Hepatitis B Vaccine and Hep B Immunoglobulin (HBIG) at Birth

Hepatitis B Vaccine

1. Mother HbsAg positive

   1. Infant should receive HBIG (<12 hours but some effect up to 72 hours), dose 100iU (0.5ml) IM given in right leg.

   2. Vaccinate as soon as possible after birth.
      Dose 5.0mcg = 0.5ml IM in left leg.

   3. Recommend follow up serology in 3-6 months to confirm status as vaccine/HBIG only 95% effective at preventing transmission.

   4. Need consent signed in two places on the National Hepatitis B immunisation programme form
      (a) for the Hep B vaccine
      (b) for the Hep B immunoglobulin
      then chart on drug sheet.
      

2. Mother's status unknown
   1. Infant should receive HBIG (<12 hours but some effect up to 72 hours), dose 100iU (0.5ml) IM given in right leg.
   2. Vaccinate as soon as possible after birth
      Dose 5.0mcg = 0.5ml IM in left leg.
   3. Need consent signed in two places on the National Hepatitis B immunisation programme form
      (a) for the Hep B vaccine
      (b) for the Hep B immunoglobulin
      then chart on drug sheet.
      
3. Mother HbsAg negative

   Follow routine vaccination schedule

   Routine Schedule for All Infants

   See also New Zealand Nation Immunisation Schedule

   Age	Vaccine	Dose	Site
   6 Weeks	Infanrix-hexa	0.5ml	Left Leg
   	Prevenar	0.5ml	Right Leg
   3 Months	Infanrix-hexa	0.5ml	Left Leg
   	Prevenar	0.5ml	Right Leg
   5 Months	Infanrix-hexa	0.5ml	Left Leg
   	Prevenar	0.5ml	Right Leg

   After discussion with Registrar/NS-ANP, Parent to countersign on Stat page of Medication Chart The 6 week and 3 month vaccinations are only administered by a Vaccination Team member and ideally checked by another Vaccination Team member. Vaccinations will be given daily. Paracetamol will not be given routinely. However, if the baby develops a temperature >37.5° C, inform the Registrar/NS-ANP and a stat dose of paracetamol may be charted. Dose 10mgs/kg.

   BCG

   If the baby meets criteria and is over 2000grams, BCG consent form is signed by parent Doctor charts on stat page of medication chart – BCG 0.05mls Intradermally. Will be given by Gazetted Nurse. Current recommendation is that neonatal BCG will be offered to those infants at increased risk of tuberculosis, i.e: Will be living in a household containing a person who has arrived in New Zealand within the previous five years from any country with a high incidence of tuberculosis (this includes most countries outside North America, Australia and Western Europe or where there will be visitors to the household from high risk countries). Will be living in a household containing a person with either current TB or history of TB. Will be living in a high incidence area of NZ where all neonates are offered BCG. These infants need to be identified prior to discharge and ideally vaccination given in hospital or arrangements made for referral to a Public Health Nurse Community BCG clinic. * Contraindications Sick infants. Infants < 2000g. Infants where an immuno-deficiency is suspected. Baby must weigh ≥2000g. Dose 0.05ml intradermally

   NOTE:

   See below Guidelines for GPs Immunisation Schedule for Babies <1000 grams or <29 weeks. See further information – Individual Policy – Nurses Immunisation/Infection Policy. For further information see MOH Immunisation Handbook.

   Guidelines for General Practitioners - Immunisation Schedule for Babies <1000 grams or <29 weeks

   • If babies are >1000 grams AND ≥29 weeks routine schedules apply.
   • Blood test (micro red top tube) to check sero conversion antibody levels of HepB >10IU/ml (protective level).
   
   

   If sero conversion is not found give the following
   6 Months	Hepatitis B	5mcg IM Left Leg
   7 Months	Hepatitis B	5mcg IM Left Leg
   8 Months	Repeat blood test on baby and advise parents of result.

   
   

   For Babies with Chronic Lung Disease or Cardiac Anomalies
   At least 6 months old and prior to the Influenza season	Influenza Vaccine
   1 month later	Influenza Vaccine
   Then annually

   Siblings

   • Note that the vaccination status of siblings should be checked.
   • Siblings should be fully vaccinated, particularly for pertussis.
   • For infants with Chronic Lung Disease who are receiving the Influenza vaccination, siblings should also be considered for Influenza vaccination (although the family may have to pay for this unless the siblings have a chronic medical condition)

   References

   1	NZ Immunisation Handbook, Ministry of Health 2006
   2	1997 Red Book, Report of the Committee on Infectious Diseases

   
   
   

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