Health-care practicitioners should ensure that pregnant women who test positive get the following information. During pregnancy or at the first visit:

Patients should receive counseling on:

• How to make behavior changes to decrease the potential of disease transmission;
• Support and information about how to seek appropriate medical care
• Encouragement to notify persons with whom there has been contact capable of transmitting the disease and why this is important
• The availability of prevention services provided for sexual and household contacts
• Increased understanding of hepatitis B infection, which includes the meaning of test results and the possible need for additional testing measures to evaluate her condition;
• The serious consequences of hepatitis B infection, the lifesaving importance of hepatitis B biologics administered to their infants, and the importance of bringing their infants in for post-vaccination serologic testing

At delivery:

• HBsAg-positive mothers need not be separated from their infants nor their infants placed in special isolation
• HBsAg-positive mothers are not precluded from breast-feeding unless there is significant breast pathology

During the first few months following delivery:

Provide or make available to the woman hepatitis B counseling that includes:

• Explanation of the need for timely vaccination with the hepatitis B vaccine for her infant and contacts
• Explanation of the importance of post-vaccination serology to check for infection and immunity

When you get the post-vaccination serology results back:

HBsAg	HBsAb (anti-HBs)	Interpretation of Results and Necessary Action
Negative	Positive >10mIU/ml*	The infant is immune to HBV
Negative	Negative <10mIU/ml	The infant is NOT immune to HBV. In this situation, the infant must receive a second series of hepatitis B vaccine. The first dose should be given as soon as possible after post-vaccination serology results are known. The second dose should be given one month later, and the third six months from the first dose. Repeat the anti-HBs testing 30 days after dose 3, and further vaccination or follow-up is not indicated.
Note: For infants who remain HBsAg-negative and anti-HBs negative following completion of the second series, an anti-HBc test should be performed. A positive anti-HBc test result indicates a resolved infection. The vaccination effort failed. The infant is infected with HBV and is likely to become a chronic carrier. Refer the child for clinical follow-up.
*Or <12mIU/ml, depending on methology.