New WHO Guidelines for Hepatitis B Virus Vaccine

The World Health Organization (WHO) issued updated recommendations for the use of the hepatitis B virus (HBV) vaccine, including a WHO report containing excerpts of the new recommendations that was published in Vaccine.^1,2

The WHO regularly publishes position papers to update guidelines on the use of vaccines for the prevention of internationally widespread and pandemic diseases, and especially vaccines that are implemented on a large-scale or nationwide basis.¹

In the position paper, the WHO continues to emphasize that “[a] comprehensive approach to eliminating HBV transmission must address prevention of infections acquired perinatally and during childhood, as well as prevention of infections acquired by adolescents and adults.” Including HBV vaccines in national immunization programs is central to achieving this mission.¹

HBV is most commonly transmitted in the perinatal period, so the HBV monovalent vaccine should be administered to all infants within 24 hours after birth. Although the HBV vaccine becomes progressively less effective within several days after birth, a late dose given after 7 days can still prevent mother-to-child transmission and should be administered if the infant has not received the early birth dose. Infants who are premature or have low birth weight should also receive the birth dose.¹

The WHO also outlined the recommended HBV vaccine schedule after the birth dose, consisting of a 3- or 4-dose schedule, with each dose separated by 4 weeks. The birth dose administered to premature and low birth weight do not count toward these series. Booster doses after completing the series are generally not recommended because of lack of supporting evidence. However, the WHO calls for studies that examine the long-term immunity provided by the vaccine and whether booster doses are necessary in certain subgroups.¹

In countries with moderate or low prevalence of HBV infection, the most important mode of HBV transmission is from an infected individual to an unvaccinated individual. Those who were born before the implementation of universal HBV vaccination in childhood should receive catch-up vaccination against HBV. Younger individuals should be prioritized for catch-up vaccination because they are at the greatest risk for chronic HBV infection.¹

Individuals who have the highest risk for HBV infection should be vaccinated. Examples of high-risk groups include patients who have diabetes or HIV or are solid organ transplant recipients. Patients with HIV should be immunized at the earliest opportunity to maximize the immune response to vaccination.¹

The WHO does not recommend routine serological testing before or after vaccination. However, it may be cost-effective to perform prevaccination testing where services are available, as doing so may help avoid unnecessary vaccination in patients who have adequate immunity against HBV.¹

The position paper also provides guidance on monitoring performance and outcome measures. The WHO recommends establishing administration of the birth dose within 24 hours (“timely delivery”) as a universal performance measure and measuring the effectiveness of vaccination programs by monitoring the prevalence of HBsAg in the population.¹

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