Hepatitis B infection prevention: ACIP updated recommendations

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The new recommendations include removal of permissive language for delaying the birth dose until after hospital discharge.
The new recommendations include removal of permissive language for delaying the birth dose until after hospital discharge.

The Advisory Committee on Immunization Practices (ACIP) has issued updated recommendations for the prevention of hepatitis B virus infection.

The new recommendations include:

  • Universal hepatitis B (HepB) vaccination within 24 hours of birth for medically stable infants weighing ≥2,000 grams
  • Testing HBsAg-positive pregnant women for hepatitis B virus deoxyribonucleic acid (HBV DNA)
  • Postvaccination serologic testing for infants whose mother's HBsAg status remains unknown indefinitely (e.g., when a parent or person with lawful custody surrenders an infant confidentially shortly after birth)
  • Single-dose revaccination for infants born to HBsAg-positive women not responding to the initial vaccine series
  • Vaccination for persons with chronic liver disease
  • Removal of permissive language for delaying the birth dose until after hospital discharge

ACIP's Hepatitis Work Group conducted a review of pertinent literature and directed an economic analysis as part of the process. The guidelines of the American Association for the Study of Liver Diseases (AASLD) were used as a reference to inform the use of antiviral therapy among pregnant women.

The draft recommendations were authored during multiple teleconferences held by the Work Group between February 2016 and February 2017. This draft was voted on by members of ACIP and subsequent modifications were made during the review process at the Centers for Disease Control and Prevention (CDC), to clarify wording in the report.

The two single-antigen vaccines recommended in the U.S. are Engerix-B (GlaxoSmithKline) and Recombivax HB (Merck), and are used for the vaccination of persons starting at birth. Of the two combination vaccines, Pediarix (GlaxoSmithKline) is for the vaccination of persons aged 6 weeks–6 years and contains recombinant HBsAg, diphtheria and tetanus toxoids and acellular pertussis adsorbed, and inactivated poliovirus. Twinrix (GlaxoSmithKline) is for the vaccination of persons aged ≥18 years and contains recombinant HBsAg and inactivated hepatitis A virus. 

In addition, the FDA recently approved a new hepatitis B vaccine, Heplisav-B (hepatitis B vaccine [recombinant], adjuvanted) for the prevention of infection caused by all known subtypes of hepatitis B virus in adults aged ≥18 years.

Reference

Schillie S, Vellozzi C, Reingold A, et al. Prevention of hepatitis B virus infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2018;67. DOI: http://dx.doi.org/10.15585/mmwr.rr6701a1

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