Hepatitis B - Perinatal

ABOUT

Perinatally acquired hepatitis B virus (HBV) is a serious public health concern. Infants born to HBV-positive mothers are especially at risk of infection, as transmission during birth is very efficient. Approximately 90% of infants who acquire the disease at birth will develop chronic (lifelong) HBV infection, and one-fourth of the affected individuals will die prematurely from cirrhosis or liver cancer.

Perinatal HBV infection is preventable. Treatment with hepatitis B immune globulin (HBIG) and hepatitis B vaccination within 12 hours of birth, followed by completion of the 3-dose vaccine series is the most effective way to prevent the disease. Routine vaccination of all healthy infants with the hepatitis B vaccine series, with the first dose administered within 24 hours, can provide long term protection from HBV.

PREVENTION PROGRAM

The Perinatal Hepatitis B Prevention Program was created in 1990 to prevent mother-to child transmission of HBV. The program works with local health departments, medical providers, and delivery facilities to ensure newborns at risk for perinatally acquired HBV receive treatment at birth and complete the hepatitis B vaccine series on time. Testing is done at 9 -12 months of age to ensure the infant has developed antibodies to hepatitis B and is protected from the infection.

General Prevention Guidelines

All pregnant women should be tested for HBV at an early prenatal visit, even if vaccinated or previously tested.
All pregnant women who test positive for HBV should also have viral load (HBV DNA) testing and be referred for further medical evaluation. A high viral load can increase the risk of mother-to-child transmission of HBV.
Case management of HBV-positive mothers and their infants to ensure:
a) Hepatitis B immune globulin (HBIG) and hepatitis B vaccine are administered to the newborn within 12 hours of birth.
b) Completion of the hepatitis B vaccine series as recommended by the Advisory Committee on Immunization Practices (ACIP). This usually includes a second vaccination when the infant is 1-2 months and a third vaccination after six months of age. Infants weighing less than 2,000 grams (4.4 pounds) at birth will need an additional hepatitis B vaccination to complete the series.
c) Post vaccination serological testing when the infant is 9-12 months of age. This includes checking for HBV infection and antibody response to ensure protection from HBV.
Routine vaccination of all infants with the hepatitis B vaccine series, with the first dose administered within 24 hours of birth.

Additional information and national guidelines can be found on the Centers for Disease Control and Prevention website.