The Hepatitis B Vaccine for Newborns

Newborn gettin ga shot
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When babies are first born, they go through a number of tests and procedures not only to make sure they are healthy but also to ensure that they get a healthy start in life. For instance, they will go through a newborn screening process including the APGAR test, which checks their heart rate, muscle tone, and other indicators to see if emergency care is needed.

These newborn procedures also include erythromycin eye drops, a vitamin K injection, and a hepatitis B vaccine. Although you can decline the hepatitis B vaccine, the American Academy of Pediatrics (AAP) advises that the vaccine be given in the first 24 hours after birth.

More than 1 million people in the United States are living with a lifelong hepatitis B infection, and a baby who gets infected with hepatitis B during the first five years of life has a 15% to 25% chance of premature death from liver disease.

What Is Hepatitis B?

Hepatitis B is a viral infection that can lead to chronic liver infections, as well as cirrhosis and hepatocellular carcinoma. Once exposed, the virus can enter the bloodstream, attack the liver, and even cause cancer.

When babies get the virus, the infection is often chronic, meaning that it remains in their body for life. What's more, about 1 in 4 infected babies will die of liver failure or liver cancer as adults. In the U.S., about 1 out of 172 people have been infected with the hepatitis B virus.

Unlike adults who may show symptoms right away, children may not show symptoms and can become chronic carriers of the virus. Although many children and teens often do not show signs or symptoms of hepatitis B, here is an overview of the most common symptoms should they surface in your child.

Symptoms of Hepatitis B

  • Appetite loss
  • Bruising easily
  • Dark urine
  • Fever
  • Light-colored bowel movements
  • Stomach pain
  • Vomiting or feeling nauseous
  • Weakness or tiredness
  • Yellow skin and eyes

Other than the vaccine, there is no way to actually protect babies from the hepatitis B virus.

How Hepatitis B Spreads

Because hepatitis B is transmitted from person to person through blood and other body fluids, it is a sexually transmitted infection (STI), but people can get the virus from casual contact with others as well, like sharing a razor or using the wrong toothbrush. Even a bite from an infected child can spread the infection.

Newborns are at high risk of getting hepatitis B through childbirth from mothers who are already infected with the virus. What's more, they can get the virus regardless of whether they are born vaginally or through a c-section. Unfortunately, even children born to a mother who doesn't have hepatitis B are at risk because the infection spreads so easily from person to person.

It's impossible to tell if someone has hepatitis B just by looking at them. In fact, most people with hepatitis B have no symptoms, don't feel sick, and are unaware that they even have the illness. Consequently, they can spread the virus to other people without even knowing it.

The only way to know if someone has hepatitis B is through a blood test. And once people find out that they have it, it's often in the advanced stages. Even if it is caught early, there is very little that can be done medically for people with the disease. In fact, the younger a person is when they become infected, the more likely they are to have lifelong liver problems.

While hepatitis B infection can be managed with medication, there is no cure, so doctors rely on the vaccine to help prevent it and reduce the risk of its serious complications.

Why Vaccinate Newborns for Hepatitis B?

If you're like many parents, you may wonder why doctors recommend vaccinating all children against hepatitis B. Although vaccinating infants of mothers who are infected with hepatitis B and delaying vaccinating others is one strategy for preventing hepatitis B in newborns, it's not as effective as universal immunization.

In fact, health experts tried this approach first, immunizing select newborns when the hepatitis B vaccination first came out, and unfortunately, it wasn't successful. Too many children were still getting sick from hepatitis B. 

It wasn't until after the universal immunization program for the hepatitis B vaccine began that the rate of new hepatitis B infections in children began to drop. That's why medical professionals recommend vaccinating all newborns against hepatitis B. 

In a universal immunization program, all newborns are immunized against the virus, even if their mothers test negative for hepatitis B infections.

Giving this birth dose of the vaccination helps prevent the disease from developing in babies who have mothers who have hepatitis B infections but never knew it. It also prevents a scenario in which the mother has a known hepatitis B infection, but the baby somehow misses the hepatitis B shot. This scenario can occur when a mother fails to report her hepatitis B infection to her doctor, forgets that she has the infection, or gets a false negative on her hepatitis B test.

Another good reason to give all newborns the hepatitis B vaccination is that, although most cases are known to be caused by exposure to blood and bodily fluids from someone who has a hepatitis B infection, about 30% to 40% of infections develop in people who don't have any risk factors for infection.

According to the Centers for Disease Control and Prevention (CDC), giving a birth dose of the hepatitis B vaccination to all healthy newborns has a number of benefits.

Benefits of Hepatitis B Vaccine

  • Provides a safety net to prevent perinatal infection among infants who are born to HBsAg-positive mothers who have not been identified
  • Protects infants at risk for infection after the perinatal period
  • Provides higher rates of on-time completion of the hepatitis B vaccine series for infants who get the birth dose of the vaccine
  • Reduces the risk that a child could get hepatitis B later in childhood

Most importantly, young children often have no symptoms when they develop hepatitis B infections, but they are still likely to develop problems with chronic hepatitis. In fact, 90% of children who develop hepatitis before they are 12 months old will develop chronic hepatitis B.

What's more, there is no cure for chronic hepatitis B and there are very few reliable treatments. For this reason, vaccinating babies against the infection has become a routine part of a newborn's hospital care, just like checking their hearing or listening to their heart.

Vaccine Safety

The hepatitis B vaccine is considered one of the safest and most effective vaccinations available. In fact, more than 1 billion hepatitis B shots have been given worldwide, and in the United States, more than 120 million people, including infants and children, have received the vaccination.

Still, some parents are nervous about giving a vaccine to such a young baby and may worry that their newborn's immune system is not mature enough to handle a vaccination. But from birth, babies are dealing with trillions of bacteria and viruses.

What's more, this vaccine is the safest and most effective way to protect your baby from hepatitis B infection and its potentially deadly complications.

According to the AAP, when the vaccine alone is given during the first 24 hours after birth, it is 75% to 95% effective in preventing hepatitis B transmission when the mother has the infection as well. And when a mother who has the infection is also treated, the likelihood of the baby getting hepatitis B is between just 0.7% to 1.1%.

Possible Risks and Side Effects

The hepatitis B vaccine is extremely safe, and most infants who get the vaccine have no issues. But as with any medication—including vaccines—there is a chance of side effects.

For those who do experience side effects, they are usually mild including soreness at the injection site and possibly a low-grade fever. Reports of serious side effects from the vaccination or allergic reactions are extremely rare. According to the AAP, commonly reported mild adverse reactions from the vaccine in all people include swelling (3%), fever (1%–6%), headache (3%), erythema or redness (3%), and pain (3%–29%).

Yet, it's normal for parents to worry about the vaccine with so much conflicting information out there. For instance, some parents worry that vaccinations like hepatitis B will increase the likelihood that their child will develop neurological issues like autism, multiple sclerosis, and attention-deficit/hyperactivity disorder (ADHD). But there is no conclusive evidence that this can occur.

What's more, the AAP points out that the safety of the hepatitis B vaccine has been studied extensively and that there is no evidence of a causal association between the vaccine and neonatal sepsis or death.

Likewise, the AAP indicates that there is no connection between the vaccine and rheumatoid arthritis, Bell's palsy, autoimmune disorders, hemolytic anemia, anaphylaxis, optic neuritis, hearing loss, and other chronic illnesses. All of these possibilities have been researched thoroughly through data analysis from the Vaccine Safety Datalink.

As a new parent, the thought of getting your new baby vaccinated also can feel overwhelming simply because you don't want your little one to experience pain. But, if you remind yourself that you're protecting your baby and that the discomfort they feel is only temporary, you will be able to get through the experience with much less stress.

Instead, focus on comforting your baby while also supporting your baby's doctor and nurses. It can help to provide some sort of distraction while the vaccine is being administered in addition to comforting measures after.

Talk to your doctor about what side effects your baby may experience, if any. Be sure you know what is normal and what constitutes a call to their office, such as a high fever, stiffness, or extreme discomfort.

Hepatitis B Vaccine Schedules

The newborn hepatitis vaccine is part of a three-dose series that begins at the hospital after birth and continues with pediatrician visits.

When it comes to vaccinating newborns, there are two schedules that can be followed—one for babies of moms who have hepatitis B and one for babies where it is unknown or the mother had a negative hepatitis B blood test. The CDC, however, recommends the following vaccination schedule for all children.

CDC Hepatitis B Vaccine Schedule
Dose Age of Dose
First Dose Right after birth; within 12–24 hours
Second Dose 1 to 2 months of age
Third Dose 6 to 18 months of age

The Hepatitis B Foundation recommends the following vaccination schedule for moms who have hepatitis B and their newborns. They stress that babies with moms who test positive for hepatitis B receive the vaccine as well as 0.5 milliliters of hepatitis B immune globulin (HBIG).

Here is an overview of the schedules they recommend when moms test positive for hepatitis B. One schedule is similar to the CDC's schedule and the other uses combination vaccines. Talk to your baby's pediatrician to determine what schedule they plan to follow.

Hepatitis B Foundation Three-Dose Schedule
Dose Age at Dose
First Dose 12–24 hours after birth; vaccine & HBIG
Second Dose 1 month after dose one
Third Dose 6 months after dose one
Hepatitis B Foundation Four-Dose Schedule
Dose Age at Dose
First Dose 12–24 hours after birth; vaccine & HBIG
Second Dose 6 weeks of age (combination vaccine)
Third Dose 14 weeks of age (combination vaccine)
Fourth Dose 24 weeks of age (combination vaccine)

It's also important to note that the Hepatitis B Foundation recommends that health care professionals vaccinate babies right in the delivery room, even though the CDC says that the vaccination can occur at any time within the first 12 to 24 hours. Their reasoning is that if that window of opportunity is missed, there is no second chance to protect an infant from hepatitis B.

When to Delay Vaccinating

Although the Hepatitis B Foundation stresses that parents should not voluntarily delay vaccinating their babies against hepatitis B, there are situations in which doctors may choose to delay the vaccination.

For instance, sometimes the hepatitis B vaccination is delayed if a baby is premature, has a low birth weight, or is medically challenged.

The CDC's report, Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices, says that all healthy newborns who weigh more than 4.4 pounds (2,000 grams) should receive the hepatitis B vaccination.

Still, parents always have the option to refuse a vaccination if they want to. But the risks associated with a hepatitis B infection far outweigh the risks of the vaccine.

A Word From Verywell

When you're about to have a baby, you have a lot of important decisions to make. It's natural to feel overwhelmed and a little confused, especially when it comes to vaccinations and other medical procedures. But, rest assured that recommended procedures—including the hepatitis B vaccine for healthy newborns—have gone through rigorous testing and are not only safe but highly effective.

But if you still have concerns about the hepatitis B vaccine or are considering delaying it for your child, talk to your doctor before your due date so you have time to get all your questions answered. Together, you can make an informed decision about what is right for your baby.

7 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Elimination of perinatal hepatitis B: Providing the first vaccine dose within 24 hours of birth. Pediatrics. 2017;140(3). doi:10.1542/peds.2017-1870

  2. Immunization Action Coalition. Hepatitis B shots are recommended for all new babies.

  3. Stanford Children's Health. Is your child at risk for hepatitis B?

  4. Stanford Children's Health. Hepatitis B virus (HBV) in children.

  5. Centers for Disease Control. Hepatitis B questions and answers for the public.

  6. Hepatitis B Foundation. Protecting your baby.

  7. 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):1-31. doi:10.15585/mmwr.rr6701a1

By Vincent Iannelli, MD
Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years.