Rubella and tetanus have been cause of infant deaths in Africa, South- East Asia and the Western Pacific regions. Babies born with congenital rubella syndrome in 2008 are believed to be at the same rate as that in 1996 as only a few countries have introduced the rubella-containing vaccine by 2008. Even though the situation has improved from 1980’s, WHO estimates that 59 000 newborns died from neonatal tetanus in 2008. By the end of 2011, 36 countries still had not eliminated maternal and neonatal tetanus in all districts.

Women with chronic hepatitis B virus infection are at high risk of developing liver disease, including cirrhosis and hepatocellular carcinoma. There is a 10% chance if the woman is hepatitis B virus surface antigen- (HBsAg-) positive to 90% if she is both HBsAg- and hepatitis ‘e’ antigen (HBeAg)-positive. Most perinatal transmissions take place at birth or in infancy or early childhood, but intrauterine transmission is also possible. About 90% of infants infected during the first year of life develop chronic infections.

Hepatitis B vaccine is 95% effective in preventing hepatitis B virus infection and its chronic consequences, and it is the first vaccine against a major human cancer. The vaccine needs to be given in either three or four separate doses as part of existing routine immunization schedules. All infants should receive their first dose of hepatitis B vaccine as soon as possible after birth or within 24 hours.

Rubella, tetanus and hepatitis B are vaccine-preventable infectious diseases and WHO recommends routine childhood immunization against these diseases.

Health problems	Issues to maternal health	Issues to infant health
Rubella	Spontaneous or therapeutic abortion	Stillbirth, congenital rubella syndrome
Tetanus	Maternal infection, death	Neonatal infection, death
Hepatitis B	Chronic liver disease, premature death	Neonatal hepatitis B infection

Health problems	Preventive interventions	Delivery mechanisms
Rubella	Rubella-containing vaccine (monovalent rubella [R] or measles–rubella [MR] or measles–mumps–rubella [MMR]) for women who have not been vaccinated previously	National immunization programme
Tetanus	Tetanus- and diphtheria-containing (Td) vaccine for women who were not fully immunized in childhood or previous pregnancies	National immunization programme
Hepatitis B	Hepatitis B vaccination	National immunization programme