Hepatitis B vaccination and prevention of mother-to-child transmission

Elimination of hepatitis B virus (HBV) infection as a public health threat requires a reduction in the prevalence of hepatitis B surface antigen (HBsAg) to below 0.1% in children 5 years of age. This can be achieved through universal immunization of newborns against hepatitis B and other interventions to prevent mother-to-child transmission (MTCT) of HBV, including the use of peripartum antiviral prophylaxis in HBsAg-positive pregnant women.

Most of the global burden of chronic hepatitis B infection can be attributed to MTCT of HBV at, or shortly after, birth or in early childhood. Such perinatal and early-childhood infections lead to a high rate of chronicity.

Hepatitis B vaccination can be given at birth – timely birth dose (TBD) of hepatitis B vaccine, if given within 24 hours of birth – and in early childhood – routine early infant immunization. This is the most important intervention to reduce MTCT of HBV and early childhood transmission. WHO currently recommends universal immunization of infants, with at least 3 doses of the hepatitis B vaccine. The first dose of hepatitis B vaccine should be given as soon as possible after birth (TBD within 24 hours). Completion of the infant hepatitis B vaccine series leads to immunological protection and prevention of infection in >95% of children.

Infant hepatitis B immunoglobulin prophylaxis shortly after birth (where available) and maternal peripartum prophylaxis with antivirals can provide additional protection for the prevention of MTCT of HBV. Since 2020, WHO also recommends that pregnant women who test positive for HBV infection (HBsAg positive) receive tenofovir prophylaxis from the 28th week of pregnancy until at least birth, under certain conditions. This recommendation, which is in addition to the 3-dose hepatitis B vaccine in all infants (including TBD), helps to prevent further transmission of HBV during pregnancy and delivery.