Public health agency for Snohomish County
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Perinatal Hepatitis B Prevention
Providing blood testing and hepatitis B immunizations for infants and household/sexual contacts of hepatitis B positive women. HBsAG positive status during pregnancy is a required reportable condition in Washington State. Healthcare providers are legally required to report all acute hepatitis B and HBsAg positive pregnant women to their local health department within 3 days of the receipt of laboratory serology reports.
Our goal is to reduce the incidence of hepatitis B virus (HBV) in infants born to hepatitis B infected (HBsAg positive) mothers through case management of HBsAg pregnant women, their newborn infants, and household/sexual contacts. Individuals at risk for HBV infection are identified and followed for recommended immunizations and blood testing to ensure protection against hepatitis B infection.
Transmission of HBV perinatally, and during early childhood, causes increased chronic HBV infections. Children that are chronically infected have a higher rate of death due to cirrhosis and liver cancer. These infections can be prevented in 90% of at risk newborns with timely identification and treatment.
At Snohomish Health District, we provide blood testing and hepatitis B immunizations for infants and household/sexual contacts of hepatitis B positive women.
The Perinatal Hepatitis B coordinators at SHD monitor the program by:
  • Receiving notification of HBsAg positive mother's blood test.
  • Notification of the mother and her healthcare provider about SHD's program.
  • Following up with the delivery hospital regarding care of the infant.
  • Notifying the mother and infant's care provider when hepatitis B immunizations and testing are due.
  • Case reporting to Washington State's Department of Health.
Resources
List of Resources:
  1. A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States, MMRW, December 2005  web
    ACIP Hepatitis B Immunization Recommendations
  2. Appendix A: Case Finding and Management of Hepatitis B Surface Antigen (HBsAg)--Positive Persons During Delivery of Vaccination Services, MMRW, December 2005  web
    ACIP Hepatitis B Immunization Recommendations
  3. Appendix C: Postexposure Prophylaxis of Persons with Discrete Identifiable Exposures to Hepatitis B Virus (HBV), MMRW, December 2005  web
    ACIP Hepatitis B Immunization Recommendations
  4. Pregnancy and Hepatitis B FAQs  web
    CDC - Pregnancy and Hepatitis B FAQs
Information for Clients
Hepatitis B is a serious disease caused by a virus that attacks the liver. It can cause liver damage, liver cancer, and even death. Many people who get hepatitis B do not feel sick and may not know they have it. They can pass it on to their children and other family members without knowing it.
Hepatitis B is a virus that enters the liver through the blood. You can pass hepatitis B to others if you have just gotten the virus (acute hepatitis) or if you are a carrier of the virus (chronic hepatitis)
  • Acute hepatitis: 9 out of every 10 adults will get rid of the virus from their bodies after a few months.
  • Chronic hepatitis: 1 out of every 10 adults will never get rid of the virus from their bodies. These people are also called carriers and are said to be chronically infected.
Hepatitis B is passed by contact with the blood or other body fluids of someone who has the virus through:
  • Being born to a mother who has hepatitis B.
  • Having unprotected sex with someone who has hepatitis B.
  • Sharing needles and syringes with someone who has hepatitis B.
Infants
Up to 9 out of 10 babies born to infected mothers will end up being carriers for the rest of their lives if they do not receive the necessary immunizations. Babies, who become carriers, have chronic hepatitis B, and are more likely to develop liver cancer as adults.
It is important to do testing early in each pregnancy so your baby will get the recommended shots after delivery. Your baby will need Hepatitis B Immune Globulin (HBIG) and a hepatitis B shot when born. A few months after your baby gets HBIG and all 3 hepatitis B shots, the doctor will do a simple blood test to see if the hepatitis B shots are protecting the child.
When a baby has the hepatitis B series of immunizations 19 out of 20 babies who get the shots will be protected for life! The hepatitis B shots help babies' bodies make antibodies, which protect them from hepatitis B.
Infected mothers
Infected mothers you may safely breast-feed your baby if he or she gets a HBIG shot and hepatitis B vaccine within 12 hours of birth. Wash your hands well after touching your blood, bloody body fluids or vaginal fluids. Do not chew or taste test your baby's food, share toothbrushes, or other personal hygiene articles.
Household and sexual contacts
Since hepatitis B virus can be passed to household contacts and sex partner(s), they should be tested to see if they have the hepatitis B virus in their bodies. If they do not have the hepatitis B virus they should get the shots to protect themselves.
Resources
List of Resources:
  1. Hepatitis B fact sheet  web
    WA DOH - Hepatitis B fact sheet
  2. Hepatitis B information for Asian Americans and Pacific Islanders  web
    Hepatitis B information for Asian Americans and Pacific Islanders
  3. Hepatitis B vaccine information statement (VIS)  web
    Hepatitis B vaccine information statement (VIS)
  4. Local Resources for Families  web
    Local Resources for Families
  5. Vietnamese hepatitis B foundation  web
    Vietnamese hepatitis B foundation
Information for Providers
Since December 2000, HBsAG positive status during pregnancy has been a required reportable condition in Washington State. Healthcare providers are legally required to report all acute hepatitis B and HBsAg positive pregnant women to their local health department within 3 days of the receipt of laboratory serology reports, chronic infections are to be reported monthly (WAC 246-101).
Once the report is received, the Perinatal Hepatitis B Program coordinator enrolls the pregnant woman in a case management tracking program to provide her with additional information on hepatitis B prevention and recommendations for her infant and household contacts.
CDC estimates that only approximately half of expected births to HBsAg-positive mothers are identified for case management. In addition, errors in management of infants born to HBsAg-positive mothers and infants born to mothers with unknown HBsAg status have kept many of these infants from receiving appropriate immunoprophylaxis to prevent HBV infection. (A link for standing orders in labor and delivery is listed under resources.)
Screening during pregnancy
All pregnant women should be screened for HBsAg during each pregnancy. Women who test negative for HBsAg early in their pregnancy but who are at increased risk for hepatitis B should be screened again at the time of delivery. It is the responsibility of the provider to assure that the client's hospital for delivery is informed of an HBsAg positive mother prior to delivery so appropriate treatment is provided for the infant.
Vaccination of exposed infant
The pregnant woman will be contacted and enrolled in the program to assure that her high risk infant receives the first dose of hepatitis B vaccine and HBIG within 12 hours of birth. HBIG may be given up to 7 days after birth, but the effectiveness diminishes the longer after exposure that it is initiated. Two additional doses of hepatitis B vaccine, at 1 month of age and six months of age are needed. These infants should also be screened at 9-15 months of age (about 3 to 9 months after the third dose of hepatitis B vaccine) for HBsAg and anti-HBs.
Resources
List of Resources:
  1. A Comprehensive Strategy to Eliminate Transmission of Hepatitis B virus Infection in the US, 12/23/2005  web
    CDC - Morbidity and Mortality Weekly Report
  2. Guidelines for standing orders in Labor and Delivery  web
    Guidelines for standing orders in Labor and Delivery
  3. Hepatitis B Task Force  web
    Hepatitis B Task Force
  4. Perinatal Hepatitis B Prevention Program  web
    WA DOH - Perinatal Hepatitis B Prevention Program
  5. Perinatal Transmission Hepatitis B  web
    CDC - Perinatal Transmission Hepatitis B
  6. Required Reportable Condition: Hepatitis B Surface Antigen (HBsAg) Positivity During Pregnancy  web
    WA DOH - Washington State DOH Required Reportable Conditions
  7. Viral Hepatitis B  web
    CDC - Viral Hepatitis B
  8. Washington State DOH Immunization Program Contact Info  web
    WA DOH - Washington State DOH Immunization Program Contact Info
Contact Info
Phone: 425.339.3505 Fax: 425.778.5324
Office Hours: Monday - Friday 8:00 am - 5:00 pm.


Last Reviewed and updated 12/13/2010