Guidelines for Perinatal Post-Vaccination Serologic Testing

Key points

  • Post-vaccination serologic testing (PVST) for infants includes testing for hepatitis B surface antigen (HBsAg) and antibody to hepatitis B surface antigen (anti-HBs) only.
  • Clinicians should provide PVST to infants born to a parent with hepatitis B virus (HBV) infection.
  • PVST helps clinicians determine whether the child has developed immunity or has HBV infection.
A doctor examining a newborn baby and making notes on her clipboard

Summary of recommendations

CDC recommends clinicians screen all pregnant people for HBsAg during each pregnancy, preferably in the first trimester, regardless of vaccination status, chronic disease, or testing history. A confirmed positive HBsAg test result indicates current HBV infection.

All infants born to an HBsAg-positive person should be tested after completing the hepatitis B vaccine series. Clinicians should test the infants for HBsAg and anti-HBs at 9–12 months of age, or 1–2 months after vaccine series completion if the series is delayed.

PVST helps identify if an infant born to an HBsAg-positive parent does not have an adequate immune response to an initial hepatitis B vaccine series — indicating that they might require additional vaccination. PVST can also identify infants with HBV infection.

Action steps for laboratories

Laboratories can play an important role in simplifying the identification of infants with HBV infection or an inadequate immune response to the hepatitis B vaccine series. Laboratories can offer a hepatitis B PVST panel consisting of tests for both HBsAg and anti-HBs for assessing vaccinated infants. Action steps are to:

1. Create a PVST panel for infants born to an HBsAg-positive parent.

  • CDC recommends this panel include two HBV serologic tests:
    • HBsAg (CPT: 87340)
    • Anti-HBs, quantitative (CPT: 86317) and/or qualitative (CPT: 86706)
  • Clearly indicate panel is intended for assessing both immunization and disease status of hepatitis B-vaccinated infants born to a parent infected with HBV.
    • Include “Post-Vaccination Serologic Testing for Infants Born to a Parent with Hepatitis B Virus” in name of panel.

2. Educate ordering clinicians.

  • Educate ordering clinicians about recommended laboratory test options and timing of PVST for infants born to an HBsAg-positive parent.
  • Encourage ordering clinicians to select the PVST panel when assessing disease and immunization of fully hepatitis B-vaccinated infants born to an HBsAg-positive parent.

Rationale

CDC estimates that only about 65% of infants born to an HBsAg-positive parent receive PVST after the hepatitis B vaccine series.

Laboratories can offer a hepatitis B PVST panel consisting of tests for both HBsAg and anti-HBs for assessing immunization of vaccinated infants born to an HBsAg-positive person. Offering this panel will assist clinicians in ordering recommended PVST.

Resources

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Content Source:
Division of Viral Hepatitis