{
  "abstract": "Hepatitis B virus (HBV) is a potentially chronic infection that can be transmitted from mother to child with the risk of developing cirrhosis, liver failure and hepatocellular carcinoma. There is a safe and effective vaccine to prevent vertical transmission that is recommended to be given as soon as possible after birth and within 24 hours.When a woman with HBV refuses the birth dose of HBV vaccine for her baby, infectious diseases and safeguarding teams are asked to provide urgent opinions on whether this crosses the threshold for triggering child protection mechanisms.We consider a low-infectivity HBV vertical transmission scenario where there is parental refusal of HBV vaccination and focus on ethical arguments for and against overruling parental refusal in the child’s best interests. As an additional resource for clinical and safeguarding teams, we also include the anonymised transcript of the only available UK court judgement to our knowledge that addresses the issue of decline of HBV vaccine to prevent vertical transmission.We propose a dialogue process for managing scenarios where a pregnant woman with HBV has concerns about vaccinating her baby when born, which is the basis of the current UK Health Security Agency guidance.",
  "authors": [
    {
      "affiliations": [
        "Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK",
        "Department of Paediatric Infectious Diseases and Immunology, Children’s Hospital, The Royal London Hospital, London, UK"
      ],
      "name": "Robindra Basu Roy"
    },
    {
      "affiliations": [
        "Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK",
        "Department of Paediatric Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"
      ],
      "name": "Stephane Paulus"
    },
    {
      "affiliations": [
        "Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK",
        "Department of Paediatric Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"
      ],
      "name": "Dominic F Kelly"
    },
    {
      "affiliations": [
        "Formerly of Children’s Liver Disease Foundation, Winchester, UK"
      ],
      "name": "Harpreet Brrang"
    },
    {
      "affiliations": [
        "Formerly of Children’s Liver Disease Foundation, Winchester, UK"
      ],
      "name": "Alison Taylor"
    },
    {
      "affiliations": [
        "Imperial College London Centre for Paediatrics and Child Health, London, UK"
      ],
      "name": "Gareth Tudor-Williams"
    },
    {
      "affiliations": [
        "UCL GOS Institute of Child Health, London, UK",
        "Advanced Pathogen Diagnostics Unit, University College London Hospitals NHS Foundation Trust, London, UK"
      ],
      "name": "Eleni Nastouli"
    },
    {
      "affiliations": [
        "Vaccinations and Screening, NHS England – Midlands, Nottingham, UK"
      ],
      "name": "Ashis Banerjee"
    },
    {
      "affiliations": [
        "Children and Families Legal Service, Warwickshire County Council, Warwick, UK"
      ],
      "name": "Marieluise Horne"
    },
    {
      "affiliations": [
        "Clinical Research Department and the Vaccine Centre, London School of Hygiene & Tropical Medicine, London, UK"
      ],
      "name": "Edward P K Parker"
    },
    {
      "affiliations": [
        "Department of Hepatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK",
        "British Liver Trust, Ringwood, UK"
      ],
      "name": "Ahmed ElSharkawy"
    },
    {
      "affiliations": [
        "Public Health Programmes, UK Health Security Agency, London, UK"
      ],
      "name": "Sema Mandal"
    },
    {
      "affiliations": [
        "Public Health Programmes, UK Health Security Agency, London, UK"
      ],
      "name": "Mary Elizabeth Ramsay"
    },
    {
      "affiliations": [
        "Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK",
        "Department of Paediatric Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"
      ],
      "name": "Andrew J Pollard"
    },
    {
      "affiliations": [
        "Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore",
        "Uehiro Oxford Institute, University of Oxford, Oxford, UK"
      ],
      "name": "Julian Savulescu"
    },
    {
      "affiliations": [
        "Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore",
        "Uehiro Oxford Institute, University of Oxford, Oxford, UK",
        "Neonatal Intensive Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"
      ],
      "name": "Dominic Wilkinson"
    }
  ],
  "title": "A vaccine emergency—when to overrule parental refusal of vaccination at birth for prevention of vertical transmission of hepatitis B virus?",
  "uid": "99a9be05-f70e-5f9e-b3a0-04d3847b37b9"
}