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Recommended schedule of hepatitis B immunoprophylaxis for term infants and preterm infants with birth weight ≥2 kg

Recommended schedule of hepatitis B immunoprophylaxis for term infants and preterm infants with birth weight ≥2 kg
Maternal HBsAg status Single-antigen vaccine* Single antigen* plus combination vaccine
Dose Age Dose Age
Positive 1 Birth (≤12 hours)* 1 Birth (≤12 hours)*
HBIGΔ Birth (≤12 hours) HBIGΔ Birth (≤12 hours)
2 1 to 2 months* 2 2 months
3 6 monthsפ 3 4 months
    4 6 months◊§
Unknown¥ 1 Birth (≤12 hours)* 1 Birth (≤12 hours)*
2 1 to 2 months* 2 2 months
3 6 months 3 4 months
    4 6 months
Negative 1 Birth (≤24 hours)* 1 Birth (≤24 hours)*
2 1 to 2 months* 2 2 months
3 6 to 18 months 3 4 months
    4 6 months
HBV: hepatitis B virus; HBsAg: hepatitis B surface antigen; HBIG: hepatitis B immune globulin; anti-HBs: antibody to HBsAg.
* Single-antigen vaccines (ie, Recombivax HB or Engerix-B) should be used for the birth dose. Combination vaccines (eg, Pediarix) cannot be administered at birth or before age 6 weeks.
¶ Infants born to HBsAg-positive mothers should receive immunoprophylaxis as recommended whether or not their mother received antiviral therapy during the third trimester.
Δ HBIG (0.5 mL) administered intramuscularly at a separate site (ie, different leg) from vaccine. 
◊ The final dose in the vaccine series should not be administered before age 24 weeks (164 days).
§ These infants should be tested for anti-HBs and HBsAg at age 9 to 12 months or 1 to 2 months after the last dose of hepatitis B vaccine. Testing should not be performed before age 9 months nor within 4 weeks of the most recent vaccine dose.
¥ Mothers should have blood drawn and tested for HBsAg as soon as possible after admission for delivery; if the mother is found to be HBsAg positive, the infant should receive HBIG as soon as possible but no later than age 7 days.
Adapted from: Schillie S, Vellozzi C, Reingold A, et al. Prevention of hepatitis B virus infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep 2018; 67:1.
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