* Universal vaccination refers to the administration of HBV vaccine to all infants as a part of the routine childhood immunization schedule and to all children younger than 11 or 12 years who have not previously received a vaccine. Rapid (0-, 1-, and 2-mo) and standard (0-, 1-, 6-mo) schedules have identical efficacy.
* Passive immunization refers to the administration of preformed human or animal antibody, in the form of hepatitis B immunoglobulin (HBIG), to patients after or just before exposure.
o The current recommendation for neonates of mothers who are HB s Ag positive is to administer HBIG 0.5 mL intramuscularly with the first dose of recombinant HBV vaccine within 12 hours of birth.
o After immunization, serology should be tested for HB s Ag and anti-HB s at age 9-18 months.
o In infants of infected mothers, combined treatment with the vaccine and HBIG has 79-98% efficacy in preventing chronic HBV infection.
* Patients on dialysis and those who are immunocompromised need to be evaluated annually for hepatitis B; if the anti HB s Ab level is less than 10 mIU/mL, a booster dose is recommended.
* Testing of hepatitis serology for immune response is recommended for high-risk groups such as homosexuals and bisexuals, patients on dialysis, sexual and household contacts of hepatitis B carriers and patients with human immunodeficiency virus (HIV) infection.
* After 3 primary doses of the vaccine, if no serologic response with anti-HB s of 10 mIU/ml is noted, reimmunization with a 3-dose series is recommended. If the response if still negative, they are unlikely to mount antibody with additional doses.
* Twinrix is a combination of hepatitis B (Engerix-B, 20 mcg) and hepatitis A (Havrix, 720 ELU) vaccine approved for people aged 18 years or older in a 3-dose schedule administered at 0 months, 1 month, and 6 or more months later.
* For preterm infants who weigh less than 2000 g and are born to mothers with unknown HB s Ag status, 0.5 ml HBIG should be given within 12 hours. The birth dose should not be counted, and 3 additional doses are given according to recommendations.
Author: Poonam Sharma, MD, Assistant Professor, Department of Pathology, Creighton University Medical Center and Veterans Affairs Medical Center; Director of Pathology Course, School of Pharmacy and Health Professions, Creighton University Medical Center
Coauthor(s): Meera Varman, MD, Assistant Professor, Department of Pediatrics, Section of Pediatric Infectious Diseases, Creighton University School of Medicine; Alexander T Kessler, MD, Consulting Staff, Northside Medical Specialties, LLC; Athena P Kourtis, MD, PhD, Assistant Professor, Department of Pediatrics, Divisions of Infectious Diseases and Epidemiology, Emory University School of Medicine
Updated: May 1, 2008