Recommended schedule of hepatitis B immunoprophylaxis for preterm infants with birth weight <2 kg

Maternal HBsAg status	Single antigen vaccine*		Single antigen plus combination vaccine*
Maternal HBsAg status	Dose	Age	Dose	Age
Positive^¶	1	Birth (≤12 hours)*	1	Birth (≤12 hours)*
	HBIG^Δ	Birth (≤12 hours)	HBIG^Δ	Birth (≤12 hours)
	2	1 month*	2	2 months
	3	2 to 3 months	3	4 months
	4	6 months^◊^§	4	6 months^◊^§
Unknown	1	Birth (≤12 hours)*	1	Birth (≤12 hours)*
	HBIG^Δ	Birth (≤12 hours)*	HBIG^Δ	Birth (≤12 hours)
	2	1 month*	2	2 months
	3	2 to 3 months	3	4 months
	4	6 months^◊	4	6 months^◊
Negative	1	Hospital discharge or age 1 month*	1	Hospital discharge or age 1 month*
	2	2 months	2	2 months
	3	6 to 18 months^◊	3	4 months
			4	6 months^◊

HBsAg: hepatitis B surface antigen; HBIG: hepatitis B immune globulin; anti-HBs: antibody to HBsAg.
* Single-antigen vaccines (ie, Recombivax HB or Engerix-B) should be used for the birth dose. Combination vaccines (eg, Pediarix) cannot be administered at birth or before age 6 weeks.
¶ Infants born to HBsAg-positive mothers should receive immunoprophylaxis as recommended whether or not their mother received antiviral therapy during the third trimester.
Δ HBIG (0.5 mL) administered intramuscularly at a separate site (ie, different leg) from vaccine.
◊ The final dose in the vaccine series should not be administered before age 24 weeks (164 days).
§ These infants should be tested for anti-HBs and HBsAg at age 9 to 12 months or one to two months after the last dose of hepatitis B vaccine. Testing should not be performed before age 9 months nor within four weeks of the most recent vaccine dose.

Adapted from: Schillie S, Vellozzi C, Reingold A, et al. Prevention of hepatitis B virus infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep 2018; 67:1.

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Recommended schedule of hepatitis B immunoprophylaxis for preterm infants with birth weight <2 kg