Newborn Vaccine Recommendations
All medically stable newborns should receive hepatitis B vaccine before hospital discharge, ideally within the first 24 hours of life. 1
Hepatitis B Vaccine at Birth
Administer monovalent hepatitis B vaccine to all newborns prior to hospital discharge. 1 This is the only vaccine routinely recommended at birth for healthy term infants.
Timing Based on Maternal HBsAg Status
If mother is HBsAg-negative: Administer hepatitis B vaccine before discharge; the birth dose can only be delayed with physician's order and documented negative maternal HBsAg laboratory report 1
If mother is HBsAg-positive: Administer both hepatitis B vaccine AND 0.5 mL hepatitis B immune globulin (HBIG) within 12 hours of birth at separate sites 1, 2
If mother's HBsAg status is unknown: Administer hepatitis B vaccine within 12 hours of birth; determine maternal HBsAg status as soon as possible and administer HBIG no later than age 7 days if mother tests positive 1
Critical Timing Considerations
The birth dose must be given within 12 hours when maternal HBsAg status is positive or unknown, as delaying beyond 24 hours significantly reduces effectiveness in preventing vertical transmission. 2 This early administration provides crucial protection against perinatal transmission and household exposure to chronic HBV carriers. 1
Special Populations
Premature infants ≥2,000 g (4.4 lbs) and medically stable: Should receive hepatitis B vaccine before hospital discharge 1
Premature infants <2,000 g born to HBsAg-negative mothers: Current recommendations suggest delaying the first dose until the infant reaches 2,000 g or 2 months of age, as infants <1,700 g have significantly lower seroprotection rates (52-68% vs 84% in larger infants) 3
Premature infants <2,000 g born to HBsAg-positive mothers: Must receive hepatitis B vaccine and HBIG within 12 hours of birth regardless of weight 1
Subsequent Vaccine Schedule (Not Given at Birth)
The following vaccines begin at 6 weeks to 2 months of age, NOT at birth:
- DTaP (Diphtheria, Tetanus, Pertussis): Minimum age 6 weeks; typically given at 2,4,6 months 1, 4
- Hib (Haemophilus influenzae type b): Minimum age 6 weeks; typically given at 2,4,6 months 1, 5
- IPV (Inactivated Poliovirus): Minimum age 6 weeks; typically given at 2,4,6-18 months 1
- PCV (Pneumococcal Conjugate): Minimum age 6 weeks; typically given at 2,4,6 months 1
- Rotavirus: Minimum age 6 weeks; first dose between 6-12 weeks 1
Common Pitfalls to Avoid
- Never delay hepatitis B vaccine in newborns of HBsAg-positive or unknown status mothers - this is a critical error that can result in chronic HBV infection 2
- Only monovalent hepatitis B vaccine can be used for the birth dose - combination vaccines are not licensed for birth administration 1
- Do not administer other routine childhood vaccines at birth - they have minimum ages of 6 weeks and should begin at the 2-month visit 1, 4