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Perinatal Hepatitis B: Pregnancy and Delivery

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:

HBsAgHBsAb (anti-HBs)Interpretation of Results and Necessary Action
NegativePositive >10mIU/ml*The infant is immune to HBV
NegativeNegative <10mIU/mlThe 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.