Hepatitis B Postexposure Prophylaxis in Newborns

Aka: 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

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II. Epidemiology

  1. U.S. Mothers with Chronic Hepatitis B: 19,000 per year
  2. U.S. perinatal Hepatitis B infection Incidence: 1000 per year

III. 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

IV. Efficacy

  1. Prophylaxis prevents 90% of perinatal Hepatitis B infections if given within 12 hours of birth

V. 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 (HepB)
    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

VI. Monitoring

  1. Check follow-up Hepatitis B labs at age 9-15 months
    1. Hepatitis B Surface Antigen (HBsAg)
    2. 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

VII. Prevention: Adult transmission

  1. See Hepatitis B
  2. Test all household contacts, sexual contacts, or IVDA contacts
  3. Hepatitis B Vaccine

VIII. 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. Vu Lam (2010) Am Fam Physician 82(10): 1225-9 [PubMed]

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