Hepatitis B is an inflammatory liver disease caused by the hepatitis B virus that results in liver cell damage and can lead to cirrhosis and an increased risk of liver cancer. The hepatitis B virus is transmitted by contact with blood and/or body fluids of the infected person.
Perinatal hepatitis B is hepatitis B infection in an infant one month to 24 months of age born to a woman who has hepatitis B infection (either acute or chronic). Preventing hepatitis B infection in early childhood is important because infants infected at birth have a 90 percent risk of chronic infection and as many as 25 percent will die of chronic liver disease as adults. More than 90 percent of these chronic infections can be prevented if the infant is treated soon after birth with a dose of hepatitis B immune globulin and begins the hepatitis B vaccine series.
Julie A. Miracle, RN. BSN, CPAN
Perinatal Hepatitis B Prevention Coordinator
Kentucky Immunization Program
(502) 564-4478 ext. 4260
Perinatal Hepatitis B Prevention Program
Established in 1991, the Kentucky Perinatal Hepatitis B Prevention Program (PHBPP) provides case management for HBsAg-positive women seen by private and public health care providers. The goal of PHBPP is to identify HBsAg–positive mothers prenatally or at time of delivery so that her infant, household and sexual contacts can be tested and treated to prevent the spread of the hepatitis B virus.
Over the last four years, Kentucky has identified an average of 65 infants born to HBsAg-positive women which has increased over the last two years. The Centers for Disease Control and Prevention estimates Kentucky should identify 95-160 infants born to HBsAg-positive women.
Prevention of perinatal transmission requires collaboration and communication between clients, laboratories, primary care providers, hospitals and the state and local health departments. The PHBPP ensures all:
- Pregnant women are screened for HBsAg during each pregnancy. All positive results are reported to the local health department in the county of residence within 24 hours and the results are sent to the delivering hospital with the prenatal record.
- Household and sexual contacts of HBsAg–positive pregnant women are identified, tested and immunized if susceptible.
- Infants of HBsAg-positive women receive the appropriate prophylaxis and post-vaccination serology.
Hepatitis B Vaccine
- The vaccine is 95 percent effective in preventing hepatitis B
- Routinely the vaccine is administered as a three-dose series
- A booster dose is not routinely recommended
- Since 1991, national guidelines recommend all newborns receive a birth dose of hepatitis B vaccine prior to discharge from the birthing facility
- The vaccine is safe for premature babies
Hepatitis B Vaccine Routine Infant Schedule
Infant should receive
||birth dose of hepatitis B vaccine|
||2nd dose of hepatitis B vaccine|
||3rd dose of hepatitis B vaccine|
Screening for hepatitis B surface antigen (HBsAg)
Appropriate screening of pregnant women is an important step in the strategy to prevent perinatal hepatitis B infection. To decrease the perinatal transmission of hepatitis B, all pregnant women in Kentucky must be screened for hepatitis B surface antigen during each pregnancy. State legislation mandating the testing became effective July 15, 1998.
Administrative regulation 902.KAR 2:020 requires all licensed health professionals and facilities to report hepatitis B in a pregnant woman to the local health department or Department for Public Health. Hospital must report to the maternal county of residence’s local health department and/or the PHBPP within 24 hours of delivery. The EPID 399 is a reporting form the hospital uses to notify the local or state health department for a delivery to an HBsAg-positive woman. The EPID 399 must be completed accurately and the HBsAg-positive mothers should contact their local health department to ensure proper case management for their infants.
Management of a newborn who mother was HBsAg-positive
All infants born to HBsAg-positive mothers must receive hepatitis B vaccine and 0.5 mL of hepatitis B immune globulin (HBIG) within 12 hours of birth in separate sites for protection from the hepatitis B virus. The infant must complete a valid hepatitis series by 6 months of age and post-vaccination serology testing for HBsAg and quantitative anti-HBs (antibodies) at 9-12 months of age.
If maternal HBsAg status is unknown, within 12 hours of birth the hepatitis B vaccine is administered for infants weighing more than or exactly 2,000 grams and Hepatitis B vaccine plus HBIG for infants weighing less than 2,000 grams. The mother's HBsAg status will be determined as soon as possible and, if she is HBsAg-positive, administer HBIG for infants weighing more than or exactly 2,000 grams (no later than 1 week of age).
If the maternal HBsAg status is negative, all infants should receive the birth dose of the hepatitis B vaccine within 24 hours after birth to prevent infection as precaution.
If you are a pregnant woman
- Request the results of your hepatitis B surface antigen test known as HBsAg. This tells you if you have hepatitis B.
- If you are not infected, get vaccinated against hepatitis B. The 3 dose vaccine series is safe during pregnancy.
- Make sure your infant is vaccinated at birth. The three-shot series can protect your baby for life against hepatitis B reducing the risk of liver cancer and liver damage.
If you are HBsAg-positive and pregnant, take extra precautions
- Get screened for liver disease. You are at increased risk for liver damage and cancer. Regular screening and treatment can reduce your risk.
- Contact your local health department. Staff can assist you in prevention of hepatitis B in family members.
- Notify your labor hall and nursery staff that you are HBsAg–positive.
- Ensure your newborn receives the hepatitis B vaccine and hepatitis B immunoglobin within 12 hours of birth to protect your infant from hepatitis B. Your infant will need to complete the hepatitis B vaccine routinely given at 1 month of age and 6 months of age.
- It is critical that your infant complete the hepatitis B vaccine series on time preferably in the first six months. Talk to your infant’s provider and keep all scheduled appointments.
- Your infant will need a blood test after completion of the vaccine series to confirm that your child is protected against the hepatitis B virus. This test is routinely completed at 9 to 18 months of age.
- Make sure your loved ones are vaccinated to protect them against the hepatitis B virus.
- Avoid drinking alcohol and get the hepatitis A vaccine.
- Remember hepatitis B can be transmitted through unprotected sex and contaminated blood. Do not share toothbrushes, razors or needles and cover all wounds with a bandage.
If you work in a laboratory
Report all hepatitis B surface antigen-positive (HBsAg-positive) results (including repeat testing, even if the results have been previously reported) within 24 hours to the local health department in the county where the patient resides or the PHBPP.
If you provide prenatal care
- Test every pregnant woman during each pregnancy for HBsAg even if they have been previously vaccinated or tested
- Inform pregnant women of their HBsAg status
- Send a copy of the HBsAg test result for current pregnancy with prenatal records to the delivery hospital
- Report all HBsAg-positive pregnant women to the LHD within 24 hours (even if they were previously reported)
- Counsel HBsAg-positive pregnant women about their status and refer for appropriate care
- Contact the pediatric provider to communicate the woman’s HBsAg-positive status and the need for hepatitis B vaccination and hepatitis B immune globulin for the infant
- Assess HBsAg-negative pregnant woman’s risk for hepatitis B virus infection
- Counsel HBsAg-negative pregnant woman on methods to prevent HBV transmission
- Vaccinate pregnant HBsAg-negative women
- Retest high risk pregnant HBsAg-negative women in their last trimester
If you work in the hospital labor and delivery unit or in the nursery unit
- Review and record the maternal HBsAg test result for the current pregnancy on both labor and delivery record, birth certificate and on EPID-399
- If a woman presents with an unknown HBsAg status or with risk factors, test for HBsAg status STAT
- If STAT test result is HBsAg-positive, report to the LHD within 24 hours (even if they were previously reported)
- Give all infants monovalent hepB vaccine at birth
- Give all infants born to HBsAg-positive women single-antigen hepB vaccine and HBIG within 12 hours of birth
- Report administration of HBIG and hepB vaccine on the electronic birth certificate worksheet and EPID-399
- Report all HBsAg-positive women and the HBIG and hepB vaccine administration to the PHBPP with 24 hours of delivery
If you provide pediatric care
- Know the maternal HBsAg status for all infants to whom you provide care (if mother is HBsAg-positive and you were not contacted, the PHBPP may not be aware of her status and will need to be notified).
- Complete the recommended hepB vaccination series and post-vaccination serology for HBsAg and anti-HBs quantitative for all infants born to HBsAg-positive women.
- If infant is HBsAg and anti-HBs negative, repeat three doses of hepB vaccine and retest one month later.
- If the infant is HBsAg-positive, counsel the family and refer the infant for appropriate care.
- Report hepB administration and post-vaccination serology results to the PHBPP.
If you provide health care to a contact of an HBsAg-positive woman
- Identify, test and treat all household and sexual contacts of women who are HBsAg-positive.
- Counsel HBsAg-positive contacts and refer them for appropriate care.
- Give susceptible contacts three doses of hepB vaccine and complete post-vaccination serology.
- Report hepB administration and post-vaccination serology results to the PHBPP.