Perinatal Hepatitis B Prevention Program (PHBPP)
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The OSDH HIV/STD Service provides hepatitis B & C prevention activities, including but not limited to, education, vaccination and Perinatal hepatitis B prevention activities.
What is Hepatitis?
Hepatitis means inflammation of the liver. The liver processes nutrients, filters the blood and fights infections. When the liver is inflamed or damaged, how it works can be impacted.
Hepatitis is most often caused by a virus. In the U.S., the most common types of viral hepatitis are Hepatitis A, Hepatitis B and Hepatitis C. Heavy alcohol use, toxins, some medications and certain medical conditions can also cause hepatitis.
What is the Perinatal Hepatitis B Prevention Program (PHBPP)?
The perinatal hepatitis B prevention program (PHBPP) began in 1990 as part of the Vaccine and Immunization Amendments (P.L. 101-502). Congress recognized the need to foster efforts to prevent perinatal hepatitis B virus (HBV) transmission and made resources available to develop and implement programs. The Center for Disease Control and Prevention (CDC) has annually awarded funds which are then provided to awardees such as the State of Oklahoma to support the program.
An estimated 25,000 infants are born to hepatitis B surface antigen (HBsAg)-positive women each year in the United States. When a pregnant woman is infected with the HBV, it poses a serious risk that her newborn will contract the infection. Of the infants infected with HBV, 90% will develop chronic HBV infection. Twenty-five percent of infants or young children that are chronically infected with the HBV will die prematurely from cirrhosis or liver cancer.
Realizing these statistic and that transmission can be prevented the PHBPP strives to educate healthcare providers and the HBsAg-positive pregnant women on prevention and the importance of treatment.
What are the goals of the PHBPP?
The objectives of the PHBPP are the following:
- Identify HBsAg-positive pregnant women
- Assist with assuring that infants born to HBsAg-positive woman obtain timely and appropriate post-exposure prophylaxis at birth
- Assist with assuring infants born to HBsAg-positive woman complete hepatitis B vaccine series
- Assist with assuring infants born to HBsAg-positive woman obtain post vaccination testing (PVST) to identify HBsAg and HBsAb status
How to screen a pregnant woman for the hepatitis B virus (HBV)?
- All pregnant women should be tested for HBsAg during an early prenatal visit (e.g., first trimester) in each pregnancy, even if they have been vaccinated or tested previously. Testing those pregnant women known to be chronically infected with HBV provides documentation of the positive HBsAg test result obtained during pregnancy and helps to ensure that their infants will be identified for timely prophylaxis.
- All HBsAg-positive pregnant women should be tested for HBV DNA to guide the use of maternal antiviral therapy during pregnancy for the prevention of perinatal HBV transmission.
- American Association for the Study of Liver Diseases (AASLD) suggests maternal antiviral therapy when the maternal HBV DNA is >200,000 IU/mL.
- All HBsAg-positive pregnant women should be reported to the Oklahoma State Department of Health (OSDH) immediately upon suspicion, diagnosis or positive test and referred to their jurisdiction’s PHBPP for case management to ensure that their infants receive timely prophylaxis and follow-up. A copy of the original laboratory report indicating the pregnant woman’s HBsAg-positive status should be provided to the hospital or birthing facility where the delivery is planned and to the healthcare provider who will care for the newborn infant. See Resources-Disease Reporting Link
- All HBsAg-positive pregnant women should receive information concerning HBV that discusses the potential use of antiviral therapy, the importance of prophylaxis for their infant (HepB vaccine and hepatitis B immune globulin (HBIG) within 12 hours of birth), completion of the vaccine series, and post-vaccination serologic testing.
A negative test for the virus means either that there is no current infection or there is not yet a sufficient amount of the antigen to be detected. If a woman participates in high-risk activities that may transmit the HBV (such as unprotected sexual contact or intravenous drug use), retesting later in the pregnancy is generally advised.
- Ordering Prenatal Hepatitis B Surface Antigen (HBsAg) Tests from Major Commercial Laboratories
- CDC-Screening and Referral Algorithm for HBV Infection among Pregnant Women
How can perinatal hepatitis B transmission be prevented?
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 (HBIG) and hepatitis B vaccine to their infants within 12 hours of birth. In addition, it is important that the infant completes the hepatitis B vaccine series according to ACIP recommendations and that the post-vaccine serology tests (PVST) are drawn to know if transmission was prevented and the infant has an immunity to the HBV.
The state of Oklahoma requires all birthing hospitals to administer the birth hepatitis B vaccine to all live infants (unless an exemption is completed) within 12 hours of birth and document it in the Oklahoma State Immunization Information System (OSIIS).
- All Oklahoma birthing hospitals shall implement a procedure to ensure that the hepatitis B vaccination is administered to all live infants within twelve hours of birth and recorded in the Oklahoma State Immunization Information System. A parent or guardian may refuse hepatitis B vaccination of their newborn on the grounds of medical reasons or that such vaccination conflicts with their religious tenets or personal beliefs. A refusal based on medical reasons shall include a statement in the medical record by a physician stating that the physical condition of the newborn is such that the vaccination would endanger the life or health of the child and that the child should be exempt from the vaccination requirement. A refusal based on the parent's or guardian's religious tenets or personal beliefs shall be documented in the newborn's medical record. [Source: Added at 29 Ok Reg 1603, eff 7-12-12]
Oklahoma State Immunization Information System (OSIIS) Information-
What labs to draw to know if transmission of the hepatitis B virus (HBV) was prevented?
For infants born to HBsAg-positive women, perform post-vaccination testing (PVST) for anti-HBs (HBsAb) and HBsAg 2 months after completion of the vaccine series and when the child is at least 9 months of age. Testing should not be performed before 9 months of age and ideally done before 12 months of age.
Recommended PVST management is as follows:
- HBsAg-negative infants with anti-HBs concentrations of >10 mIU/mL are protected and need no further medical management;
- HBsAg-negative infants with anti-HBs concentrations of
- Infants who are HBsAg positive should be reported to OSDH and the PHBPP and receive appropriate follow-up.
Provider and Delivery Hospital Resources
CDC -Perinatal Hepatitis B Prevention (https://www.cdc.gov/hepatitis/hbv/perinatalxmtn.htm)
MMWR 2018 Prevention of Hepatitis B Virus Infections in the United States: Recommendations of the Advisory Committee on Immunization Practices (https://www.cdc.gov/mmwr/volumes/67/rr/rr6701a1.htm)
Interpretation of Hepatitis B Serologic Test Results (https://www.cdc.gov/hepatitis/hbv/pdfs/SerologicChartv8.pdf )
Delivery Hospital Algorithm (https://www.cdc.gov/hepatitis/hbv/pdfs/PerinatalAlgorithm-Avaliable.pdf )
Guidelines for Standing Orders in Labor & Delivery & nursery Units to Prevent Hepatitis B Virus (HBV) Transmission in Newborn (https://www.immunize.org/catg.d/p2130.pdf)
Ordering Prenatal Hepatitis B Surface Antigen (HBsAg) Tests from Major Commercial Laboratories(http://www.cdc.gov/hepatitis/hbv/pdfs/prenatalhbsagtesting.pdf)
Oklahoma Perinatal Hepatitis B Prevention Program (PHBPP) and Algorithm https://www.ok.gov/health2/documents/New PHBPP Color (02).pdf
CDC Immunization Provider Schedule (https://www.cdc.gov/vaccines/schedules/index.html)
Hepatitis B Vaccine Schedules for Infants, by Infants Birthweight and Maternal HBsAg Status (Table 3) Birthweight Schedule
MMWR 2015 Shortened Interval for Postvaccination Serologic Testing of Infants Born to Hepatitis B-Infected Mothers (https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6439a6.htm)
24 Hours Drop In Form https://www.ok.gov/health2/documents/DROPIN.pdf
Give the Birth Dose https://www.immunize.org/protect-newborns/guide/chapter2/give-birth-dose.pdf
Title 310 Oklahoma State Department of Health Chapter 667. Hospital Standards https://www.ok.gov/health2/documents/OK Law.pdf
Oklahoma State Immunization Information System (OSIIS) (https://www.okizserviceportal.com/)
Immunization Action Coalition (IAC) Birth Dose Initiative (https://immunize.org/protect-newborns/)
Know Your Role in the Perinatal Hepatitis B Prevention Program https://www.ok.gov/health2/documents/Know Your Role Scan.pdf
Asian Liver Center (http://liver.stanford.edu/ )
Patient Educational Resources
CDC Immunization Parent Friendly Schedule (https://www.cdc.gov/vaccines/schedules/index.html)
CDC Vaccine Information Statements (VIS) ( https://www.cdc.gov/vaccines/hcp/vis/current-vis.html)
IAC VIS (Translations Available) ( https://www.immunize.org/vis/)
CDC Hepatitis B Patient Education (https://www.cdc.gov/hepatitis/hbv/patienteduhbv.htm)
CDC Perinatal Hepatitis B Patient Education (Translations Available) (https://www.cdc.gov/hepatitis/hbv/perinatalxmtn.htm)
Asian Liver Center (http://med.stanford.edu/liver.html)
Free Brochures (Translations Available) (http://med.stanford.edu/liver/resources.html)
Free Brochure Order (http://med.stanford.edu/liver/resources/brochure_orders.html)
Additional Resources: http://www.cdc.gov/hepatitis/HBV/PerinatalXmtn.htm
Test results for all infants born to HBsAg-positive women should be faxed to the Perinatal Hepatitis B Prevention Coordinator at 405-271-5149.