Perinatal Hepatitis B Prevention
The
number of
births to hepatitis B surface antigen positive women in North Dakota has
continued to increase over the years. Pregnancy in a Hepaitis B positive person
is a reportable condition in North Dakota. Health Care Providers
are responsible for reporting hepatitis B positive pregnant
women to the North Dakota Department of Health (NDDoH).
This can be done by filling out the
Health
Care Provider Report Form and faxing it to the NDDoH's
confidential fax: 701.328.0355.
Transmission of hepatitis B virus from
mother to infant during the perinatal period is the most
efficient mode of hepatitis B virus infection and can lead to
severe long-term sequelae. Infants born to hepatitis B surface
antigen positive mothers have a 70-90 precent chance of
acquiring perinatal hepatitis B infection, and approximately 90
percent of infected infants will become chronic hepatitis B
virus carriers.
Hepatitis B positive pregnant women
will be enrolled in the Perinatal Hepatitis B Prevention Program
with the NDDoH. The goal of this program is to eliminate the
incidence of hepatitis B infection in infants born to hepatitis
B positive women in North Dakota. More information on the NDDoH
Perinatal Hepatitis B Prevention Program is available in the
Protocol for the Prevention of Perinatal Hepatitis B.
Perinatal Provider Responsibilities:
¨ All pregnant women should be screened for hepatitis
B surface antigen.
¨ Hepatitis B surface antigen positive women should be tested
for hepatitis B virus deoxyribonucleic acid (HBV DNA).
¨ Hepatitis B positive pregnant women should be reported to
the NDDoH by the health care provider using the
Health
Care Provider Report Form (completed and faxed to
701.328.0355).
Hospital Responsibilities:
¨ The
mother's hepatitis B surface antigen laboratory results should be
reviewed upon admission to the delivery hospital. If these are
not available, the woman should be tested as soon as possible.
¨
After delivery, the infant should receive the
hepatitis B vaccine birth dose and hepatitis B immune globulin
(HBIG) within 12 hours of birth, regardless of the infants
weight.
¨ TIf
mother's status is still unknown, infant should receive hepatitis
B vaccine birth dose within 12 hours of birth regardless of
birth weight.
¨ Infants
<2000 grams should also receive HBIG if status isn't determined
within 12 hours.
¨ Infants
≥2000 grams should receive HBIG if mother is determined to be
HBsAg+, as long as it has not been longer than 7 days.
¨ The
Hospital Report Form should then be completed and faxed
to the NDDoH (701.328.0355).
Pediatric Provider Responsibilities:
¨ It is important that the infant receives the remaining two
doses of hepatitis B vaccine on time. If the infant was less
than 2kg at birth, the infant will need to receive three
additional doses rather than two. The infants primary care
provider should report all hepatitis B doses to the NDDoH using
the Provider
Checklist (fax to 701.328.0355) each time the
child receives a dose of hepatitis B vaccine.
¨ One to two months after the last hepatitis B vaccine dose,
and when the child is at least nine months old, post-vaccination
serological testing (PVST) should be done to ensure the child
has not developed hepatitis B infection (HBsAG) and has
developed adequate antibody to hepatitis B surface antigen
(anti-HBs). This ensures that the child is protected from the
virus. The Provider
Checklist should be completed and returned to
the NDDoH after the serological testing is completed, regardless
of the results.
¨ If the infant has not developed adequate immunity (anti-HBs
>10 IU/mL) the infant will need to receive one additional dose
of hepatitis B vaccine. ACIP recommends one additional dose,
followed by PVST (anti-HBs) to ensure the infant has
seroconverted. If the infant has not, two additional doses
should be given followed by another PVST. Providers may also
chose to give the full series again and then test for
seroconversion.
Provider Documents:
Health Care Provider
Hepatitis B Report Form:
Health
Care Provider Report Form
Hepatitis B Hospital
Report Form:
Hospital Report Form
Provider Checklist:
Provider
Checklist
Protocol for the Prevention of Perinatal Hepatitis B.
More Resources on Perinatal Hepatitis B Prevention can be found
at the following links:
CDC Perinatal
Hepatitis B Transmission:
https://www.cdc.gov/hepatitis/hbv/perinatalxmtn.htm
CDC Post-vaccination
serological testing (PVST) for infants born to hepatitis B
positive women:
https://www.cdc.gov/hepatitis/hbv/pvst.htm
Interpretation of
hepatitis B serological test results:
https://www.cdc.gov/hepatitis/hbv/pdfs/serologicchartv8.pdf
CDC Patient Education
Fact Sheet on Perinatal Hepatitis B:
https://www.cdc.gov/hepatitis/HBV/PDFs/HepBPerinatal-ProtectWhenPregnant.pdf
https://www.cdc.gov/hepatitis/HBV/PDFs/HepBPerinatal-ProtectHepBYourBaby.pdf
Immunization
Action Coalition Hepatitis B Birth Dose Materials:
http://www.immunize.org/birthdose/