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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
- See Also
- Postexposure Prophylaxis for Hepatitis B
- Hepatitis B
- Epidemiology
- U.S. Mothers with Chronic Hepatitis B: 19,000 per year
- U.S. perinatal Hepatitis B infection Incidence: 1000 per year
- Pathophysiology
- Vertical transmission is uncommon prior to delivery (represents only 5% of cases)
- Risk of in utero transmission increases if high viral load and HebBeAg positive
- Vertical transmission risk to newborn from HBsAg positive mother
- HBeAg Negative: 10% vertical transmission risk
- HBeAg Positive: 70-90% vertical transmission risk
- Outcomes from perinatal Hepatitis B infection
- 90% of infants with perinatal Hepatitis B will develop Chronic Hepatitis B (most in the first year of life)
- 25% will die in adulthood from Cirrhosis or Hepatocellular Carcinoma
- Efficacy
- Prophylaxis prevents 90% of perinatal Hepatitis B infections if given within 12 hours of birth
- Protocol: Administer HBIG and HepB <12 hours from birth
- Screening for Hepatitis B
- Indications
- All women in pregnancy (as part of Prenatal Labs)
- Women presenting to labor and delivery with unknown Hepatitis B status
- Management for positive cases
- Refer to gastroenterology or infectious disease specialist
- Consider for antiviral agents (category B agents include Telbivudine and Tenofovir) under specialist direction
- Hospitalize patients with signs or symptoms of hepatic failure
- Indications for prophylaxis
- Maternal Hepatitis B positive
- Maternal Hepatitis B status unknown or positive
- Hepatitis B Immunoglobulin (HBIG)
- HBIG 0.5 ml within 12 hours of birth
- Hepatitis B Vaccine (HepB)
- Initial dose within 12 hours of birth
- Administer at separate site from HBIG
- Repeat Heptavax at exactly 1 and 6 months of age
- Factors that do not impact transmission
- Ceserean section does not reduce transmission
- Breast Feeding does not increase transmission rate
- Monitoring
- Check follow-up Hepatitis B labs at age 9-15 months
- Hepatitis B Surface Antigen (HBsAg)
- Hepatitis B Surface Antibody (HBsAb)
- If Antibody titer <10 mIU/ml, revaccinate with a repeat of entire Hepatitis B series
- Retest HBsAb after second series
- Prevention: Adult transmission
- See Hepatitis B
- Test all household contacts, sexual contacts, or IVDA contacts
- Hepatitis B Vaccine
- References
- (2017) Pediatrics 140(3): e20171870 [PubMed]
- (2007) Obstet Gynecol 110(4): 941-56 [PubMed]
- Euler (2003) Pediatr Infect Dis J 22:123-9 [PubMed]
- Vu Lam (2010) Am Fam Physician 82(10): 1225-9 [PubMed]