Perinatal HBV transmission can be prevented by identifying HBV positive pregnant women 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 women should be tested for evidence of hepatitis B virus (HBV) infection, specifically hepatitis B surface antigen (HBsAg), during every pregnancy. CDC recommends healthcare providers order ‘prenatal’ HBsAg tests (vs. non-specific tests) for pregnant women. If positive, providers should report these women to the Massachusetts Department of Public Health using the Hepatitis B Infected Pregnant Woman Reporting Form. HBV positive women should be tested further for hepatitis B e antigen (HBeAg) and HBV DNA levels, and referred for care appropriately using the CDC’s Screening and Referral Algorithm for Hepatitis B Virus (HBV) Infection among Pregnant Women.
Additional Resources for managing HBV infection in pregnant women can be found on the ACOG and CDC websites. For the latest recommendations for treatment of chronic HBV infection in pregnant women, 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 women. 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 moms 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 women 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. A useful chart from the CDC assists with Interpretation of Hepatitis B Serologic Test Results .
Hepatitis B birth dose for all newborns
All newborns, regardless of mom’s HBV status, should receive their first dose of hepatitis B vaccine within 24 hours of birth. Parents can be given a factsheet entitled Hepatitis B Shots Are Recommended for All New Babies, 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 women who are HBV positive and their infants. 338 infants born in 2017 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, 91% completed the vaccine series by 12 months of age, and 84% completed the vaccine series and received PVST by December 31, 2018. As of December 31, 2018 no infants born in 2017 tested HBsAg positive!