Preventing Hepatitis B in

1 Newborns: What’s Needed

Hepatitis B: What Hospitals Need to Do

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to Protect Newborns – Executive Summary

Measuring Hepatitis B Vaccination for Newborns

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Prior to Hospital Discharge Is Endorsed by the

National Quality Forum (NQF)
Hepatitis B:
What Hospitals Need to Do to Protect Newborns
Background on Hepatitis B
• Hepatitis B is a liver disease caused by the hep-
atitis B virus (HBV). HBV is found in the blood
and certain body fluids (such as serum, semen,
saliva, and vaginal secretions) of people
infected with the virus. An infected mother can
transmit HBV to her baby at birth. An infant can
also acquire HBV from a chronically infected
member of their household.
• HBV can cause acute infection and chronic
infection. Approximately 90% of children who
are infected at birth or during the first year
of life will become chronically infected; only
4% of newly infected adults become chronically
infected.
• Most morbidity (e.g., liver cancer and liver fail-
ure) and mortality from HBV occurs in people
with chronic HBV infection. Thus, the primary
goal of administering hepatitis B vaccine at
birth (i.e., the “birth dose”) is the first step to
prevent chronic HBV infection.
• Post-exposure prophylaxis of newborns born to
chronically infected mothers is 85%–95% effec-
tive when administered within 12 hours of birth.
Timing of the birth dose is critical to achieve the
highest rates of protection. Prophylaxis consists
of hepatitis B vaccine along with hepatitis B
immune globulin (HBIG). Hepatitis B vaccine
alone starting at birth will prevent transmission
of the virus in 70%–95% of infants born to
chronically infected mothers.
The Problem
• Each year in the United States, more than 24,000
infants are born to mothers who are chronically
infected with HBV. If none of these infants were
to receive prophylaxis at birth, it is estimated
that almost 10,000 would become chronically
infected with HBV, and 2,500 would eventually die
of liver failure or liver cancer as early as the sec-
ond decade of life.
Hepatitis B:
What Hospitals Need to Do to Protect Newborns
Executive Summary
• All infants of HBV-infected mothers should be
reported to their local health department for
case management to ensure timely completion
of the vaccination series and resulting protec-
tion; however, only about half of the 24,000
infants are reported.
• Although most infants could be protected if
hospitals routinely provided a dose of hepatitis
B vaccine to all newborns, the most recent
CDC survey found that only 70% of U.S. infants
received a dose of hepatitis B vaccine within
What’s Needed
3 days of birth.
• Based on average rates of newborn hepatitis B
vaccination in hospitals and on vaccine efficacy,
CDC estimates that more than 800 newborns
become chronically infected with HBV each year.
The Hospital’s Role
Preventing Hepatitis B in Newborns
• All hospitals should implement the recom-
mended “universal birth dose policy” to ensure
that every newborn receives the first dose of
hepatitis B vaccine at birth, or no later than hos-
pital discharge. This will provide a safety net
to prevent HBV infection for any at-risk newborn,
including infants not identified because the
mother did not receive prenatal care; because
of errors made by healthcare professionals in
ordering, recording, or communicating lab tests
results to determine a mother's hepatitis B status;
or because of exposure to chronically infected
members of the household (many people do not
know they are infected).
• All hospitals should follow national recommen-
dations for prophylaxis of newborns born to
women with chronic HBV infection.
See pages 41–74 of this booklet for the recom-
mendations of CDC’s Advisory Committee on
Immunization Practices titled A Comprehensive
Immunization Strategy to Eliminate Transmission of
Hepatitis B Virus Infection in the United States.
7
www.immunize.org/protect-newborns
Measuring Hepatitis B Vaccination for Newborns
Prior to Hospital Discharge Is Endorsed by the
National Quality Forum (NQF)
The National Quality Forum (NQF) is a widely facility during given time period (one year),” exclud-
looked to standards-setting organization for health- ing infants whose parents refuse vaccination.
care facilities. In response to a submission by the
Hospitals that adopt this measure will be taking
Centers for Disease Control and Prevention, the
an important step to ensure that no baby born to
NQF endorsed as a standard the reporting of “Hep-
an HBsAg-positive mother slips through the
atitis B Coverage Among All Live Newborn Infants
cracks and becomes infected.
Prior to Hospital or Birthing Facility Discharge.”

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For more information on the NQF hepatitis B
Specifically, NQF Measure #0475 recommends that
birth dose endorsement, visit www.quality
hospitals measure and report the “percent of live

What’s Needed
forum.org/MeasureDetails.aspx?actid=0&
newborn infants that receive hepatitis B vaccination
SubmissionId=287#k=0475.
before discharge at each single hospital / birthing

Preventing Hepatitis B in Newborns

Hepatitis B: 8
What Hospitals Need to Do to Protect Newborns www.immunize.org/protect-newborns