Perinatal Transmission

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
• Screening all HBsAg-positive pregnant women for HBV DNA to guide the use of maternal antiviral therapy during pregnancy. AASLD suggests maternal antiviral therapy when HBV DNA is >200,000 IU/mL
• 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 within 12 hours of birth
• Routine vaccination of all infants with the hepatitis B vaccine series, with the first dose administered within 24 hours of  birth

Guidelines and Recommendations

Scientific Tools and Resources

Commercial Hepatitis B Serologic Assays

• Anti-HBs assays Cdc-excel[XLS – 15 KB] (updated in 2012)
• HBsAg assays Cdc-excel[XLS – 14 KB] (updated in 2012)

Interpretation of Hepatitis B Serologic Test Results

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

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

Page one lists the 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 Cdc-pdf[PDF- 2 pages]

Policies and Procedures for Prenatal Care and Delivery Hospitals

Prenatal Care

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

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

Delivery Hospitals

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

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

Sources for HBIGCdc-pdfExternal
HBIG Tables for download Cdc-pdf[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 CDC 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 websiteExternal 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 websiteExternal.

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 Cdc-pdf[PDF – 3 pages]
AppendixA Cdc-pdf[PDF – 2 pages]

Additional Resources

• Perinatal Hepatitis B Prevention 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
• Childhood Immunization Schedule
• Laboratory Reporting of Pregnancy Status for hepatitis B-positive Women
• PVST Panels for Infants Born to 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.
• Menu of State Healthcare Facility Hepatitis B Vaccination Laws from the CDC Public Health Law Program
• Give birth to the end of Hep BExternal from Immunization Action Coalition

Patient Education Tools

Fact Sheets

 

Educational Slide Presentations

Hepatitis B and a Healthy Baby
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. The 13 page slide set uses simple language and has audio in: Mandarin Chinese, Hmong, Korean, and Vietnamese, as well as English. Tagalog, in the form of Taglish, is available in a written format only.

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. The text is in easy to understand English, and is also available in Spanish.