Perinatal Hepatitis B

Perinatal Hepatitis B

Background

Hepatitis B is a liver infection that is caused by the hepatitis B virus (HBV). It is transmitted when blood, semen, or other body fluid with the virus infects someone who does not have the virus. People can become infected from birth (from infected mother to baby during birth), sexual contact with someone infected with HBV, sharing needles or syringes, or direct contact with blood/open sores.  Without post-exposure prophylaxis with HBIG and HepB vaccine, approximately 45% of infants born to HBV-infected mothers will become infected and up to 90% of those infected will develop chronic, life-long infection. Among infants who do develop infection, 25% will die prematurely of liver cirrhosis or cancer. Although, treatment of HBV infection is now possible and can attenuate the impact of infection, hepatitis B cannot yet be cured.

Prevention of perinatal hepatitis B infection requires prenatal identification and early reporting of HBV-infected mothers [hepatitis B surface antigen (HBsAg) positive] during each pregnancy.

The Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP) recommend:

  • Universal testing of pregnant women for HBsAg,
  • Testing HBsAg-positive pregnant women for HBV DNA.
  • Post-exposure prophylaxis within 12 hours of birth with HBIG and the first dose of HepB vaccine for infants born to HBV-infected mothers,
  • Universal HepB vaccination within 24 hours of birth for medically stable infants weighing ≥2,000 grams regardless of the mother’s HBsAg status.
  • Completion of a valid three or four dose vaccine series in all infants, and
  • Post-vaccination serologic testing (PVST) for HBsAg and anti-HBs at 9-12 months for infants born to HBV-infected mothers or infants born in regions of high and intermediate HBV endemicity.

The Chicago Department of Public Health (CDPH) Perinatal Hepatitis B Case Prevention Program (PHBPP) helps promote these recommendations and provides case management of HBV-infected mothers and their infants.

 

Perinatal HBV Exposure

REPORTING GUIDELINES FOR PEDIATRIC PROVIDERS:

Lab Reports

Laboratories are required to report HepBsAg positive reports to local health departments/Chicago Department of Public Health (CDPH).

Lab reports can either be from:

  • INEDSS- direct report electronically from laboratories
  • Faxed lab report for hospitals/outpatient labs

Telephone Reporting

Providers may report to CDPH directly by phone. CDPH investigator will fax the “Case Report Form” to provider with instructions to fax the report back to CDPH.

APORS (Adverse Pregnancy Outcome Reporting System)

Hospitals are advised to report Hepatitis B positive mothers/infants to APORS. The APORS report OF ANY HBsAg positive mother or infant born to an HBsAg positive mother to the CDPH for case management.

ROLE OF CDPH:

  • Review of all HBsAg positive laboratory results in women of child-bearing age and determine pregnancy status.
  • Enroll HBsAg positive women and their infants in the PHBPP.
  • Collaborate with healthcare providers, delivery hospitals, laboratories, and families in Chicago to ensure identification of HBsAg positive mothers, treatment of infants at birth, timely completion of hepatitis B vaccination, timely and appropriate post-vaccination serologic testing, identification and referral of household contact, and appropriate education of patients.
  • Complete documentation of case management of mothers in INEDSS and mothers and infants in CDPH data base(s).
  • Provide follow-up education as needed to the healthcare partners on reporting and appropriate immunoprophylaxis, vaccination and testing.
  • Provide standardized culturally appropriate health education materials to reinforce the importance of preventing perinatal hepatitis transmission.

ROLE OF CLINICIANS:

  • Notify CDPH for all HBV+ mothers.
  • Select a test designated as “prenatal” or on a prenatal/obstetric panel when ordering an HBsAg screening test for a pregnant woman to help ensure confirmatory testing is performed on all positive HBsAg screens.
  • Inform selected laboratory of a woman’s pregnancy status to ensure confirmatory testing is performed on all positive HBsAg screens.
  • Include any and all ICD- 9/10 diagnosis codes indicating current or recent pregnancy when ordering HBsAg tests.

Hepatitis B Vaccine Schedules

Hepatitis B Vaccine Schedules for Newborn Infants Weighing > 2,000 gm

By Maternal Hepatitis B Surface Antigen (HBsAg) Status

 

Mother’s HBsAg

Result

Single Antigen Vaccine

Single Antigen + Combination Vaccine

Dose

Age

Dose

Age

Positive

1st dose: Hep B

vaccine and HBIG

Within 12 hours of

birth (no longer than 7 days after birth)

1st dose: Hep B

vaccine and HBIG

Within 12 hours of birth

(no longer than 7 days

after birth)

2nd dose: Hep B vaccine

1-2 months

2nd dose: Combination vaccine

2 months

3rd dose: Hep B vaccine

6 months

3rd dose: Combination vaccine

4 months

Serology testing for HBsAg and anti-HBs

9 months

4th dose: Combination vaccine

6 months

Serology testing for

HBsAg and anti-HBs

9 months

Unknown

1st dose: Hep B vaccine and HBIG

Within 12 hours of

birth (no longer than 7 days after birth)

1st dose: Hep B vaccine and HBIG

Within 12 hours of birth (no longer than 7 days after birth)

Test mother for HBsAg immediately. If positive, continue series as above. If negative, continue series as below.

Test mother for HBsAg immediately. If positive,

continue series as above. If negative, continue

series as below.

Negative

1st dose: Hep B vaccine

Before discharge

1st dose: Combination vaccine

Before discharge

2nd dose: Hep B vaccine

1-2 months

2nd dose: Combination vaccine

2 months

3rd dose: Hep B vaccine

6-18 months

3rd dose: Combination vaccine

4 months

4th dose: Combination vaccine

6 months

 

Hepatitis B Vaccine Schedules for Preterm Infants Weighing < 2,000 gm

By Maternal Hepatitis B Surface Antigen (HBsAg) Status 

Mother’s HBsAG Result

Recommendation

Dose

Age

Positive

Hep B vaccine and HBIG

< 12 hours

1st dose: Hep B vaccine

1 month

2nd dose: Hep B vaccine

2-4 months

3rd dose: Hep B vaccine

6-7 months

Serology testing for HBsAg and anti-HBs

9 months or 1-2 months after 3rd dose

Unknown

1st dose: Hep B vaccine and HBIG

Within 12 hours of birth (no longer than 7 days after birth)

Test mother for HBsAg immediately. If positive, continue series as above. If negative, continue series as below.

Negative

1st dose: Hep B vaccine

Before discharge

2nd dose: Hep B vaccine

2-4 months

3rd dose: Hep B vaccine

6-18 months

 

Perinatal HBV infection

Can be prevented with appropriate infant case management.

Clinical Criteria: Perinatal HBV infection in a child ≤ 24 months of age may range from asymptomatic to fulminant hepatitis.

Laboratory criteria:

  • positive hepatitis B surface antigen (HBsAg) test (only if at least 4 weeks after last dose of Hep B vaccine)
  • positive hepatitis B e antigen (HBeAg) test
  • detectable HBV DNA

CSTE 2017 Case Definition (https://wwwn.cdc.gov/nndss/conditions/hepatitis-b-perinatal-virus-infection/case-definition/2017/ )

PROBABLE CASE:

  • If a child born in the US and positive for HBsAg at ≥ 1 month of age and ≤ 24 months of age OR
  • If a child is positive for HBsAg or HBV DNA ≥9 months of age and ≤ 24 months of age, but whose mother’s hepatitis B status is unknown (i.e. epidemiologic linkage not present).

CONFIRMED CASE:

  • If a child born in the US to a HBV-infected mother and positive for HBsAg at ≥ 1 month of age and ≤ 24 months of age OR
  • If a child is positive for HBeAg or HBV DNA ≥9 months of age and ≤ 24 months of age.

 

Contact Information

FOR REPORTING CASES: (312) 743 – 9000

FOR PROGRAM RELATED QUESTIONS CONTACT:

VAN QUACH, RN

P: (312) 746-6281

F: (312) 746-6388

Hepatitis B Testing and Support Services for Families at High Risk

MIDWEST ASIAN HEALTH ASSOCIATION

230 W. Cermak 2nd floor

Chicago, IL 60616

F: (312) 225-8659

hongliu@maha-us.org

www.maha-us.org

 

Narjus Sayeed, MPH

ASIAN HUMAN SERVICES

4753 N. Broadway, Suite 700

Chicago, IL 60640

T: (773) 293-8441

nsayeed@ahschicago.org

www.ahschicago.org

 

Doha Mohammad

Hepatitis B Project Coordinator

ASIAN HUMAN SERVICES

4753 N. Broadway, Suite 700

Chicago, IL 60640

T: (773) 293-8498

dmohammad@ahschicago.org   

www.ahschicago.org

Resources

Schillie S, Vellozzi C, Reingold A, et al. Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the ACIP. MMWR 2018;67(No. RR-1):1–31. DOI: http://dx.doi.org/10.15585/mmwr.rr6701a1

Terrault NA, Bzowej NH, Chang K-M, et al. AASLD Guidelines for Treatment of Chronic Hepatitis B. https://www.aasld.org/sites/default/files/guideline_documents/hep28156.pdf

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