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    Vaccination of Newborns

    Apprehension about the use of hepatitis B vaccines containing thimerosal appears to have led some hospitals to change their newborn vaccination policies, despite recommendations by the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC).

    Thimerosal, a preservative used in some vaccines, contains mercury, which in large amounts causes brain damage; vaccines containing it are being phased out, in favor of preservative-free vaccines. In the meantime, the relatively small potential for mercury toxicity must be weighed against the potential for serious and lifelong illness or even death that could occur from hepatitis B, when deciding how and when to vaccinate infants.

    The AAP, CDC, and U.S. Public Health Service (USPHS) have monitored this situation closely for several months. Newborns can be placed into one of three categories, based on their risk for developing hepatitis B and recommendations address these groups. Infants whose mothers are carriers of the disease or who belong to populations or groups that are known to have a high risk for early childhood hepatitis B infection are particularly vulnerable. Therefore, guidelines consistently advocate vaccination soon after birth, usually within 12 hours, even when only thimerosal-containing vaccines are available.

    Initially, it was suggested that when only thimerosal-containing vaccine is available, parents of healthy babies born to mothers who have never had this disease could choose to limit their infants' overall exposure to mercury by delaying vaccination until the baby is two to six months old.

    In July 1999 guidelines for low-risk infants changed somewhat. The new guidelines strongly suggest that hospitals continue to vaccinate all newborns until policies are in place that guarantee identification of all mothers carrying the disease, and vaccination of infants whose mothers are either carriers or of unknown immunity status.

    Despite these guidelines, a CDC survey of 574 hospitals that are aware of the recommendations and had previously routinely vaccinated all newborns, revealed that 262 (46 percent) later changed their policies or standing orders to discontinue routine vaccination of low-risk babies. The CDC is aware of other hospitals where similar policy changes resulted in a failure to vaccinate high-risk infants.

    It is the CDC's hope that the availability of thimerosal-free vaccines will prompt hospitals to revisit this issue, and take the necessary steps to comply with current recommendations.



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