(ACIP) recommends that infants born to mothers who are positive for hepatitis B surface antigen (HBsAg) receive hepatitis B immune globulin and a first dose of the hepatitis B vaccine within 12 hours of birth. To improve adherence to that guideline, the committee offers the following recommendation:

Recommendation 4-1. All infants weighing at least 2,000 grams and born to hepatitis B surface antigen-positive women should receive single-antigen hepatitis B vaccine and hepatitis B immune globulin in the delivery room as soon as they are stable and washed. The recommendations of the Advisory Committee on Immunization Practices should remain in effect for all other infants.

The ACIP recommends administration of the hepatitis B vaccine series to unvaccinated children and young adults under 19 years old. School-entry mandates have been shown to increase hepatitis B vaccination rates and to reduce disparities in vaccination rates. Overall, hepatitis B vaccination rates in school-age children are high (for example, about 80% of states reported at least 95% hepatitis B vaccine coverage of children in kindergarten in 2006–2007), but there is variability in coverage among states. Additionally, there are racial and ethnic disparities in childhood vaccination rates—Asian and Pacific Islander (API), Hispanic, and African American children have lower vaccination rates than non-Hispanic white children. Regarding vaccination of children and adults under 19 years old, the committee offers the following recommendation:

Recommendation 4-2. All states should mandate that the hepatitis B vaccine series be completed or in progress as a requirement for school attendance.

Hepatitis B vaccination for adults is directed at high-risk groups—people at risk for HBV infection from infected household contact and sex partners, from injection-drug use, from occupational exposure to infected blood or body fluids, and from travel to regions that have high or intermediate HBV endemicity. Only about half the adults who are at high risk for HBV infection receive the hepatitis B vaccine. Low coverage of high-risk adults is attributed to the lack of dedicated vaccine programs; limitations of funding, insurance coverage, and cost-sharing; and noncompliance of the involved populations. To increase the rate of hepatitis B vaccination of at-risk adults, the committee offers the following recommendation:

Recommendation 4-3. Additional federal and state resources should be devoted to increasing hepatitis B vaccination of at-risk adults.

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