Since 1991, the American College of Obstetricians and Gynecologists (ACOG), the American Academy of Pediatrics (AAP), and the Advisory Committee on Immunization Practices (ACIP) have recommended that all pregnant women be serologically screened for hepatitis B virus (HBV) infection. The State of Oregon supports these recommendations and advises that all pregnant women be tested for hepatitis B as part of their prenatal profile during every pregnancy. In addition, the ACIP recommends that infants born to women positive for HBV or women who have an unknown HBV status be enrolled in the Perinatal Hepatitis B Prevention Program (PHBPP) for case management in order to ensure they receive the proper preventative treatment. The major components of the PHBPP are to ensure that:
All pregnant women are tested for the hepatitis B surface antigen (HBsAg)
The following Oregon Revised Statute (ORS) and Oregon Administrative Rule (OAR) support the testing of women during every pregnancy for HBsAg.
- ORS 433.017 - Test of blood of pregnant woman required.
- OAR 333-019-0036 - Said blood sample be submitted for testing of reportable infectious diseases (including HBV).
If you do not have an identified laboratory for completing hepatitis B screening tests, the Oregon State Public Health Laboratory can test specimens submitted on pregnant women and their household, sexual contacts and infants.
HBsAg-positive women are reported and tracked
Laboratory and Provider reporting
Local Health Department reporting
Prenatal HBsAg testing records are provided to delivery hospitals
For all pregnant women:
- HBsAg test results should be included on all forms and in all records related to care during pregnancy
- A copy of the original HBsAg test result should be transferred from the prenatal care provider to the delivery hospital
Infants born to HBsAg-positive mothers are identified and provided the proper preventative treatment at birth and complete the hepatitis B vaccine series
- Within 12 hours of delivery, infants born to HBsAg-positive women should receive a dose of Hepatitis B Immune Globulin (HBIG), as well as the first dose of the hepatitis B vaccine series
- Completing the hepatitis B vaccine series by six months of age is recommended. The vaccination schedule for infants at high risk for hepatitis B are as follows:
||Not to be used < 6 weeks of age|
Use single antigen Hep B vaccine at birth
- Premature infants born to HBsAg-positive mothers should also receive HBIG and hepatitis B vaccine within 12 hours of birth. However, if the infant weighs <2,000 grams, do not count the first hepatitis B dose. Start the three dose series when the infant is more stable (typically 1 month of age) and follow the recommended spacing.
- For more information on vaccine spacing, please refer to the CDC immunization schedule.
Infants born to women without HBsAg test results are identified and managed
The date and time of delivery and hepatitis B vaccine administration should be recorded in the patient’s record, as well as the HBsAg test results once received. If the mother is found to be HBsAg-positive, HBIG should be administered to the infant as soon as possible (no more than 7 days after delivery).
Infants weighing <2,000 grams born to women without documented HBsAg test results should receive BOTH hepatitis B vaccine and HBIG if the mother's status cannot be determined in 12 hours.
- Hospital policies and procedures should be in place to ensure all women of unknown HBsAg status are identified, testing is ordered, and their infants receive post-exposure vaccination
Infants born to HBsAg-positive mothers complete post-vaccination serology testing (PVST)
- Infant PVST should be completed no earlier than 9 months of age, and at least 1-2 months after vaccine series completion.
- For PVST, HBsAg and antibody to HBsAg (anti-HBs) should be ordered. Antibody to hepatitis B core antigen (Anti-HBc) is not recommended because passively acquired material anti-HBc might be detected up to 24 months after birth in some infants. Interpretation of PVST results are as follows:
||The infant is immune or fully protected against HBV |
||The infant is still susceptible and needs to complete a second hepatitis B vaccine series (3 doses), followed by re-testing. †|
||The infant is infected and needs medical followup|
*Or ≥12mIU/ml, depending on methodology.
|†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 acute 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.|
For a full list of PHBPP activities, please visit the Morbidity and Mortality Weekly Report (Vol. 54) (pdf). Refer to page 16 for the components of case management.
In addition to these activities, it is also important to ensure that household and sexual contacts of women found to be HBsAg-positive during pregnancy are referred to the local health department to ensure they receive the proper testing and treatment as indicated.