Indications for accelerated Hepatitis B vaccination
- All babies whose mothers have a history of past or present hepatitis B. Some will also require Hepatitis B immunoglobulin
see next section for indications for Hepatitis B immunoglobulin.
NB babies born to a mother who is negative for hepatitis B but who will subsequently be living with another individual who is positive for Hepatitis B should get a single dose of monovalent Hepatitis B vaccine at birth but should otherwise follow the routine childhood vaccination schedule
Monovalent Preparation - Only Engerix B (0.5ml) or HBVaxPRO (0.5ml) to be used.
Schedule – Two doses of monovalent Hepatitis B vaccine should be given, at birth and at 4 weeks of age. The first dose is to be given as soon as possible after birth (within 24 hrs of delivery at the latest). Subsequent to this, infants born on, or after, the 1st Aug 2017 should be offered Infanrix Hexa vaccine according to the normal childhood schedule outlined above. This will involve 3 doses of the Hexavalent vaccination at 8, 12 and 16 weeks of age.
A booster, using the monovalent vaccine, will be given at 1yr of age at the same time as the Hib /MenC booster vaccination.
Preterm babies follow the same schedules with no correction for their prematurity.
For infants born to mothers infected with Hepatitis B, serology is required at 1yr of age, on the day of the booster vaccinations, to determine whether vaccination has successfully prevented infection with Hepatitis B.
Hepatitis B in the Immunisation schedule for routine childhood and selective neonatal hepatitis B programmes following the introduction of the Infanrix hexa®

Local arrangements for serology – GG&C
This is arranged by the GP, with a reminder to them from public health if the postnatal notification form (see appendix) has been completed and returned.
Reporting - Women who are surface antigen positive on antenatal screening will have been reported to Public Health prior to delivery who will in turn inform the Obstetricians. All immunised infants, low or high risk, must be reported to the Community Screening Department to ensure adequate follow-up. Notification forms (see appendix) should be scanned and emailed to the Community Screening Department, and the original stored in the baby’s notes, as soon as possible after vaccination/immunoglobulin administration. Please note that where there is uncertainty about a baby’s final discharge address or carer (i.e. when there is consideration of foster care etc) at the time of vaccination then it is better to send the form with the current maternal details in place to Public Health. Delaying sending the form until such details are complete can cause delays and confusion- the CHI number allows effective tracking of the baby through public health systems.
Antenatal testing process.
Please refer to the obstetric guidelines page for full details.
In summary hepatitis B testing is offered as part of routine booking bloods to all pregnant women. In the event of a positive result the Regional Virus Laboratory will inform the patient’s obstetrician and a named link obstetrician by letter. This letter will give recommendations for vaccination +/- immunoglobulin administration depending on the maternal serology (predominantly based on e antigen and antibody status at this point). The named obstetrician will also record these recommendations on the neonatal alert section of the maternal notes.
At 26 weeks gestation all of those that had tested positive on booking bloods will have further bloods taken by their obstetrician for HBV DNA levels. Following this the recommendation for neonatal treatment of the baby may change (if the HBV DNA level is ≥200,000 IU/mL (≥ log 5.3) but initial serology was anti-HBe positive). The named link obstetrician will amend the initial virology letter and the neonatal alert sheet with this information ensuring that up to date and accurate information is available to the neonatal team at delivery.
Notes - In viral infections the presence of virus indicates ongoing infection and the detection of specific antibody indicates previous infection. Following hepatitis B infection, 90% of individuals clear the virus, become immune and are not infectious to others. These patients do not have detectable circulating virus (hepatitis B surface antigen (HBsAg) negative) but have antibody against hepatitis B core antigen (anti HB core positive). Note that immunisation stimulates antibody against HBsAg (anti HBs) but not against HBcore antigen (anti HB core negative). A small minority of those infected by hepatitis B virus remain carriers of the virus and are HBsAg positive. If the hepatitis B e-antigen (HBe antigen) is positive, this means that the patient has viral protein associated with a high rate of transmission. Babies of women who are infectious carriers may be infected at delivery (or rarely during pregnancy). Perinatal infection has a much higher risk of carrier status, more common among people born in endemic areas such as South East Asia.
Hepatitis B virus can also be transmitted through intravenous drug use or sexual intercourse. These transmission routes are less likely to result in carrier status. Babies of non-infectious women are not at risk of vertical transmission but other members of the family may be carriers and the mother’s immunity may indicate a high-risk environment in which the baby may be infected at a later date.
The risk of perinatal transmission can be reduced by administration of hepatitis B immunoglobulin (HBIg) at birth together with a course of active immunisation (HB vaccine). Environmental infection can be avoided by active immunisation commenced at birth, but in this situation, HBIg is not required. (See indications for Hep B Immunoglobulin – next section)