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Hepatitis B Postexposure Prophylaxis in Newborns

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Hepatitis B Postexposure Prophylaxis in Newborns, Hepatitis B Prophylaxis in Newborns, Postexposure Prophylaxis for Hepatitis B in Newborns, Perinatal Hepatitis B Exposure, Infants born to Mothers with Hepatitis B, HBV Vertical Transmission

  • See Also
  1. Postexposure Prophylaxis for Hepatitis B
  2. Hepatitis B
  • Epidemiology
  1. U.S. Mothers with Chronic Hepatitis B: 19,000 per year
  2. U.S. perinatal Hepatitis B infection Incidence: 1000 per year
  • Pathophysiology
  1. Vertical transmission is uncommon prior to delivery (represents only 5% of cases)
    1. Risk of in utero transmission increases if high viral load and HebBeAg positive
  2. Vertical transmission risk to newborn from HBsAg positive mother
    1. HBeAg Negative: 10% vertical transmission risk
    2. HBeAg Positive: 70-90% vertical transmission risk
  3. Outcomes from perinatal Hepatitis B infection
    1. 90% of infants with perinatal Hepatitis B will develop Chronic Hepatitis B (most in the first year of life)
    2. 25% will die in adulthood from Cirrhosis or Hepatocellular Carcinoma
  • Efficacy
  1. Prophylaxis prevents 90% of perinatal Hepatitis B infections if given within 12 hours of birth
  • Protocol
  • Administer HBIG and HepB <12 hours from birth
  1. Screening for Hepatitis B
    1. Indications
      1. All women in pregnancy (as part of Prenatal Labs)
      2. Women presenting to labor and delivery with unknown Hepatitis B status
    2. Management for positive cases
      1. Refer to gastroenterology or infectious disease specialist
      2. Consider for Antiviral Agents (category B agents include Telbivudine and Tenofovir) under specialist direction
      3. Hospitalize patients with signs or symptoms of hepatic failure
  2. Indications for prophylaxis
    1. Maternal Hepatitis B positive
    2. Maternal Hepatitis B status unknown or positive
  3. Hepatitis B Immunoglobulin (HBIG)
    1. HBIG 0.5 ml within 12 hours of birth
  4. Hepatitis B Vaccine (HBV Vaccine)
    1. Initial dose within 12 hours of birth
      1. Administer at separate site from HBIG
    2. Repeat Heptavax at exactly 1 and 6 months of age
  5. Factors that do not impact transmission
    1. Ceserean section does not reduce transmission
    2. Breast Feeding does not increase transmission rate
      1. Assumes infant received HBIG and HBV Vaccine after delivery
  • Protocol
  • Antivirals in Pregnancy for HBV Positive Mothers
  1. Indications (in addition to those already with ongoing treatment)
    1. HBV DNA Viral Levels at 26-28 weeks gestation >200,000 IU/ml
  2. Efficacy of HBV Antiviral therapy in third trimester
    1. Reduces HBV transmission by 95%
  3. Protocol
    1. Antiviral therapy initiated in third trimester
    2. May discontinue Antivirals at birth up to 3 months after delivery
    3. Recheck Alanine Aminotransferase (ALT) at 3-6 months after discontinuation to evaluate for flare
  4. References
    1. Terrault (2018) Hepatology 67(4): 1560-99 [PubMed]
  • Monitoring
  1. Infant
    1. Check follow-up Hepatitis B labs at age 9-15 months
    2. Hepatitis B Surface Antigen (HBsAg)
    3. Hepatitis B Surface Antibody (HBsAb)
      1. If Antibody titer <10 mIU/ml, revaccinate with a repeat of entire Hepatitis B series
      2. Retest HBsAb after second series
  2. Mothers who did not receive Antivirals in pregnancy
    1. Recheck Alanine Aminotransferase (ALT) at 3 months for postpartum flare (ocurs in 25%)
  • Prevention
  • Adult transmission
  1. See Hepatitis B
  2. Test all household contacts, sexual contacts, or IVDA contacts
  3. Hepatitis B Vaccine
  • References
  1. (2017) Pediatrics 140(3): e20171870 [PubMed]
  2. (2007) Obstet Gynecol 110(4): 941-56 [PubMed]
  3. Euler (2003) Pediatr Infect Dis J 22:123-9 [PubMed]
  4. Moore (2026) Am Fam Physician 113(3): 229-34 [PubMed]
  5. Vu Lam (2010) Am Fam Physician 82(10): 1225-9 [PubMed]