Perinatal Hepatitis B Prevention Program (PHBPP)Frequently Asked Questions for Medical Providers1. Is hepatitis B a reportable disease, and by whom? Yes. Hepatitis B and Hepatitis B Surface Antigen (HBsAg)-positive results in pregnant women are notifiable conditions and are considered diseases of public health significance to the Florida Department of Health. As such, they are to be reported by the laboratory conducting the test and the physician who orders the test. Reporting should be made to the health department in the county in which the woman resides. This allows for the follow-up of the woman to the Perinatal Hepatitis B Prevention Program Coordinator. Refer to Florida statutes 381.0031, 384.25 and 384.33, along with Florida Administrative Codes 64D-3.013(6) and 64D-3.019. All links below open in new window
2. How can the Perinatal Hepatitis B Prevention Program (PHBPP) help? The PHBPP offers free hepatitis B testing for household/sexual contacts, free Hepatitis B Immune Globulin (HBIG) and hepatitis B vaccine as needed. The program provides case management of the pregnant woman to increase the likelihood of completion of the vaccination series followed by testing to assure immunity. Contact your county health department for more information. 3. Is it necessary to test every pregnant woman with each pregnancy? Yes. The American College of Obstetrics and Gynecology, American Academy of Pediatrics, Advisory Committee on Immunization Practices and American Academy of Family Practice highly recommend that all pregnant women be routinely tested for HBsAg during an early prenatal visit, in each pregnancy. Assuming a woman is not high-risk because she was negative for HBsAg with a prior pregnancy puts the infant at risk. She may have contracted the virus since the last testing. See Florida Administrative Code 64D-3.019. 4. If the pregnant woman has been diagnosed as having chronic hepatitis B, is there a risk for the unborn baby? Yes. Chronicity indicates infectious status. The infant will be
exposed to the mothers 5. What blood tests should be used to screen a pregnant woman for hepatitis B? HBsAg is the ONLY test that indicates that a woman has an active HBV infection that can be transmitted to her infant. If a woman is found to be HBsAg positive, the most useful additional test would the IgM anti-HBc with a repeat HBsAg which would tell if the woman has an acute infection or if she is chronically infected. Chronicity can also be determined by two positive HBsAg tests six months, or more, apart.
6. Should any recommendations be made for household/sexual contacts of the HBsAg positive woman? Ideally all household/sexual contacts should be tested and vaccinated and counseled as needed. Women of child-bearing age need to be informed that any other children should receive the three dose series as well a post-vaccine serology to determine the development of antibody response or disease (unless it can be documented that the woman was negative for HBsAg with the prior pregnancies). Contacts should also be counseled on ways to prevent the further spread of hepatitis B: not sharing razors, toothbrushes or needles and practicing safe sex using condoms. 7. Can COMVAX be used with the high-risk hepatitis B child? It is not recommended because the dosing schedule does not match the high-risk schedule of 0, 1, 6 months. (However, the use of COMVAX is not a conflict for Universal Dosing [first dose of hepatitis B vaccine in the hospital for infants at low-risk for hep B] as the child will receive four doses of hepatitis B vaccine without adverse affects.) Comvax must not be used for doses at birth or one month of age for a child on a 0-1-6 month hepatitis B vaccine schedule. 8. If a person is HBeAg negative and HBsAg positive, are they infectious? Yes. HBeAg indicates high viral replication activity, so an
individual who is actively 9. The hospital OB staff tell me they need the date of the HBsAg on the pregnant woman. Why is this necessary? See question 3 above. If the womans HBsAg status is unknown, the infant is to be treated as high-risk for hepatitis B exposure. If not tested with the current pregnancy, it is recommended the woman be tested for HBsAg on admission for delivery. If the results cannot be obtained within 12 hours of delivery, the infant should receive HBIG and HBV. 10. The 2003 Report of the Committee on Infectious Diseases (Red Book) states HBV should be given within 12 hours of birth and HBIG can be administered up to seven days after birth if the mothers HBsAg status is unknown. Why do you say it should be given sooner? The Red Book bases this on the high cost of HBIG. Florida provides the HBIG and HBV free of charge to all birthing facilities enrolled in the Vaccines for Children Program (VFC). Also, the HBIG insert states, Efficacy of prophylactic Hepatitis B Immune Globulin (Human) in infants at risk depends on administering Hepatitis B Immune Globulin (Human) on the day of birth. It is therefore vital that HBsAg-positive mothers be identified before delivery Hepatitis B Immune Globulin (Human) efficacy decreases markedly if treatment is delayed beyond 48 hours. 11. When should the Post Vaccine Serology (PVS) be done, and what does it consist of? Infants should have PVS done three months after the last dose of HBV, but no sooner than 9 months of age. A Hepatitis B Surface Antigen (HBsAg) and Hepatitis B Surface Anti-body (HBsAB also written anti-HBs) should be drawn at the same time. This will determine if the infant has sero-converted or developed the disease. 12. How are the results of the PVS interpreted?
13. If additional vaccine is needed, what schedule is followed? Additional vaccine can be administered one of two ways:
14. Can Pediarix be used for the birth dose of the hepatitis B series? No. The minimum age for the first dose of Pediarix is 6 weeks. In addition, Pediarix is approved for 3 doses at two, four, and six months. |
||||||||||||||||||||||||||||||||||||||||||||||||
