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Perinatal Hepatitis B Prevention Program (PHBPP)

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The OSDH HIV/STD Service provides hepatitis B & C prevention activities, including but not limited to, education, vaccination and Perinatal hepatitis B prevention activities.


What is Hepatitis?

Hepatitis means inflammation of the liver.  The liver processes  nutrients, filters the blood and fights infections.  When the liver is inflamed or damaged, how it works can be impacted.

Hepatitis is most often caused by a virus.  In the U.S., the most common types of viral hepatitis are Hepatitis A, Hepatitis B and Hepatitis C.  Heavy alcohol use, toxins, some medications and certain medical conditions can also cause hepatitis.

 

What is the Perinatal Hepatitis B Prevention Program (PHBPP)?

The perinatal hepatitis B prevention program (PHBPP) began in 1990 as part of the Vaccine and Immunization Amendments (P.L. 101-502). Congress recognized the need to foster efforts to prevent perinatal hepatitis B virus (HBV) transmission and made resources available to develop and implement programs.  The Center for Disease Control and Prevention (CDC) has annually awarded funds which are then provided to awardees such as the State of Oklahoma to support the program.

In 2010, an estimated 24,000 infants were born to hepatitis B surface antigen (HBsAg)-positive women in the United States. When a pregnant woman is infected with the HBV it poses a serious risk that her newborn will contract the infection. Of the infants infected with HBV 90% will develop chronic HBV infection.  Twenty-five percent of infants or young children that are chronically infected with the HBV will die prematurely from cirrhosis or liver cancer. 

Realizing these statistic and that transmission can be prevented the PHBPP strives to educate healthcare providers and the HBsAg-positive pregnant women on prevention and the importance of treatment. 

     CDC: 2010  Expected Births point estimate

     MMWR December 23. 2005

                                            

What are the goals of the PHBPP?

The objectives of the PHBPP are the following:

  • Identify HBsAg-positive pregnant women
  • Assist with assuring that infants born to HBsAg-positive woman obtain timely and appropriate post-exposure prophylaxis at birth
  • Assist with assuring infants born to HBsAg-positive woman complete hepatitis B vaccine series
  • Assist with assuring infants born to HBsAg-positive woman obtain post vaccination testing (PVST) to identify HBsAg and HBsAb status

 

How to screen a pregnant woman for the hepatitis B virus (HBV)?

The hepatitis B virus (HBV) screening test is called the hepatitis B surface antigen (HBsAg). It detects a protein produced by the virus and can detect a hepatitis B infection even before it causes symptoms.  A positive test for a pregnant woman is to be reported to the Oklahoma State Department of Health (OSDH) immediately upon suspicion, diagnosis or positive test. https://www.ok.gov/health/Disease,_Prevention,_Preparedness/Acute_Disease_Service/Disease_Reporting/What_to_Report/index.html

A negative test for the virus means either that there is no current infection or there is not yet a sufficient amount of the antigen to be detected. If a woman participates in high-risk activities that may transmit the HBV (such as unprotected sexual contact or intravenous drug use), retesting later in the pregnancy is generally advised.

  • Ordering Prenatal Hepatitis B Surface Antigen (HBsAg) Tests from Major Commercial Laboratories

            http://www.cdc.gov/hepatitis/hbv/pdfs/prenatalhbsagtesting.pdf  

  • CDC-Screening and Referral Algorithm for HBV Infection among Pregnant Women

             http://www.cdc.gov/hepatitis/hbv/pdfs/prenatalhbsagtesting.pdf

 

How can perinatal hepatitis B transmission be prevented?

Perinatal HBV transmission can be prevented by identifying HBV-infected (i.e., hepatitis B surface antigen [HBsAg]-positive) pregnant women and providing hepatitis B immune globulin (HBIG) and hepatitis B vaccine to their infants within 12 hours of birth. In addition, it is important that the infant completes the hepatitis B vaccine series according to ACIP recommendations and that the post-vaccine serology tests (PVST) are drawn to know if transmission was prevented and the infant has an immunity to the HBV.

The state of Oklahoma requires all birthing hospitals to administer the birth hepatitis B vaccine to all live infants (unless an exemption is completed) within 12 hours of birth and document it in the Oklahoma State Immunization Information System (OSIIS).

 TITLE 310. OKLAHOMA STATE DEPARTMENT OF HEALTH-CHAPTER 667 HOSPITAL STANDARD    SUBCHAPTER 13-INFECTION CONTROL § 310:667-13-5. Universal birth dose hepatitis B vaccination

  • All Oklahoma birthing hospitals shall implement a procedure to ensure that the hepatitis B vaccination is administered to all live infants within twelve hours of birth and recorded in the Oklahoma State Immunization Information System. A parent or guardian may refuse hepatitis B vaccination of their newborn on the grounds of medical reasons or that such vaccination conflicts with their religious tenets or personal beliefs. A refusal based on medical reasons shall include a statement in the medical record by a physician stating that the physical condition of the newborn is such that the vaccination would endanger the life or health of the child and that the child should be exempt from the vaccination requirement. A refusal based on the parent's or guardian's religious tenets or personal beliefs shall be documented in the newborn's medical record.   [Source: Added at 29 Ok Reg 1603, eff 7-12-12]
  • Oklahoma State Immunization Information System (OSIIS) Information-

    https://www.ok.gov/health/Disease,_Prevention,_Preparedness/Immunizations/Oklahoma_State_Immunization_Information_System_-_OSIIS/index.html

 

What labs to draw to know if transmission of the hepatitis B virus (HBV) was prevented?

  • For infants born to HBsAg-positive women, perform post-vaccination testing (PVST) for anti-HBs (HBsAb) and HBsAg 2 months after completion of the vaccine series and when the child is at least 9 months of age.  Testing should not be performed before 9 months of age and ideally done before 12 months of age.

  • MMWR Regarding Importance of Timing of PVST (October 9, 2015 / 64(39);1118-20)

    http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6439a6.htm?s_cid=mm6439a6_e

  • Recommended PVST management is as follows:

    • HBsAg-negative infants with anti-HBs concentrations of >10 mIU/mL are protected and need no further medical management;
    • HBsAg-negative infants with anti-HBs concentrations of
    • Infants who are HBsAg positive should receive appropriate follow-up.

 

Additional Resources: http://www.cdc.gov/hepatitis/HBV/PerinatalXmtn.htm 

 


 Test results for all infants born to HBsAg-positive women should be faxed to the Perinatal Hepatitis B Prevention Coordinator at 405-271-5149.

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