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Routine Newborn Hepatitis B Immunization: A Review of Schedules

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

Infectious Diseases in Clinical Practice: September 2011 - Volume 19 - Issue 5 - p 326-331
doi: 10.1097/IPC.0b013e31822b7dda
Review Articles

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.

From the *King Chulalongkorn Memorial Hospital, Bangkok, Thailand; †Mary Chiles Hospital, Manila, Philippines; and ‡Sanofi Pasteur, Lyon, France.

Correspondence to: Andrew Lane, BSc, MPhil, PhD, Global Medical Affairs, Sanofi Pasteur, 2 avenue Pont Pasteur, 69007, Lyon, France. E-mail:

This article was written with the financial support of Sanofi Pasteur, Lyon, France.

Usa Thisyakorn and May Montellano have acted as principal investigators for clinical trials sponsored by Sanofi Pasteur but received no payment for their involvement in the development of this article. Andrew Lane is an employee of Sanofi Pasteur.

An abstract of this article was presented as a poster at the Fifth Asian Congress of Pediatric Infectious Diseases, Taipei, Taiwan, September 23-26, 2010.

© 2011 Lippincott Williams & Wilkins, Inc.