Discussion of Immunization Practices Advisory Committee/American Academy of Pediatrics recommendations for universal infant hepatitis B vaccination.

The Committee on Infectious Diseases of the American Academy of Pediatrics and the Advisory Committee on Immunization Practices of the United States Public Health Service have revised the recommendations for hepatitis B control to include universal immunization of infants. Previous selective strategies targeting high risk groups for immunization have failed to prevent the significant morbidity and mortality associated with hepatitis B virus infection. The committees considered several alternative policy options before selecting universal immunization of infants as the most effective strategy for preventing the disease and its sequelae in the United States. More than 30 other countries have also adopted universal infant immunization programs. All children should receive three doses of vaccine by the time they are 18 months of age. Scheduling of the three doses is flexible. Two hepatitis B vaccines are currently available in the United States, and both are highly effective and safe. Dosage depends on several factors, including manufacturer, age at vaccination, maternal serologic status for hepatitis B surface antigen and presence of underlying disease. The committees continue to recommend immunization of high risk older children and adults, and immunization of adolescents is encouraged where resources are available.