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Infectious Diseases in Clinical Practice:
doi: 10.1097/IPC.0b013e31822b7dda
Review Articles

Routine Newborn Hepatitis B Immunization: A Review of Schedules

Thisyakorn, Usa MD*; Montellano, May MD†; Lane, Andrew BSc, MPhil, PhD‡

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This article reviews the arguments for a hepatitis B vaccination schedule at birth and at 1 month and 6 months of age. Vertical transmission is a major route of hepatitis B infection and in 2009 the World Health Organization stated that "All infants should receive their first dose of hepatitis B vaccine as soon as possible after birth, preferably within 24 hours." Administering the second dose 1 month after the birth dose counters risk of infection and minimizes risk of chronic carriage. The risk of developing chronic hepatitis B infection is almost four times higher in infants with an interval of more than 10 weeks between the first 2 doses than in infants with intervals of less than 10 weeks. Administering the second dose at age 1 month also promotes the achievement of protective antibodies at an early age. The interval between the second and third doses impacts on hepatitis B antibody concentrations after the third dose: shorter intervals (eg, third dose at 2 months of age) results in linear response kinetics, whereas administration at 6 months of age results in an anamnestic response. The World Health Organization considers the birth dose mandatory regardless of hepatitis B endemicity, and the second dose given 1 month later reduces the risk of chronic carriage in high-risk newborns. Finally, at least 4 months between the last 2 doses is important to ensure longer-term protection.

© 2011 Lippincott Williams & Wilkins, Inc.

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