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/