HepB Vaccine for Newborn

[joannayang]

Hello, our baby is being delivered via scheduled c-section on Thursday at 37w1d due to placenta complications. I am filling out the pre-paperwork and have agreed to Vitamin K, eye ointment, but the HepB vaccine is giving me pause. Let me be clear, my baby WILL get the HepB vaccine. However, at 3 weeks early, I am concerned about risks associated with administering the vaccine before full-term. I have read research that indicates delay of HepB until the baby has grown a bit. I also read that the recommended aluminum exposure is 17 micrograms while the HepB shot contains 250 micrograms. Our doula is pushing hard to delay, but when I asked for her sources she sent me an instagram reel from Candice Owens

That said, I know HepB is highly contagious. My husband and I are not carriers. What we do not know, and cannot know, is carrier hospital staff caring for our baby. I’m looking for some research and reassurance that we should proceed with the vaccine — or documented non conspiracy theory research that we should delay until our baby has reached 40 weeks.

Just as a general note, we’re highly pro vaccine. I work in pharma myself and got the RSV shot a few weeks ago and two iron infusions to reduce my risk of blood transfusion at birth. I don’t want to in any way come across as an anti-vaxxer. Thanks!

 

[sarebear1992]

@joannayang The American academy of pediatrics strongly recommends the HepB vaccine for all babies, and especially those born premature (which your child is not). To be clear: 37+1 is considered a full term birth—mine was born at 37+2 . I’m not sure what research you’re referring to, but please trust the medical professionals and get your LO vaccinated at birth.

https://www.healthychildren.org/Eng...s/Pages/Immunizations-For-Preterm-Babies.aspx

Note: The AAP recommends that all medically stable preterm babies with a minimum birth weight of 2000 grams (about 4 lbs., 6 oz.) be treated like full-term babies and receive the first dose of the hepatitis B immunization according to the recommended childhood immunization schedule. If birth weight is less than 2000 g, the AAP recommends administering the hepatitis B vaccine at one month of age or at the time of discharge from the hospital – whichever comes first.

https://www.healthychildren.org/Eng...epatitis-b-vaccine-what-you-need-to-know.aspx

 

[deborahallen]

@sarebear1992 37+1 is early term. OP did say "before term", not that baby is preterm. I'm not disagreeing with the other things you mentioned - just wanted to clarify what she said.

 

[sarebear1992]

@deborahallen They are still considered term. They are not “before term”. Pre means before. 37 weeks is not before or pre term. Even if called early term, that’s still within term for a pregnancy (in other words early term is still within the term family). It’s not considered before pre-term.

https://www.nhs.uk/pregnancy/week-by-week/28-to-40-plus/37-weeks/.

“At 37 weeks, your pregnancy is considered full-term.”

 

[deborahallen]

@sarebear1992 Apparently it depends who you ask. I'm a nicu nurse and we use more precise categories for gestational ages in my area:

"These sub-categories are: early term (37 0/7 weeks of gestation through 38 6/7 weeks gestation); full term (39 0/7 weeks of gestation through 40 6/7 weeks of gestation); late term (41 0/7 weeks of gestation through 41 6/7 weeks of gestation); and, post term (42 0/7 weeks of gestation and beyond)"

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5139808/#:~:text=These%20sub%2Dcategories%20are%3A%20early,weeks%20of%20gestation%20and%20beyond).

 

[sarebear1992]

@deborahallen They’re still not considered premies or premature babies. 37 weekers don’t get adjusted age. OBs schedule these c sections and inductions at 37 weeks because the baby is still considered within term.

As the article you cite acknowledges, “a 2012 international stakeholder working group recommending sub-categorisation of term birth to more accurately describe deliveries and their outcomes.” But 37 weeks is still within the term category.

 

[deborahallen]

@sarebear1992 Right. But OP didn't say they are.

 

[sarebear1992]

@deborahallen She seems to think her child isn’t “term” and that’s where her concern lies in wanting to wait. For all relevant medical purposes her baby is term and should be vaccinated and measured on the “normal” schedule. Which is why I pointed it out. Every OB I met with, my pediatrician and my husband (ER doc) all told me my child born at 37 weeks was still considered a “term” baby even if in the earlier side and therefore no adjusted age/adjusted schedules.

 

[deborahallen]

@sarebear1992 You're totally right. I don't disagree with you or your reasoning. I was just being pedantic. Sorry.

 

[notworthconsideration]

@joannayang Pediatrician Association deems it safe for preterm babies over 2000g (4.4lbs).

My guy was born at 32+6 at 6lbs 6oz. He had a 19 day nicu stay. He was given 35+3 as we thought he was going home (he ended up needing just a little more time - he was a feeder/grower). His doctor has continued his vaccine schedule based on his chronicological age.

 

[foreverroyal87]

@notworthconsideration Mom of preemie born at 26 weeks and 4 days and family medicine physician. It is safe to give to babies smaller than 2000mg, it just may not be as effective.

 

[owoicho99]

@notworthconsideration My daughter was born at 25+0 and received all her vaccines as if she was full term. Standard practice in the NICU. She was well under 2lb for the initial batch.

OP your little one will be just fine getting the shots.

 

[iemrima]

@joannayang The vaccine contains aluminum salts, your baby isn’t being injected with actual aluminum. Check out Unbiased SciPod or this article from the CDC

 

[pchris]

@joannayang In the UK the Hep B vaccine is given at 8 weeks as part of the 6-in-1 vaccine: https://www.nhs.uk/conditions/vaccinations/hepatitis-b-vaccine/

Unless the mother is positive for Hep B and then a dose of only the Hep B vaccine is given at birth and 4 weeks, and then the normal vaccination schedule continue, plus another dose of just Hep B at 12 months. Here is the article outlining the introduction of the vaccine and the timings: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6422463/

All of this is to say the UK has very low rates of Hep B, and you would have to make a judgement call based on information in your local area but hundreds and thousands of children across the pond are not immunised against Hep B until 8 weeks of age.

 

[heisalive1]

@joannayang FDA website has all the vaccine inserts posted.

Do a search (control + F) for “premature” so you can get an idea of what the manufacturer says, considering you will be delivering early.

Then I would look at the middle of page 4, where they discuss how many babies were included in the trials, their ages, and how many days they were monitored for side effects.

https://www.fda.gov/files/vaccines, blood & biologics/published/package-insert-recombivax-hb.pdf

Hope this helps.

 

[stageandgrace]

@joannayang My son was born at 28 weeks weighing just under 1kg. He was given a hep b vaccine at birth, 2 months, 4 months, 6 months and he had a booster at 12 months. This is standard practice in Australia.

Our neonatologist essentially said to us there’s no risks in getting the vaccine but the risk of getting hep B is deadly. OP- your LO will be fine to receive the hep B at birth. These vaccines are safe, effective and well studied.

https://immunisationhandbook.health.gov.au/contents/vaccination-for-special-risk-groups/vaccination-for-preterm-infants#:~:text=Hepatitis%20B%20vaccine,-Low%2Dbirthweight%20preterm&text=Low%2Dbirthweight%20infants%20(%3C2000,at%2012%20months%20of%20age

 

[joannayang]

@stageandgrace Thank you so much! We are definitely planning to proceed after reading the links shared by everyone here. I’m very thankful for the support.

 

[zintec]

@joannayang Interesting, here in British Columbia we aren’t offered hep b at birth for our infants unless deemed high risk. They get their first dose at 2 months.

WHO recommends it at birth for all babies.

http://www.bccdc.ca/resource-galler...hapter 2 - Imms/Part2/InfantsHighRiskHepB.pdf

 

[iamstefanie]

@joannayang There is no reason to delay. The HepB vaccine is safe, in particular the level of aluminium adjuvant is safe for a newborn, see https://pubmed.ncbi.nlm.nih.gov/22001122/

Waiting for 40 weeks sounds really bogus and dangerous. Countries with good prenatal care don't necessarily vaccinate at birth (vaccinating at birth is mostly to prevent mother/baby transmission, so it's recommended in the US, as a substantial fraction of people don't get prenatal care in the US, sadly), but the vaccine is still given relatively early, for instance the first HepB vaccine as part of a multivalent vaccine is compulsory at 2 months in France.

The risk of your baby being exposed to hepatitis B is likely low, though there are documented cases of hepatitis B transmission in daycares: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1467-842X.1997.tb01797.x https://pubmed.ncbi.nlm.nih.gov/2626287/ , but when an infant is infected, they have a 90% probability to develop a chronic infection https://www.cdc.gov/hepatitis/hbv/index.htm , which is terrible. Following the Hepatitis B recommended schedule also gives your child a long term strong protection against Hepatitis B.

There is a lot of info here too: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5416a1.htm . For instance, saliva of HepB infected people can be infectious, and "HBV is comparatively stable in the environment and remains viable for >7 days on environmental surfaces at room temperature (53). HBV at concentrations of 102--3 virions/mL can be present on environmental surfaces in the absence of any visible blood and still cause transmission "

 

[joannayang]

@iamstefanie Thank you so much for this! Yes I was meaning 40 weeks equivalent since we are delivering at 37w1d. It sounds like an overwhelming yes, and the research links on this whole thread are extremely helpful, so we’ll plan on it