Hepatitis B immunoprophylaxis and follow-up for infants born to HBsAg-positive women

HBsAg: hepatitis B surface antigen; HBV: hepatitis B virus; HBV DNA: HBV deoxyribonucleic acid; HBeAg: hepatitis B e antigen; HepB vaccine: hepatitis B vaccine; IM: intramuscularly; HBIG: hepatitis B immune globulin; anti-HBs: antibody to HBsAg; mIU: milli-international units.
* Refer to UpToDate content on hepatitis B vaccination in infants and children for management of infants born to women whose HBsAg status is unknown at the time of delivery or whose HBsAg status will remain unknown indefinitely (eg, if the infant is abandoned or safely surrendered after home birth).
¶ Infants <6 weeks should receive single-antigen HepB vaccine (eg, Engerix-B, Recombivax HB). Infants ≥6 weeks may receive either single-antigen HepB vaccine or HepB in combination with other vaccines (eg, Pediarix).
Δ Infants who receive appropriate immunoprophylaxis may be breastfed beginning immediately after birth.
◊ Postvaccination serology should not be obtained before nine months of age or sooner than four weeks after the last dose of HepB vaccine. If the last dose is delayed beyond six months of age, postvaccination serology should be obtained one to two months after the last dose of HepB vaccine.
§ This is the preferred option. As an alternative, depending upon clinical circumstances or family preference, infants may be revaccinated with a second complete three-dose series, followed by serologic testing (HBsAg and anti-HBs) one to two months after the third dose.
¥ Refer to UpToDate content on management of hepatitis B virus in children.
‡ Refer to UpToDate content on hepatitis B virus postexposure prophylaxis.