The Advisory Committee on Immunization Practices voted today (February 22) in favor of a single-dose alternative to 3-dose revaccination for infants born to hepatitis B surface antigen-positive mothers who failed to respond to the initial hepatitis B vaccination series.
In a 13-1 vote, with one recusal, the committee approved the recommendation that HBsAg-negative infants with hepatitis B surface antibody levels <10 IU/L should be revaccinated with a single dose of hepatitis B vaccine, followed by post-vaccination serologic testing 1-2 months later.
“Infants whose antibody levels remain less than 10 IU/L following single-dose revaccination should receive two additional doses of vaccine, followed by retesting 1-2 months following the last dose,” Noele Nelson, MD, PhD, MPH, from the CDC’s division of viral hepatitis, said during the meeting.
Prior recommendations had instructed providers to order post-vaccination serologic testing, consisting of HBsAg and antibody to HBsAg for infants born to HBsAg-positive others at age 9-12 months, or 1-2 months following the final dose of the vaccine series if the series was delayed.
Data reviewed both by the Advisory Committee on Immunization Practices (ACIP) and its working group indicated that fewer vaccine doses would allow for shorter duration of case management and would be more cost-effective. However, the working group did note that having both single-dose and three-dose revaccination options would require additional provider/parent decision-making.
“Based on clinical circumstances or family preference, HBsAg-negative infants with hepatitis B surface antibody levels less than 10 IU/L may instead be revaccinated with a second complete three-dose series followed by post-vaccination serologic testing performed 1-2 months after the final vaccine,” Nelson said. “However, available data do not suggest a benefit for administering additional vaccines doses to infants who have not attained antibody levels greater than or equal to 10 IU/L following receipt of two complete vaccine series.”
By Bob Stott