis B receive the first dose of the hepatitis B vaccine within 24 hours of birth. Ideally a dose of hepatitis B immunoglobulin (HBIG) is also given if recommended and available. These shots must be followed by the additional hepatitis B vaccine doses given on the recommended schedule. In the U.S., infants should follow a 1 month and 6-month schedule for the additional two doses.
4-Dose Combination Vaccine Series for Infants (Pentavalent or Hexavalent)
Combination vaccines, such as the pentavalent and hexavalent vaccines, provide protection against 5 or 6 diseases, including hepatitis B. The first shot is usually given at 6 weeks of age, but in order to protect infants from hepatitis B beginning at birth, a monovalent or single dose of the hepatitis B vaccine is also recommended within 24 hours of birth. Their hepatitis B vaccine series can then be completed with the pentavalent or hexavalent vaccine on the recommended schedule.
Important Information about Vaccine and Hepatitis B Immunoglobulin (HBIG) Shot Administration
Where recommended and available, the hepatitis B “birth dose” and HBIG should be administered within 24 hours of birth in order to prevent the transmission of hepatitis B from mother to child. It is very important that the shots be given in opposite limbs, to ensure the highest effectiveness. Please see chart above for more information.
*Please Note: Although the U.S. CDC states that the medications can be given within the first 12 hours of life and the WHO states vaccine birth dose to be given within 24 hours, 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.
General Information About Vaccination Outside the U.S.
In developing countries the pentavalent vaccine, a combination five-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 who have hepatitis B, waiting for the first dose of the pentavalent vaccine is too late and will NOT protect the baby from mother-to-child (vertical) transmission or from being infected during the first few weeks of life through accidental household exposure from close contacts who may unknowingly be infected (horizontal transmission). Babies born to a mother who has hepatitis B have a greater than 90% chance of developing chronic hepatitis B if they are not properly treated at birth.
WHO recommends the hepatitis B vaccine within 24 hours of birth for ALL babies. Individual countries may have their own recommendations or no recommendations at all. 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 have hepatitis B.
If you are unsure of your hepatitis B status, please be sure your doctor tests you for hepatitis B. It is now recommended globally that all pregnant women get tested for hepatitis B!
For babies NOT receiving the pentavalent vaccine, the first dose of the monovalent, hepatitis B vaccine must be given within 24 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 24 hours of birth, and the second and third doses of the hepatitis B vaccine will be included in dose 1 and dose 2 of the pentavalent vaccine.
Making sure babies get the birth dose of the hepatitis B vaccine is critical to eliminating hepatitis B virus. 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, which may not be available in all countries. Talk to your doctor if you have questions.
Page updated September 2020.