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

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