Perinatal Hepatitis B
The PDPH Perinatal Hepatitis B Program works with families and physicians to identify cases and ensure that at-risk children will not be infected with Hepatitis B virus (HBV).
HBV infection in a pregnant woman poses a serious risk to her infant at birth. Without postexposure immunoprophylaxis, approximately 40% of infants born to HBV-infected mothers in the United States will develop chronic HBV infection, approximately one-fourth of whom will eventually die from chronic liver disease. Perinatal HBV transmission can be prevented by identifying HBV-infected (i.e., Hepatitis B surface antigen [HBsAg]-positive) pregnant women and providing Hepatitis B immune globulin and Hepatitis B vaccine to their infants within 12 hours of birth.
Perinatal Hepatitis B Program
The PDPH Perinatal Hepatitis B Program was created to eliminate perinatal transmission of Hepatitis B. In order to do so, the Perinatal Hepatitis B Program aims to:
- Ensure that all pregnant residents of Philadelphia are screened for Hepatitis B.
- Ensure that all infants born to HbsAg-positive mothers receive immuno-prophylaxis and post-immunization screening for Hepatitis B as recommended by the Advisory Committee on Immunization Practices and the American Academy of Pediatrics.
- Identify and screen all household and sexual contacts of all HbsAg-positive women and to immunize all who are susceptible to Hepatitis B.
- Educate the public and health care providers about Hepatitis B and its prevention.
HbsAg-positive pregnant women and their infants and sexual and household contacts are eligible.
Perinatal Hepatitis B Services
The Perinatal Hepatitis B Program offers the following services:
- Contact identification and education.
- Home visits by public health nurse to HbsAG-positive women and contacts for health education and case management.
- Referral to medical providers for screening and immunization of contacts and medical management if HbsAg positive.
- Drawing blood for serologies in the home from contacts who can’t or won’t accept care at a medical care facility.
- Giving Hepatitis B vaccine to susceptible contacts and other vaccines to children whose immunizations are delayed, in the home if necessary.
- Medical consultation with Infectious Disease specialist on Hepatitis B for primary medical care providers.
- In-service education programs on Hepatitis B providers of prenatal, obstetric, neonatal and pediatric care.
General Perinatal Hepatitis B Exposure Prevention Recommendation
Perinatal Hepatitis B Prevention (Minimum age: birth)
- Administer monovalent HepB vaccine to all newborns before hospital discharge.
- For infants born to hepatitis B surface antigen (HBsAg)–positive mothers, administer HepB vaccine and 0.5 mL of hepatitis B immune globulin (HBIG) within 12 hours of birth. Administer HepB vaccine at 1 month (dose 2) and 6 months of age (dose 3). These infants should be tested for HBsAg and antibody to HBsAg (anti-HBs) at 9 – 12 months of age (preferably 9 months).
- If mother’s HBsAg status is unknown, within 12 hours of birth administer HepB vaccine regardless of birth weight. For infants weighing less than 2,000 grams, administer HBIG in addition to HepB vaccine within 12 hours of birth. Determine mother’s HBsAg status as soon as possible and, if mother is HBsAg-positive, also administer HBIG for infants weighing 2,000 grams or more as soon as possible, but no later than age 7 days.
- The recommendations for infants with low birth weight (<2,000 grams) can be found in the next section.
Information for the Hepatitis B immunization schedule is taken directly from the CDC’s Recommended Immunization Schedule for Persons Aged 0 Through 18 Years — 2015.
MMWR October 9, 2015 Update: Shortened Interval for Postvaccination Serologic Testing of Infants Born to Hepatitis B-Infected Mothers
Low Birth Weight Hepatitis B Exposure Prevention Recommendation
Preterm infants with low birth weight (< 2,000 grams) born to HBsAg positive women and women with unknown HBsAg status must receive immunoprophylaxis with HBV and HBIG within 12 hours of birth. Preterm infants of low birth weight whose mothers are laboratory-confirmed HBsAg negative can receive the first dose of the HBV series at chronologic age 1 month. Preterm infants discharged from the hospital before chronologic age 1 month can also be administered HBV at discharge if they are medically stable and have gained weight consistently. The full recommended dose should be used. See the table below for the full recommendation.Click here to view the table in a larger format.
Perinatal Hepatitis B Prevention Report Form
Please use the form below for perinatal Hepatitis B reporting in Philadelphia:
Hepatitis B Resources
Below is a list of many resources on Hepatitis B infection and the vaccine:
- Hepatitis B Vaccine Information Statement
- Hepatitis B Vaccination of Infants, Children, and Adolescents (CDC)
- Hepatitis B General Information Fact Sheet (CDC)
- Protect Your Baby for Life (CDC)
- When Someone Close To You Has Hepatitis B (CDC)
- Hepatitis B and Sexual Health (CDC)
- Information for Gay/Bisexual Men (CDC)
- Asian Liver Center — Stanford University
Perinatal Hepatitis B Program Statistics
In 2010, the most recent year with follow-up completed, 165 live infants were born to women with chronic HBV who reside in Philadelphia, 161 of which were managed by the program. That year, 99% of these infants received the birth dose of HBV vaccine and the Hepatitis B Immunoglobulin (HBIG). By one year of age, 87% of these infants had received all immunophylaxis (HBIG and 3 vaccine doses). Of the infants available for follow-up serological testing (some patients moved out of the jurisdiction or refused serology) 97% of infants were found to be immune. During home visits 130 household contacts of HBaAg+ mothers were identified, educated and offered free serological testing.
Last Updated: March 2013.