Hepatitis B vaccination of preterm infants and risk of bronchopulmonary dysplasia: a cohort study, Australia
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World Health Organization
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This research article assesses whether administration of the hepatitis B virus (HBV) vaccine within 24 hours of birth is associated with an increased risk of bronchopulmonary dysplasia among extremely preterm infants in Australia. The study was undertaken in response to concerns arising from immunological research suggesting a possible relationship between early HBV vaccination, T-helper lymphocyte type 2 immune polarization and the development of chronic lung disease in very premature infants. Using linked population-level data from Victoria, the authors conducted a retrospective cohort study of infants born before 29 weeks’ gestation between 2017 and 2020, examining associations between birth-dose HBV vaccination and bronchopulmonary dysplasia diagnosed at 36 weeks’ postmenstrual age.
Among 818 eligible infants, rates of bronchopulmonary dysplasia were not higher among those who received the birth-dose vaccine than among unvaccinated infants. Analyses adjusting for measured confounding factors similarly found no evidence of increased risk, and secondary analyses showed no association between birth-dose vaccination and all-cause mortality during the first three months of life. While acknowledging limitations inherent to observational data and the possibility of residual confounding, the study provides population-based evidence supporting the safety of birth-dose HBV vaccination in extremely preterm infants and reinforces current World Health Organization recommendations for hepatitis B immunization within 24 hours of birth.
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