Hep B Vaccine in the Newborn

[MikeyBSN]

I noticed that they are giving newborns Heb B a few hours after birth. Why are we giving a vaccine to a child before it has an immune system? I mean, I suppose there might be some response, but it just doesn't make much sense to me. Is there anyone who works the nursery who knows the justification for this?

[wish_me_luck, BSN, RN]

I am not positive, so don't quote me on this. But, I think it had something to do with mothers not disclosing if they were hep B positive and just to cover everything, they started doing it. Again, I am not positive. :-/

[AnonRNC]

Personally, I think it's weird and my kids didn't start the Hep B series until they were older babies. BUT I was well-aware of my own Hep B status (negative).

Professionally, Hep B bites and if a mom is Hep B+ the baby needs the Hep B vax AND HBIG (immune globulin). If the mom's status is at all questionable (and whose isn't - very few of us), giving the baby the vax now can be protective. Hep B is transferred via breastmilk.

If you doubt the "questionable" Hep B status, consider the newborn eye prophylaxis administered in many states. As a married monogamous woman who previously tested without disease, my babies were probably at very low risk for blindness due to maternal STD....but ONE dose to prevent blindness? It's worth it to me.

Risk vs. Benefit...EVERYTHING we do is risk vs. benefit.

[klone, MSN, RN]

Hep B is transferred via breastmilk..

Actually it's not. There is no evidence of vertical transmission of HBV through breastmilk and all organizations, including WHO recommend breastfeeding, even if the mother has HBV infection. The only time breastfeeding is temporarily stopped is if there are visible cracks on the nipples or frank bleeding.

[eden]

I'm not sure the reasoning, it's not given here until school. If a primary caregiver is hep B positive it is given at birth.

[AnonRNC]

Thanks for pointing that out. I was going on old information that said breastfeeding was contraindicated for "active Hep B infection." You are correct: the current CDC & WHO recommendations are to breastfeed (and vaccinate).

[klone, MSN, RN]

No prob. I'm an IBCLC, so it's my job to keep up-to-date on breastfeeding recommendations. :)

[CTRN1]

The reason I was given for why we start the series at birth is because the vaccine's follow-up doses fall in line with the newborn visits and it can be combined with other vaccines they give. If they wait until the child is older, the parent is much less likely to bring the child in for the 2+3rd doses either from forgetting or not having insurance coverage for a misc visit. Most people bring their newborns in regularly so they can ensure they get all the doses in. In CT it is a mandatory vaccine now for school admission.

I don't necessarily agree, but this is what we were told.