Test Hepatitis B Vaccine Response Earlier in Infants, CDC Says

Pam Harrison

October 09, 2015

Physicians should request postvaccination serologic testing (PVST) for infants born to hepatitis B–infected mothers between 9 and 12 months of age, the Centers for Disease Control and Prevention says in an updated recommendation.

The recommendation, published in the October 9 issue of the Morbidity and Mortality Weekly Report, shortens the interval between vaccination and PVST. Previously, the recommended timing was from 9 to 18 months of age.

Sarah Schillie, MD, from the Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues note that infants born to hepatitis B–infected mothers should receive postexposure prophylaxis within 12 hours of birth, including hepatitis B (HepB) vaccine and hepatitis B immune globulin. The prophylaxis has been shown to reduce infants' risk for perinatal hepatitis B (HBV) infection.

The updated recommendations state that PVST, including tests for hepatitis B surface antigen (HBsAg) and antibody to HBsAg (anti-HBs), should be performed between the ages of 9 and12 months, or 1 to 2 months after the vaccine series is completed.

"This recommendation was prompted by the discontinuation of the Hib/HepB vaccine (Comvax) and new data from the Enhanced Perinatal Hepatitis B Prevention Program supporting PVST 1–2 months after receipt of the last HepB vaccine dose, and at age ≥9 months," the authors write.

For infants born to HBsAg-positive mothers who are HBsAg negative and have an adequate response to the vaccine, PVST will show anti-HBs levels ≥10 mIU/mL. In contrast, infants whose anti-HBs levels are below 10 mIU/mL require revaccination with a second 3-dose HepB vaccine series. These infants should also be retested for anti-HBs 1–2 months after completing the vaccine series.

The authors note that PVST before the age of 9 months should be avoided, as earlier testing could detect the anti-HBs from hepatitis B immune globulin administered at birth.

"For most infants born to HBsAg-positive mothers, PVST at age 9–12 months provides opportunities for testing at two well-child visits," the authors note. "An added benefit of a shortened interval to PVST is a reduction in the period during which nonresponders are at risk for transmission from close contacts with HBV infection," they add, and it "might also increase adherence with recommendations for timely completion of PVST and conserve public health resources."

"Postvaccination seroprotection is achieved in 98% of healthy full-term infants who received a 3-dose or 4-dose HepB vaccine series, although it is lower among infants with birthweights <4.4 lbs."

Morb Mortal Wkly Rep. 2015;64:1118-1120. Full text

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