Single-dose HepB Infant Re-Vaccination Recommendation

At its February 2017 meeting, the Advisory Committee on Immunization Practices (ACIP) voted to approve revised language for its recommendation on re-vaccinating unprotected infants who are born to HBsAg-positive mothers, with hepatitis B (HepB) vaccine.

The ACIP’s amended revised language reads:

• HBsAg-negative infants with antibody to HBsAg (anti-HBs) less than 10 mIU/mL should be revaccinated with a single dose of HepB vaccine and receive post-vaccination serologic testing (PVST) one to two months later. Infants whose anti-HBs remains less than 10 mIU/mL following single-dose revaccination should receive two additional doses of HepB vaccine, followed by PVST 1 - 2 months after the last dose.

• Based on clinical circumstances or family preferences, HBsAg-negative infants with anti-HBs less than 10mIU/mL may instead be revaccinated with a second complete three-dose series, followed by PVST performed 1-2 months after the final dose of the vaccine.

• Available data do not suggest a benefit from administering additional HepB vaccine doses to infants who have not attained anti-HBs greater than or equal to 10mIU/mL following receipt of 2 complete three-dose HepB vaccine series.

According to health experts, the ACIP is focused on minimizing vaccine exposure in children and reducing the time frame when a child is released from case management

Margot Savoy, M.D., M.P.H., told AAFP News, "Ideally, the ACIP's recommendation is to use the least number of shots possible to get the best coverage for the child. If the infant's serologic test is still negative and they're covered by the hepatitis B vaccine, you are done. If you are worried the child is a nonresponder at the end of their serologic testing, you can re-immunize with the three doses, which you would do anyway."

Dr. Savoy added, "if a family wanted to do the full course of six doses, that's still acceptable, but is no longer the default option.”

Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease. The virus is transmitted through contact with the blood or other body fluids of an infected person.

Transmission of hepatitis B virus (HBV) from mother to infant during the perinatal period represents one of the most efficient modes of HBV infection and often leads to severe long-term consequences.

Infants born to mothers positive for hepatitis B surface antigen (HBsAg) and hepatitis B "e" antigen (HBeAg) have a 70%-90% chance of acquiring perinatal HBV infection and 85%-90% of infected infants will become chronic HBV carriers.

It has been estimated that more than 25% of these carriers will die from primary liver cell carcinoma or cirrhosis of the liver.

The current CDC vaccine price list can be found here.

No conflicts of interest were disclosed by the ACIP.