Perinatal Hepatitis B Prevention Pocket Guide

A pocket guide to assist healthcare providers with recommended strategies to prevent perinatal transmission of hepatitis B including the vaccine schedule for infants born to HBsAg positive mothers.

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Perinatal Hepatitis B Prevention Pocket Guide (PDF: 40KB/2 pages)

On this page:
Management of Pregnant Women
Management of Delivery and Infant
Case Management of Infants Born to HBsAg-positive Mothers
Interpretation of Serology Results

Management of Pregnant Women

Prenatal HBsAg Testing

  • Test ALL pregnant women within first trimester of EACH pregnancy, even if tested before or had hepatitis B vaccines.
  • Send copy of lab report with the HBsAg-positive results to the hospital of delivery and the infant’s healthcare provider.
  • Report to MDH all HBsAg-positive women within one working day of knowledge of the pregnancy.
  • Refer for or provide HBsAg-positive women counseling and medical management. Give the following information:
    • Modes of hepatitis transmission.
    • Perinatal concerns (i.e. HBsAg-positive mothers may breastfeed, treatment of newborns for exposure to hepatitis B).
    • Prevention of HBV to contacts, include vaccine prophylaxis for infant(s) and testing and/or hepatitis B vaccination for household, sexual, and needle-sharing contacts.
    • Substance abuse treatment and/or mental healthcare if appropriate.
    • Medical evaluation and possible treatment of chronic hepatitis B.

Management of Delivery and Infant

At admission for delivery:

  • Review HBsAg status of all pregnant women. Perform HBsAg testing as soon as possible on women who:
    • do not have a documented HBsAg test result,
    • were at risk for HBV infection during pregnancy, or
    • had clinical hepatitis since previous testing.
  • Retest HBsAg-negative women (at time of hospital delivery) with high-risk behaviors for infection:
    • Injection-drug use,
    • More than one sex partner in 6 months,
    • HBsAg-positive sexual partner,
    • Evaluation or treatment for sexually transmitted disease (STD),
    • Exhibits clinical hepatitis symptoms.
  • Place copy of maternal HBsAg results on labor/delivery record, infant’s delivery summary, and nursery medical record.

After delivery:

ALL infants should receive:
If mother’s
HBsAg status is:
Also give infant:
Hep B vaccine within 12 hours of birth
Positive
HBIG within 12 hours of birth
Negative
No HBIG needed

Unknown
(at discharge)

Give HBIG if test positive
Must be given within 7 days of birth

 

  • Preterm infants weighing less than 2,000g:
    • Born to HBsAg-positive mothers: give hep B vaccine and HBIG within 12 hours of birth.
    • Born to HBsAg-negative mothers: give first dose of hep B vaccine at one month of age.
    • Born to mothers whose HBsAg status is unknown:give hep B vaccine and HBIG within 12 hours of birth.
  • For HBsAg-positive mothers and mothers whose HBsAg status is unknown at time of discharge
    • Fax “Hospital Report Form” to MDH within 1 working day of infant’s birth.
    • Alert infant’s pediatric provider.
  • Record date and time vaccines were given on infant’s record.

Case Management of Infants Born to HBsAg-positive Mothers

  • Completion of hep B vaccine series at 1-2 months and 6 months of age (using monovalent vaccine).
  • If using a combination hep B vaccine (e.g. Hib-hep B or DTaP-IPV-hep B), final dose should NOT be administered before age 24 weeks (164 days).
  • Administration of 4 doses of hep B vaccine is permissible when giving combination vaccines after the birth dose.
  • Report all vaccine dates to local and/or state health departments.
  • Perform post-vaccination serology at 12 months of age. (No earlier than 9 months of age.)
  • Test for both HBsAg and anti-HBs.
  • Report test results to local and/or state health department.

Interpretation of Serology Results

Interpretation of Serology Results
Result Follow-up needed
Anti-HBs positive
HBsAg-negative

None. Infant is protected.
Anti-HBs negative
HBsAg-negative
No response. Infant is susceptible to infection. Repeat 3 doses of hep B vaccine series as soon as possible. Schedule of 0,1,4 months. Recheck serology 4-6 weeks after last dose. Monovalent hepatitis B vaccine must be used for second series.
Anti-HBs negative
HBsAg-positive
Infant infected with hepatitis B. Needs regular check-ups and liver function tests.
Remember to report HBsAg-positive test results to local and/or state health department.

Updated Tuesday, July 01, 2014 at 11:06AM