Guidance

Hepatitis B vaccine for at-risk infants: aide memoire

Updated 9 April 2025

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Each year, around 2,500 babies are at risk of developing hepatitis B infection following exposure to the hepatitis B virus (HBV) from their mother’s blood during childbirth. It is important to ensure the baby is promptly registered at the surgery and the vaccine ordered in good time.

The selective neonatal hepatitis B programme is for babies who are at risk of hepatitis B infection. These babies will receive 6 hepatitis B-containing vaccines.

Hepatitis B vaccine should be prioritised for these infants as it can prevent infection in over 90% of babies if given on time. Timely vaccination is critical to preventing chronic infection in infants.

The first monovalent dose should be given within 24 hours of birth.

The second monovalent dose of vaccine needs to be given to the infant promptly at 4 weeks of age. It is important to ensure the baby is registered at the surgery as soon as possible and the vaccine ordered in good time.

The third, fourth and fifth doses of hepatitis B-containing vaccine are given to all babies at 8, 12 and 16 weeks at their routine immunisation appointments. This is contained within the hexavalent vaccine which will also protect against other serious infections including diphtheria, tetanus, polio, whooping cough and haemophilus influenzae type B.

The final dose of monovalent hepatitis B vaccine should be given when the baby reaches one year of age. This dose can be given at the same time as their other routine vaccines.

Testing for infection hepatitis B surface antigen, (HBsAg) is vital and should be done at the same time as their 12-month dose of monovalent hepatitis B vaccine.

Take a Dried Blood Spot (DBS). This is the preferred method as this is a free service, can be completed during a routine practice nurse appointment and results are accompanied by appropriate advice. Alternatively refer to paediatric phlebotomy services, ensuring the child is tested for infection (HBsAg), not immunity. UKHSA provides DBS kits. Your local Screening and Immunisation Team can advise on how to request DBS kits if you are unsure.

Checklist

Individuals living with hepatitis B who are pregnant

When pregnant women attend for vaccination during pregnancy

  • flag the notes of all pregnant women with hepatitis B, noting their due date (to schedule follow-up of the baby shortly after birth and to ensure the monovalent hepB vaccine dose is ordered ready for 4-week dose)
  • at every contact during pregnancy, remind the pregnant woman of the importance of ensuring baby is registered with the surgery as soon as possible after birth to enable the 4-week monovalent hepB vaccine dose to be administered on time
  • information about hepatitis B and the vaccination programme should be given to the pregnant woman, supported by leaflets such as Protecting your baby against hepatitis B

When baby is registered

  • check to ensure baby received their birth dose. Notify your local Screening and Immunisation Team if this has been missed
  • order the monovalent hepB vaccine dose directly from the supplier as soon as possible (details are in hepatitis B: the green book, chapter 18)
  • advise parents of the importance of timely vaccination and book 4-week monovalent hepB vaccine appointment on time
  • practice reimbursement for the monovalent hepB dose can be claimed from NHS Business Services Authority
  • at each appointment, schedule the next appointment (if not already done so) and advise parents of the importance of continuing the hepB vaccination programme through all the routine hexavalent vaccines (due at 8, 12 and 16 weeks) as well as final monovalent dose and the DBS test to check for infection at one year of age
  • record details of each vaccine dose in the GP system and child’s Red Book
  • take a DBS test (or venous blood sample) to check for infection (HBsAg) when the infant is one year of age. Information on the free DBS testing for infants service is available
  • if test results indicate the child has hepatitis B infection, refer immediately to a liver specialist
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