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The End of Hepatitis B Transmission Begins at Birth

Editor’s note: August is National Immunization Awareness Month.

Dr. Deborah Wexler

Dr. Deborah Wexler

According to the Centers for Disease Control and Prevention (CDC), the rate of acute hepatitis B virus infection in the U.S. has declined by more than 80 percent since 1990, when routine hepatitis B vaccination of babies was implemented. While this is certainly good news, there are still about a million people in the U.S. today who suffer from chronic hepatitis B virus infection.

It is also important to know that the likelihood of acute hepatitis B infection becoming chronic is higher the younger a person is when infected. Approximately 90 percent of infants who are infected will develop chronic infection; worldwide, most people with chronic hepatitis B were infected at birth or during early childhood.

This is just another reason why preventing hepatitis B virus transmission at birth is so critical, and why the Immunization Action Coalition Exit Disclaimer (IAC) launched a major campaign in July—Give Birth to the End of Hep B Exit Disclaimer—that urges the nation’s birthing institutions to adopt or strengthen their hepatitis B vaccine birth dose policies. A policy that ensures all newborns receive a dose of hepatitis B vaccine after birth provides a “safety net” to protect all newborns against potentially tragic outcomes and save lives.

Experts agree that hepatitis B can be eliminated in the U.S., and that preventing transmission at birth is essential to this effort. In fact, administering a universal birth dose of the hepatitis B vaccine is a major part of CDC’s Advisory Committee on Immunization Practices’ (ACIP) 2005 strategy to eliminate hepatitis B virus (HBV) transmission in the United States [PDF 1MB].

In 2011, the U.S. Department of Health & Human Services (HHS) echoed ACIP’s recommendations in its Action Plan for the Prevention, Care and Treatment of Viral Hepatitis [PDF 672KB]. HHS further recommended birth dose coverage as a standard of care and a national quality measure.

1 in 3 U.S. Newborns Don’t Receive Vaccine

Yet despite expert consensus on the importance of a hepatitis B vaccine birth dose, nearly one in three U.S. newborns leaves the hospital unprotected. As a result, approximately 800 U.S. newborns become chronically infected each year because of perinatal exposure.

Campaign Resources

Hepatitis BThe centerpiece of the campaign is a free, comprehensive guidebook that contains a wide range of resources to help birthing institutions establish, implement, and optimize their hepatitis B birth dose policies. This IAC publication, “Hepatitis B: What Hospitals Need to Do to Protect Newborns,” is endorsed by the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the Centers for Disease Control and Prevention.

The guidebook explains that universal hepatitis B vaccination is needed at birth because it:

  • Prevents 70–95 percent of transmission to infants born to HBsAg-positive women even when the recommended hepatitis B immune globulin (HBIG) isn’t given;
  • Prevents household transmission to infants from infected family members and other caregivers; and
  • Provides a safety net to prevent perinatal transmission when medical errors occur.

With the launch of its new guidebook and corresponding Hepatitis B Birth Dose Honor Roll Exit Disclaimer, which recognizes birthing institutions that have attained high birth dose coverage rates, IAC urges hospitals and birthing centers to Give birth to the end of Hep B Exit Disclaimer. For more information about the campaign, and to download the guidebook, visit immunize.org/protect-newborns Exit Disclaimer.

Comments

  1. Why would infants be at such a higher risk of contracting HBV than say a chronically ill ICU pt (who we don’t typically vaccinate). If the mother is screened appropriately and found to be HBV negative, why is it so critical for an infant to receive the vaccination at birth? Especially with decreasing prevalence, I wonder how much of the current HBV transmission in the US is really happening perinatally. Is there any recent data on this?

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