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 between 26 and 28 weeks. 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.

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.

• 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.

• 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.

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.

• 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.

• 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 hepatitis B vaccine on the electronic birth certificate worksheet and EPID-399.
• Report all HBsAg-positive women and the HBIG and hepatitis B vaccine administration to the PHBPP with 24 hours of delivery.

• 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 hepatitis B 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 hepatitis B 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.

• 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 hepatitis B vaccine and complete post-vaccination serology.
• Report hepatitis B administration and post-vaccination serology results to the PHBPP.