Management of Infants Born to Women with Hepatitis B Virus Infection for Pediatricians

Management of Infants Born to Women with

Hepatitis B Virus Infection for Pediatricians

Management of Perinatally Hepatitis B Virus (HBV)-Exposed Infants

with Birth Weights ≥2,000 grams (≥4.4 lbs)

Administer hepatitis B immune globulin (HBIG) and single-antigen vaccine in separate limbs

at birth (≤12 hours).

Complete vaccine series with 2 additional doses of single-antigen vaccine (3 total doses) OR

with 3 additional doses of combination vaccine (4 total doses).

≤12 hours of birth 1 mo 2 mos 4 mos 6 mos

Single-Antigen

Vaccine Series*

dose 2

dose 3

dose

Single-Antigen

and Combination

Vaccine Series*

dose (single-

antigen vaccine)

dose 3

dose 4

dose

*Administer the ﬁnal dose no earlier than 6 months of age (minimum age 164 days includes 4-day grace period). Complete postvaccination serologic testing

(PVST) at 9–12 months of age (or 1–2 months after ﬁnal dose, if series delayed) by testing for ONLY hepatitis B surface antigen (HBsAg) and antibodies to

hepatitis B surface antigen (anti-HBs). Do NOT test for antibodies to hepatitis B core antigen (anti-HBc).

Management of Perinatally Hepatitis B Virus (HBV)-Exposed Infants

with Birth Weights <2,000 grams (<4.4 lbs)

Administer HBIG and single antigen vaccine in separate limbs at birth (≤12 hours).

Complete vaccine series with 3 additional doses of single antigen or combination vaccine

(4 total doses).

≤12 hours of birth 1 mo 2 mos 3 mos 4 mos 6 mos

Single-Antigen

Vaccine Series*

dose 2

dose 3

dose 4

dose

Single-Antigen and

Combination Vaccine

Series*

dose (single-

antigen vaccine)

dose 3

dose 4

dose

*Administer the ﬁnal dose no earlier than 6 months of age (minimum age 164 days includes 4-day grace period). Complete postvaccination serologic testing

(PVST) at 9–12 months of age (or 1–2 months after ﬁnal dose, if series delayed) by testing for ONLY hepatitis B surface antigen (HBsAg) and antibodies to

hepatitis B surface antigen (anti-HBs). Do NOT test for antibodies to hepatitis B core antigen (anti-HBc).

Interpreting Post Vaccination Serologic Test (PVST) Results

Immune Still Susceptible

HBsAg-Negative

Anti-HBs-Positive

Antibody Level ≥10mIU/mL

No further follow up necessary

Report results to your Perinatal

Hepatitis B Prevention Program

(PHBPP) coordinator.

https://www.cdc.gov/vaccines/vpd/hepb/hcp/

perinatal-contacts.html

HBsAg-Negative

Anti-HBs-Negative

Antibody Level <10mIU/mL

Needs additional follow

up and vaccines

Contact your PHBPP coordinator

for assistance

https://www.cdc.gov/vaccines/vpd/hepb/hcp/

perinatal-contacts.html

Infected

HBsAg-Positive

Anti-HBs-Negative

Antibody Level <10mlU/mL

Needs additional follow up

Contact your PHBPP coordinator

for assistance

https://www.cdc.gov/vaccines/vpd/hepb/hcp/

perinatal-contacts.html

CS 325363-A September 29, 2021

Hepatitis B Virus FAQs

What is hepatitis B virus (HBV)?

Hepatitis B is an infectious liver disease. The infection

can be acute or chronic. Chronic infections can lead

to cirrhosis, liver cancer, and premature death. Though

usually asymptomatic, most infants (90%) who are

infected with HBV will develop chronic infection and 25%

will die prematurely from liver cancer or cirrhosis. HBV is

transmitted through contact with infectious blood or body

uids or from a person who is infected (HBsAg+) to their

newborn during delivery.

Can perinatal transmission be prevented?

Yes, perinatal transmission can be prevented by

screening for HBsAg during every pregnancy. Infants

born to HBsAg+ women should receive HBIG and a

dose of single-antigen hepatitis B vaccine ≤12 hours

of birth, followed by a complete series of hepatitis B

vaccine, which is up to 94% effective in preventing

perinatal transmission.

What if my practice identifies a Perinatally

HBV-exposed newborn that did not receive

HBIG before hospital discharge?

The infant should receive an urgent referral to receive

HBIG, which can be administered up to 7 days after

birth. If more than 7 days have passed, HBIG is unlikely

to be effective in preventing transmission. However, it

is still important for the infant to complete the hepatitis

B vaccine series, and providers should adhere to the

minimum intervals between doses.

What is postvaccination serologic testing (PVST)

and why is it necessary?

Postvaccination serologic testing (PVST) is recommended

for infants and children born to women with hepatitis B

infection. Serologic testing conrms whether the child has

developed immunity or has been infected with HBV. PVST

should include hepatitis B surface antigen (HBsAg) and

hepatitis B surface antibody (anti-HBs) only. PVST should

occur between 9–12 months of age or 1–2 months after

vaccine series completion, if the series is delayed. Note:

Tests for antibodies to hepatitis B core antigen (anti-HBc)

should not be ordered.

Why aren’t antibodies to hepatitis B core antigen

(anti-HBc) included in PVST?

A positive anti-HBc test result indicates a past or current

hepatitis B infection. In infants, a positive anti-HBc test

may result from measuring passively acquired maternal

antibodies that are detectable in HBV-exposed infants up

to 24 months of age.

Why must providers wait until the infant is 9

months of age to perform PVST?

Testing performed before 9 months of age can provide

inaccurate anti-HBs results by detecting passive

antibodies from HBIG administered at birth rather

than actual response to the hepatitis B vaccine. Also,

for infants who receive HBIG at birth, there can be a

prolonged HBV incubation period. Waiting until 9 months

of age can maximize detection of late HBV infection

if present.

If vaccine series completion is delayed and I

am concerned that the infant will NOT return for

PVST, can I perform testing immediately after

completing the vaccine series?

No, transient HBsAg positivity has been reported for up

to 18 days after vaccination. To assure accurate PVST

results, the test must be conducted at 9–12 months of

age or 1–2 months after vaccine series completion if the

series is delayed.

Can PVST be delayed until the infant is older?

No, anti-HBs concentrations decline rapidly within the rst

year after the series is completed. Delaying PVST beyond

the recommended time frame may yield a negative/non-

reactive anti-HBs result, making it difcult to determine if

immunity has waned or vaccine has failed. This ambiguity

may lead to unnecessary revaccination. For this reason,

providers are encouraged to test at 9–12 months of age

or 1–2 months after vaccine series completion if the series

is delayed.

Is assistance available for management of HBV-

exposed infants?

Yes, CDC provides funding and technical assistance for

perinatal hepatitis B prevention programs (PHBPPs) in

all 50 states and 14 other jurisdictions. All Perinatally

HBV-exposed infants should be managed by the PHBPP.

To nd contact information for the perinatal hepatitis B

prevention program coordinator in your area, please go to:

https://www.cdc.gov/vaccines/vpd/hepb/hcp/perinatal-

contacts.html

PHBPP Coordinator contact information:

CDC Tip Sheet is adapted with permission from the Georgia Department of

Public Health publication, “A Pediatric Guide: Caring for Infants Born to Hepatitis

B-Infected Mothers.”

*Reference: MMWR, January 12, 2018, Vol 67,(1);1–31, Prevention of Hepatitis B

Virus Infection in the United States: Recommendations of the Advisory Committee on

Immunization Practices. https://www.cdc.gov/mmwr/volumes/67/rr/rr6701a1.htm