Perinatal Hepatitis B - HAN
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Overview
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 ABsAg positive reports to local health departments/Chicago Department of Public Health (CDPH). Lab reports can either be from:
|
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 10 diagnosis codes indicating current or recent pregnancy when ordering HBsAg tests
Hepatitis B Vaccine Schedule
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) |
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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 |
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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. |
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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.
Perinatal Hepatitis B Prevention Guide Hepatitis B Vaccine Schedule for Infants born to HBsAg+ Mothers |
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Birth Weight |
If Mother’s HBsAg status is |
Hepatitis B Vaccine |
Give HBIG |
|
Dose |
Age |
|||
≥2000 g |
Positive |
1 |
Birth (≤12hrs) |
Birth (≤12hrs) |
2 |
1-2 months |
|||
3 |
6 months |
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≥2000 g |
Positive |
1 |
Birth (≤12hrs) |
Birth (≤12hrs) |
2 |
1 months |
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3 |
2-3 months |
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4 |
6 months |
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Note: Always report HBsAg positive test results to CDPH |
Perinatal Hepatitis B Prevention Guide Post-Vaccination Serology Testing for Infants born to HBsAg+Mothers |
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Post-Vaccination Serology Testing (9 months of age) |
Follow-up needed? |
|
Result |
Anti-HBs positive HBsAg negative |
None. Infant is protected |
Anti-HBs negative HBsAg negative |
No response. Infant is susceptible to infection. Repeat hep B monovalent vaccine series using an accelerated schedule of 0, 1, and 4 months. Recheck serology 1-2 months after third dose. |
|
Anti-HBs negative HBsAg positive |
Infant is infected with hepatitis B. Consult with liver specialist. |
|
Note: Always report HBsAg positive test results to CDPH with every pregnancy. |
Management Tools
Perinatal Hepatitis B Toolkit
CDC: General Hepatitis B Information
CDC: Hepatitis B and a Healthy Baby
CDC: Hepatitis B and Your Healthy Baby
Interpretation of Hepatitis B Serologic Test Results
CDC: Screening Pregnant Woman for Hepatitis B Virus (HBV) Infection
Perinatal Hepatitis B Palm Cards
Hepatitis B Testing and Support Services for Families at High Risk
230 W. Cermak 2nd floor
Chicago, IL 60616
F: (312) 225-8659
hongliu@maha-us.org
www.maha-us.org
Hepatitis-B Reporting
For Clinical Questions Or To Report Suspect Cases, Contact:
The CDPH Disease Reporting Hotline at 312-743-9000
*After hours, weekends, and holidays, call 311 and ask for the communicable disease physician on-call (or 312-744-5000 if outside the City of Chicago)
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Hepsini GörüntüleHepatitis-B Contacts
For Reporting Cases:
For Program Related Questions Contact:
VAN QUACH, RN
P: (312) 746-6281
F: (312) 746-6388