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August 1, 2001

Hepatitis B Vaccination for Newborns—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor

JAMA. 2001;286(5):535-536. doi:10.1001/jama.286.5.535

In Reply: Dr Cantekin and Mr Belkin question the importance of initiating routine HBV vaccination at birth, a practice whose benefits we described recently.1 They are correct that some behaviors rendering people at high risk for HBV do not begin until adolescence or adulthood. However, a lower but nevertheless substantial incidence of HBV infection affects individuals, including adults and children, who do not engage in these high-risk behaviors.2 Furthermore, there are at least 4 benefits to newborns of HBV-infected mothers. First, it eliminates confusion in birthing units regarding the need for immediate immunization of newborns of mothers whose hepatitis surface antigen status is positive or unknown, thereby avoiding irretrievable missed opportunities to interrupt vertical transmission, which can have tragic consequences.3,4 Second, rendering children immune to HBV in early infancy provides protection against the small but measurable incidence of HBV infection that is acquired horizontally during childhood. Third, initiation of the 3-dose series at birth has been associated with a higher likelihood of on-time receipt of the entire series of HBV vaccinations,5,6 and of unrelated immunizations, such as diphtheria, tetanus, pertussis vaccine; inactivated poliovirus vaccine; and measles, mumps, rubella vaccine.5 Fourth, immunization during infancy with integration into a schedule with other vaccinations has the best chance for high coverage and protection for most US children when the burden of disease increases sharply beginning in adolescence. Such a strategy has paid great dividend in the case of rubella immunization.