Maternal, Newborn, and Child Health
MNCH Immunization Interventions
Maternal, Newborn, and Child Health
MNCH Immunization InterventionsImmunization in Labor & Delivery
Establishing Early Protection Through Birth Dose Vaccination
Immunizing newborns at birth provides critical protection during their most vulnerable period when maternal antibodies are waning and their immune systems are still developing. This timing is particularly crucial for hepatitis B, where greater than 90% of babies who are not vaccinated and become infected will develop lifelong infection.
Birth vaccination also prevents mother-to-child transmission of serious diseases and establishes immediate immunity against infections that pose the greatest risk to newborns in their first weeks of life.
Two vaccines are essential at birth: the hepatitis B birth dose, which the WHO recommends within 24 hours as the most effective intervention for preventing hepatitis B virus-associated disease worldwide, and the BCG vaccine, recommended for all infants in high tuberculosis burden countries. BCG can safely be given together with the hepatitis B birth dose through intradermal injection, making it feasible to provide comprehensive protection from the first day of life.
Evidence supports vaccination at birth as a cornerstone of any comprehensive MNCH program, offering immediate protection when infants are most vulnerable while building the foundation for lifelong health.
What Are the Benefits of Immunization during Labor & Delivery?
- Immediate Protection: Provides critical protection when maternal antibodies are insufficient.
- Prevention of Mother-to-Child Transmission: The hepatitis B birth dose prevents 95% of mother-to-child transmission when given within 24 hours.
- TB Prevention: BCG vaccination protects against severe forms of tuberculosis meningitis and disseminated TB in infants.
- Optimal Timing: Birth dose vaccines are most effective when given immediately after delivery.
- Foundation for Routine Schedule: Establishes the beginning of the routine immunization series.
How to Implement
1. Establish Birth Dose Protocols
- Establish protocols for immediate birth dose administration at all delivery facilities.
2. Develop Age-Appropriate Vaccination Schedules for Women 15–49 Years
- Train delivery staff on safe vaccine administration techniques for newborns.
3. Manage Supply and Distribution
- Ensure adequate vaccine supplies and proper cold chain at delivery points.
4. Track Administration
- Implement recording systems to document birth dose administration.
5. Integrate with Family Planning and Reproductive Health Services
- Establish referral systems to routine immunization services.
6. Ensure Quality Delivery
- Create quality assurance protocols for birth dose administration.
What’s the Evidence?
- More than 90% of babies who are not vaccinated and become infected with hepatitis B will develop lifelong infection, making the birth dose essential to their protection (Hepatitis B Foundation vaccine schedules).
- Every dollar spent on immunization produces an average return of up to $26 across a child’s lifetime in low- and middle-income countries.
- It is estimated that high coverage with a birth dose of hepatitis B vaccine, followed by at least two more doses, will prevent 710,000 deaths in the cohort of children born between 2020 and 2030 alone, 78% of them in African countries. Within a generation, mother-to-child transmission of the virus could be virtually eliminated.
- BCG induces specific changes in blood lipids that may contribute to the vaccine’s protective effects and could inform future early-life vaccine development.
Key Indicators
- Birth Dose Coverage: Percentage of newborns receiving the hepatitis B vaccine within 24 hours.
- BCG Coverage: Percentage of newborns receiving the BCG vaccine.
- Facility Readiness: Percentage of delivery facilities with birth dose capacity.
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Tips
- Ensure the hepatitis B vaccine is given within 24 hours of birth, ideally within 12 hours.
- Train all delivery staff, including traditional birth attendants, on vaccine administration.
- Maintain vaccine supplies at all delivery points, including lower-level facilities.
- Combine with other newborn care protocols like vitamin K and eye prophylaxis.
Challenges
- Home Birth and Community Access Barriers: Establish community health worker networks to provide birth dose vaccines in home settings, strengthen referral systems between traditional birth attendants and health facilities, and create mobile vaccination teams for remote areas.
- Inconsistent Vaccination Schedules and Delayed Protection: Advocate for universal birth dose policies, standardize vaccination schedules to include immediate newborn vaccination, and ensure hepatitis B birth dose is available separately from pentavalent vaccines when needed.
- Infrastructure and Cold Chain Limitations: Invest in portable cold chain equipment and solar-powered refrigeration systems, train facility staff on proper vaccine storage protocols, and establish backup supply chains with nearby facilities that have adequate cold storage capacity.
Key Resources
- Preventing Perinatal Hepatitis B Virus Transmission: A Guide for Introducing and Strengthening Hepatitis B Birth Dose Vaccination. WHO 2015
- BCG vaccine position paper. WHO 2018
- Global Alignment of Immunization Safety Assessment in Pregnancy (GAIA). Brighton Collaboration 2019
- National EPI guidelines for birth dose vaccination
