Coverage With Perinatal HepB Vaccine Is Low

Worldwide, only 27% of all newborns received a birth dose of hepatitis B vaccine (HepB) in 2006, and the coverage rate in countries with a high prevalence* of the infection was only 36%, according to estimates from the WHO-UNICEF Joint Reporting Form. A birth dose of the vaccine (administered within 24 hours) is intended to reduce the risk of perinatal disease by 70%-95%.

According to the CDC, HepB coverage—especially within 24 hours after birth—is hampered in endemic areas by limited access (for instance, among infants born at home in remote areas), poor training or coordination among maternal healthcare workers, inadequate delivery of the vaccine (which requires cold storage), and the use of combination vaccines (eg, the Haemophilus influenza type b and HepB vaccine), which cannot be administered at birth. In 2006, 46% of the world's infants were born in countries where chronic infection with hepatitis B virus is historically high.

The major routes of HBV transmission in infancy include maternal transmission during delivery and infection from household contacts. The risk of developing chronic HBV disease among infected infants is very high, 90%, and the risk of premature death due to cirrhosis or liver cancer (photo) with chronic HBV is 25%, according to the CDC. Perinatal infection with hepatitis B virus causes nearly one quarter of the world's 620,000 HBV-related deaths each year.

The CDC recommends vaccination with monovalent HepB in all newborns before hospital discharge and within 12 hours of birth if the mother is positive for hepatitis B surface antigen or her status is unknown. A monovalent or combination vaccine containing HepB is administered at 1-2 months of age, and a final dose is given at 6 months of age or later.

HBV = hepatitis B virus; UNICEF = United Nation's Children's Fund; WHO = World Health Organisation.

* Defined as ≥8% in the general population and includes 87 countries: 45 in Africa; 23 in the Western Pacific; 10 in Europe; 5 in Southeast Asia; and 4 in the Eastern Mediterranean. 

Photo of Cambodian woman with hepatocellular carcinoma due to chronic HBV infection from the CDC.