Hepatitis B immunisation is not offered routinely to infants in the UK despite the World Health Organization recommendation in 1992 that all countries should introduce universal hepatitis B vaccination into their immunisation schedules by December 1997.
UK guidelines recommend that all pregnant women should be offered screening for hepatitis B infection during each pregnancy and all babies born to infective mothers should receive a complete course of vaccine.
If mothers are chronically infected with Hep B or have had an acute hepatitis B infection during pregnancy the infection can be transmitted to their babies at or around the time of birth. These babies have a high risk of becoming chronically infected with the virus and this can be prevented in over 90% of cases by appropriate vaccination, starting at birth.
Most Asian countries have a very high prevalence of Hepatitis B infection and travellers to areas of high or intermediate prevalence may be at increased risk. This will include children who may require medical care while travelling to visit families or relatives in high or moderate-endemicity countries. If such travel is likely to occur, completion of the baby's immunisation schedule is a sensible precaution.
Usual schedule for hepatitis B immunisation in infancy
- The first dose is given with 2 days of birth
- Second dose is given at 1 month old
- Third dose is given at 2 months old
- Booster dose and blood test are given at 12 months old
The evidence suggests that the immunity acquired after vaccination lasts for life.
These immunisations are all included within the global sum and the cost of the vaccine to complete the immunisation may be charged to the PPA on FP 34D.
Further information on Hepatitis B Immunisation may be found on the Green Book which is available at www.dh.gov.uk/greenbook
Footnote
World wide prevalence
The prevalence of HBV infection varies markedly but overall approximately 45% of the global population live in areas of high chronic HBV prevalence.
In sub-Saharan Africa, the Pacific, and particularly Asia, HBV infection is endemic, with the majority of individuals becoming infected during childhood.
Outside of the endemic areas, regions with high rates of chronic HBV infection include the southern parts of Eastern and Central Europe, the Amazon basin, the Middle East, and the Indian subcontinent.
In western and northern European countries and North America, HBV infection is relatively rare and acquired primarily in adulthood.
What do I do if a baby arrives with an incomplete Hepatitis B immunisation schedule?
The local Health Protection Unit has advised that only those immunisations included in the UK's routine infant immunisation schedule should be given at public expense. They argue that a baby that has received any routine immunisations would have a greater degree of immunity than most British babies. If you subscribe to this view then the baby should be referred to a private practitioner for immunisation. You may not charge the patient yourself for providing this service.
You may, however, choose to complete the immunisations under the NHS if you believe this is in the best interests of your patient.
Before refusing to complete the schedule it is essential to check that the immunisation was, in fact, purely routine and was not given to the baby because the mother or another close family member was infected with Hepatitis B. If this is the case then it is essential that the baby completes the course of immunisation.
CED 09/04/09
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