Perinatal hepatitis B

Hepatitis B virus (HBV) infection in a pregnant person poses a serious risk to their infant at birth.

Perinatal HBV transmission can be prevented by identifying HBV positive pregnant persons and providing hepatitis B immune globulin and hepatitis B vaccine to their infants within 12 hours of birth. These infants should also complete their hepatitis B vaccine by 6 months of age, and have a blood test done at 9-12 months of age to determine if they are protected against hepatitis B.

Pregnant persons should be tested for evidence of hepatitis B virus (HBV) infection, specifically hepatitis B surface antigen (HBsAg), during every pregnancy. If positive, providers should report these persons to the Massachusetts Department of Public Health using the Hepatitis B Infected Pregnant Woman Reporting Form. All HBsAg positive pregnant persons should be further tested for HBV DNA levels to guide the use of maternal antiviral therapy, and referred for care appropriately using the CDC’s Screening and Referral Algorithm for Hepatitis B Virus (HBV) Infection among Pregnant Women (PDF).

Additional Resources for managing HBV infection in pregnant persons can be found on the CDC website. For the latest recommendations for treatment of chronic HBV infection in pregnant persons, see pages 276-277 in the American Association for the Study of Liver Diseases Guidelines for Treatment of Chronic Hepatitis.

Birthing facilities and hospitals should ensure they have methods in place to identify and manage the care of HBV positive persons. A variety of tools are available from the Immunization Action Coalition, including Guidance for Developing Admission Orders in Labor & Delivery and Newborn Units to Prevent Hepatitis B Virus Transmission and Labor & Delivery HBsAg Admission Checklist for Birthing Mother. Babies born to HBV positive persons should receive HBIG and their first dose of hepatitis B vaccine within 12 hours of birth. These infants should be reported to MDPH using the Hepatitis B Maternal/Infant Birth Reporting Form.

Pediatricians should ensure that babies born to HBV positive persons are followed closely and complete their hepatitis B vaccination series by 6 months of age on a 0-, 1-2-, and 6-month schedule. Once their vaccination series has been completed, babies should then have Post-Vaccination Serological Testing (PVST) done between 9-12 months of age, or 1-2 months after the last dose of hepatitis b vaccine, if the series was delayed. PVST consists of both HBsAg and anti-HBs, and it is imperative that both tests be run to be able to determine if the baby is protected against hepatitis B infection. This concise 2-page document for pediatric providers describes management of infants born to HBV-infected persons, guidance on interpreting PVST results, and frequently asked questions.

Hepatitis B birth dose for all newborns

All newborns, regardless of the birth parent’s HBV status, should receive their first dose of hepatitis B vaccine within 24 hours of birth. Parents can be given a factsheet entitled Vaccinate Your Baby Against Hepatitis B, which emphasizes the importance of the birth dose. Also, the American Academy of Pediatrics Policy Statement also reinforces the importance of the birth dose within 24 hours of birth. Hospitals with a hepatitis B birth dose administration rate of ≥90% over a 12-month period can apply to be on the Immunization Action Coalition’s Birth Dose Honor Roll.

Massachusetts perinatal hepatitis B statistics

MDPH provides case management to pregnant persons who are HBV positive and their infants. 204 infants born in 2021 were case managed by the Perinatal Hepatitis B Prevention Program (PHBPP). Over 99% of these infants received treatment (HBIG and first dose of hepatitis B vaccine) at birth, 95% completed the vaccine series by 12 months of age, and 84% completed the vaccine series and received PVST by December 31, 2021. As of December 31, 2022, no infants born in 2021 tested HBsAg positive!

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