Hepatitis B Vaccination


Reviewed by Clinical Practice Committee
September 2015
Clinical Guidelines Back Newborn Services Home Page
Information Positive Mothers and those with Unknown Status Hib-HepB (Comvax) 2-in-1 Vaccine Other Related Documents

Hepatitis B - Introduction

Risk of vertical transmission

For a newborn born to HepBsAg positive mother, there is a risk of vertical transmission as high as 90% if no prophylaxis given.4 The risk of vertical transmission is associated with the following:

Other considerations


For Known HepBsAg positive mother

  1. There is an evidence to suggest that hepatitis B immunoglobulin alone, hepatitis B vaccine alone and hepatitis B vaccine plus hepatitis B immunoglobulin given at birth prevents hepatitis B occurrence in Newborn
  2. For these newborns please follow the figure below


Management of a baby of an HBsAg-positive woman
Screen all women in early pregnancy for hepatitis B carriage

Woman is HBsAg positive No  Figure 8.2: arrow1   See ‘Infants’ in section 8.5.2
Figure 8.2: arrow2
All HBsAg-positive pregnant women should also be tested for HBeAg and should have HBV DNA measured. The results should be discussed with a specialist or, early in her pregnancy, the woman should be referred to a specialist for ongoing care. Give the baby hepatitis B protection as follows.
At age Action to be taken
Birth Give hepatitis B immunoglobulin 100–110 IU neonatal and hepatitis B vaccine 5 µg
6 weeks DTaP-IPV-HepB/Hib
3 months DTaP-IPV-HepB/Hib
5 months DTaP-IPV-HepB/Hib
9 months Take a blood test to check for hepatitis B infection (HBsAg) and for vaccine-induced immunity (anti-HBs).
  • If HBsAg is negative and anti-HBs level is >10 IU/L at age 9 months, immunity is proven.
  • If HBsAg is positive, the baby has become infected despite prophylaxis: refer to an appropriate specialist.
  • ​If HBsAg is negative and anti-HBs level is ≤10 IU/L at age 9 months, give 1 to 3 further doses of hepatitis B vaccine at least 4 weeks apart. Recheck serology 4 weeks after each dose to determine if further doses are necessary (ie, if anti-HBs is still ≤10 IU/L). If there is no seroconversion after the third further dose of hepatitis B vaccine, discuss with a specialist.
All other vaccines should be administered as per the Schedule.

Source: New Zealand immunization handbook 2014

For unknown HepBsAg status mother

  1. Newborn should receive hepatitis B vaccine at birth. Mother should be tested for hepatitis B serology and if HepBsAg positive the infant should also receive hepatitis B immunoglobulin within 48 hrs
  2. Follow routine vaccine schedule from 6 weeks
  3. If mother was determined to be HepBsAg positive then infant should have HepB serology tests at 9 months of age.10

For HepBsAg negative mother

  1. Follow routine vaccine schedule from 6 weeks. 10

For further information regarding hepatitis B immunization please check New Zealand immunization handbook

Hepatitis B - Information

  • Spread through close physical contact with body fluids of an infected person.
  • The most infectious period is from several weeks before symptoms appear until several weeks or months later.
  • Carriers have the virus in their blood and can remain infectious for many years.
  • The younger a person is when Hep B infection occurs the more likely they are to become a chronic carrier.
Hepatitis B Immunoglobulin (HBIg)
  • Is prepared from plasmas that contain high levels of antibody to the surface antigen of the Hepatitis B virus. It is given to all babies (including premature infants) whose mothers are Hepatitis B antigen positive.
Storage of vaccine-

Hepatitis B - Mothers Antigen Positive and Status Unknown

Babies born to carrier mothers are at greater risk of catching Hep B virus during birth. Baby can be protected from Hepatitis B by having extra injections of Hep B vaccine and Immunoglobulin (HBIG) at birth. If the recommended immunisations are completed the baby’s risk of becoming infected is reduced by about 95%.

Parental consent/ prescribing of

Hep B vaccine.

  • See flow chart for parental consent and vaccinations to give.

Mothers Hepatitis B antigen (HBsAg) status unknown

  • See flow chart for process – consent vaccinations and Hep B Immunoglobulin (HBIG).
  • 85-95% and virtually complete protection in those who develop antibody levels of greater than or equal to 10mlU/ml (the protection level). At least 95% in children after 3 doses.
  • The red form HNN2 then goes into the multidisciplinary notes. Later one copy goes to the Medical Officer of Health, Community Health.
Ordering of Hep B Immunoglobulin
  • On the request form for Human Plasma Protein Products (S405). Send to Blood Bank by chute plus a phone call.

Hepatitis B - Nursing Care of Baby whose Mother is Hep B Antigen Positive or Status Unknown

Nursing care of baby
  • The Nurse will ensure the following steps are carried out in the nursing care for baby whose mother is Hepatitis B antigen positive or status unknown.





Strict handwashing.


Gloves for all cares, where contact with body fluid is anticipated.


Baby may have breast milk.


Babies greater than 32 weeks gestation bath as soon as possible, if condition stable, using chlorhexidine surgical scrub 4%:
  • Have bath water and towels on hand.
  • Nurse wears long sleeve gown and gloves.
  • Nurse wets hands, pours some chlorhexidine surgical scrub 4% into hands, lathers up solution. Then using hands cover all of baby's skin-hair (avoiding eyes and ears)
  • Place baby in bath water and rinse off the chlorhexidine.
  • Dry baby.