January 26, 2012

Amidst the many changes surrounding the birth of a child, the family must make an important decision before leaving the hospital regarding the birth dose of hepatitis B vaccine. Many infants still aren’t receiving it, and new data shed some light on why that may be.

The birth dose of hepatitis B vaccine (HBV) is recommended by both the American Academy of Pediatrics and the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices as a way of making sure that all infants of potentially infected mothers are covered.

By Dr. Christopher J. Harrison

This is important because approximately 90% of neonatal infections result in chronic hepatitis B infection. In contrast, only 10% of adult-acquired hepatitis B infections become chronic. Also, at the time of delivery in the real world, we don’t always have results for maternal hepatitis B testing from prenatal visits, and even when early prenatal results are available, results could have changed by the time of delivery.

In 2005, ACIP recommended the implementation of policies as well as procedures, laws, and regulations for birthing hospitals to ensure that all medically stable infants of HBsAg-negative mothers weighing more than 2,000 g at birth receive a birth dose of HBV before discharge from the newborn nursery (MMWR Recomm. Rep. 2005;54[RR-16]:1-23).

(Separate recommendations are given for premature infants weighing less than 2,000 g at birth. There is some confusing language in the AAP’s Red Book, and I’ll address that later in this column.)

In a retrospective cohort study of 64,425 infants born in Colorado in 2008, more than a third (38%) did not receive a birth dose of HBV (Pediatr. Infect. Dis. J. 2012;31:1-4). Of note, the proportion of infants who did not receive the birth dose increased as household income increased, with 46% of babies in households with annual incomes greater than $75,000 not receiving it, compared with just 27% of infants whose mothers reported incomes less than $15,000 per year.

The investigators also found that newborns of mothers with more education were less likely to receive the birth dose. Compared with those whose mothers had an eighth-grade education or less, those whose mothers had a bachelor’s degree, master’s degree, or doctorate/professional degree were 38%, 66%, and 51% less likely, respectively, to receive a birth dose.

Although the study could not evaluate the reasons for nonreceipt of HBV, the pattern is essentially the same as in mothers whose children have purposeful delays or who don’t receive other recommended vaccines. This surprised me a bit, although I guess it shouldn’t have. I expected to see more evenly distributed proportions across all socioeconomic groups for nonreceipt of HBV.

Hospital policy made a difference, too, the researchers found. Not surprisingly, infants born at facilities that did not offer HBV to all newborns before discharge were the least likely to receive it. Compared with infants born in hospitals that had a birth dose policy, those born in hospitals that had no policy were 39% less likely to receive it. Infants born in hospitals that had a policy to review maternal hepatitis B status but not to offer HBV to all newborns were more than twice as likely not to receive the birth dose.

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