Fatal Fulminant Hepatitis B in an Infant Despite Appropriate Prophylaxis

It is currently recommended that all newborns be vaccinated against the hepatitis B virus to prevent infection and the long-term complications of chronic liver disease and hepatocellular carcinoma. 1 Previous recommendations called for the immunization of all persons known to have behavioral or contact risks and prenatal testing for the carrier state for all women. 2,3 These recommendations also included prophylaxis with hepatitis B immune globulin and a course of recombinant vaccine for children born to chronic carriers. 4 One argument advanced in favor of universal immunization is that universal immunity among childbearing women is necessary to prevent vertical transmission of hepatitis B. This assertion is underscored by the report herein of an infant born to a chronic hepatitis B carrier, in whom fulminant hepatic failure developed despite appropriate prophylaxis. His case serves to illustrate the limitations of the effectiveness of the immunization policy that existed prior to the one