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Perinatal Transmission

Prgnant woman holding a glass and looking out a window.

Hepatitis B virus (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.

Preventing perinatal HBV transmission is an integral part of the national strategy to eliminate hepatitis B in the United States. National guidelines call for the following:

  • Universal screening of pregnant women for HBsAg during each pregnancy
  • Case management of HBsAg-positive mothers and their infants
  • Provision of immunoprophylaxis for infants born to infected mothers, including hepatitis B vaccine and hepatitis B immune globulin
  • Routine vaccination of all infants with the hepatitis B vaccine series, with the first dose administered at birth

Guidelines and Recommendations

Hepatitis B Vaccination Recommendations for Infants, Children, and Adolescents MMWR 2005;54(RR-16)
Appendix A: Case Finding and Management of HBsAg-Positive Persons
Appendix B: Immunization Management Issues
Appendix C: Postexposure Prophylaxis
PDF version [PDF – 39 pages]: (with appendices)

Scientific Tools and Resources

Commercial Hepatitis B Serologic Assays

Updated 2012

Interpretation of Hepatitis B Serologic Test Results

image of publication

This one page tool describes the four most common tests used in hepatitis B serologic testing and provides guidance to interpret different patterns of test results.
Summary Table [PDF- 1 page]

Screening Pregnant Women for Hepatitis B Virus (HBV) Infection and Screening and Referral Algorithm for hepatitis B Virus (HBV) Infection among Pregnant Women

Icon reflecting two page tool

Page one of this tool lists newly offered prenatal hepatitis B surface antigen (HBsAg) tests at four major commercial laboratories that indicate pregnancy status on reportable positive HBsAg results. Page two provides a clinical algorithm for screening and referral of pregnant women who are HBsAg-positive.  Tool [PDF- 2 pages]

Policies and Procedures for Prenatal Care and Delivery Hospitals

Prenatal Care

Prenatal Care Provider Policies and Procedures [PDF – 1 page]

Algorithm Illustrating Prenatal Care Provider Testing Procedures [PDF – 1 page]

Delivery Hospitals

Algorithms illustrating delivery hospital procedures to prevent perinatal HBV transmission when maternal HBsAg test results are available [PDF – 1 page] and unavailable [PDF – 555 KB]

Guidelines for Standing Orders in Labor & Delivery & Nursery Units to Prevent Hepatitis B Virus (HBV) Transmission to Newborns [PDF – 2 pages]

Sources for HBIG
HBIG Tables for download [PDF – 2 pages]

Reporting Requirements by State
Maternal Hepatitis B Screening and Reporting Requirements (by State)

National Quality, Forum (NQF) Measure 0475 “hepatitis B Vaccine Coverage Among All Live Newborn Infants Prior to Hospital or Birthing Facility Discharge”

The National Quality Forum (NQF) has endorsed the Centers for Disease Control and Prevention NQF Perinatal Measure 0475 “Hepatitis B Vaccine Coverage Among All Live Newborn Infants Prior to Hospital or Birthing Facility Discharge.” This measure was 1 of 14 measures formally endorsed by the NQF Board of Directors on April 2, 2012. Measure 0475 can be found on the NQF website and was updated there on April 2, 2014 with e-specification for calculation of the measure, which can also be found on the Agency for Healthcare Research and Quality’s website.

As a quality indicator, each hospital/birthing facility is encouraged to measure the rate of administration of the first dose of hepatitis B vaccine prior to discharge among all live infants born in their hospital/birthing facility during a specific time period (usually one calendar year). Hospitals are asked to exclude infants whose parents refused vaccination. Please find below documents outlining the specifications for the measure and an appendix of the ICD-9 codes and ICD-10 codes that might be used to calculate the hepatitis B birth dose coverage rate.
NQF #0475 [PDF – 3 pages]     AppendixA [PDF – 2 pages]

Public Health Department Perinatal Hepatitis B Coordinator List

Contact information for state, territorial, and local coordinators who work in the health department and provide case management to prevent perinatal transmission of HBV infection
Perinatal Hepatitis B Prevention Coordinator List

Childhood Immunization Schedule

Case Management

Components of Case Management Programs to Prevent Perinatal hepatitis B Virus (HBV) Infection [PDF – 2 pages]

Laboratory Reporting of Pregnancy Status for hepatitis B-positive Women

Information for laboratory reporting of HBsAg-positive pregnant women

PVST Panels for Infants Born to HBV-infected Women

Information on post-vaccination serologic testing (PVST) for infants born to hepatitis B virus (HBV)-infected women and information on an effort to improve PVST among this group by recruiting laboratories to offer hepatitis B PVST panels for infants.

Patient Education Tools

Fact Sheets

Title English Other Languages
Color B/W Color B/W
When a Pregnant Woman Has Hepatitis B PDF PDF
Hepatitis B and Your Baby PDF PDF Spanish Spanish

Educational Slide Presentations

Hepatitis B and a Healthy Baby

Audio enhanced

This slide presentation is audio-visual educational tool that describes the importance of getting babies vaccinated against hepatitis B if a mother has hepatitis B infection. It can be played from the website, or downloaded and printed to be used as a flip chart. The 13 page slide presentation uses plan and simple language. Audio is available in:

  • Mandarin Chinese
  • Hmong
  • Korean
  • Vietnamese
  • Tagalog/Taglish (written only)
  • English

Hepatitis B and Your Healthy Baby

This slide presentation is a 24 page illustrated educational tool for pregnant women who have hepatitis B. The slide presentation explains the importance of getting babies vaccinated against hepatitis B to prevent transmission of the disease. It is available in a written format only, but can be downloaded and printed to be used as a flip chart. The text is in easy to understand English, and also available in Spanish.

Specific Sites and Tools