Perinatal Hepatitis B Prevention

Hepatitis B is a serious disease caused by the hepatitis B virus (HBV). When infected the virus enters the bloodstream, attacks the liver and can lead to serious, even life-threatening health issues like liver disease or liver cancer. 

Babies born to moms infected with HBV are at risk for infection.  Almost all cases of perinatal HBV can be prevented if the newborn receives the recommended immunizations at the recommended times.

All pregnant individuals should have a blood test for hepatitis B surface antigen. All positive test results are required to be reported by health care providers, hospitals, and laboratories to the NH DHHS (per RSA-141 C).

When infants and young children are infected with HBV, the virus often remains in the body for life and causes ongoing liver damage, including liver failure and liver cancer.

The primary objective of the NH Division of Public Health Services’ Perinatal Hepatitis B Prevention Program is to prevent transmission of hepatitis B virus from a hepatitis B-positive pregnant individual to their infant. The Program Coordinator helps ensure that all babies born to hepatitis B-positive moms:

1. Get their first hepatitis B vaccine and hepatitis B immune globulin at birth;
2. Complete their hepatitis B vaccine series on time; and,
3. Have blood testing done to show that they are protected.

How does the virus spread?

The virus is spread by contact with the blood or body fluid of an infected person. A person can become infected in several ways, including but not limited to:

• Having sex with an infected person;
• Injection drug use that involves sharing needles or other contaminated drug-preparation equipment;
• Being stuck with a used needle or sharp instrument; or
• During birth when the virus passes from an infected mother to their baby.

HBV can survive outside the body at least 7 days. During that time, the virus can still cause infection if it enters the body of a person who is not infected.

Not all people newly infected with HBV have symptoms, but for those that do, symptoms can include fatigue, poor appetite, stomach pain, nausea, and jaundice.

Is there a vaccine?

Fortunately, a vaccine can prevent this very serious illness. Hepatitis B vaccine information and other information on vaccines for children and adults is available from the NH Immunization Program.

Please complete the Hepatitis B Provider Case Report Form  or contact the Perinatal Hepatitis B Prevention Program Coordinator:

NH Department of Health and Human Services
Division of Public Health Services
Bureau of Infectious Disease Control, Immunization Section
29 Hazen Drive
Concord, NH 03301-6504

Phone (Monday – Friday 8:00 AM-4:30 PM): (603) 271-4482
Toll free in NH: (800) 852-3345 Ext. 4482
Fax: (603) 271-3850

• Test ALL pregnant women for HBsAg status during an early prenatal visit in EACH pregnancy, even if tested before or previously vaccinated.
• Send copy of lab report with the HBsAg-positive results to the planned delivery hospital.
• Report to NH DHHS all HBsAg-positive pregnant people within one week of identification using the Hepatitis B Provider Reporting Form.
• Refer all HBsAg-positive pregnant people to a specialty provider for medical management and order HBV DNA testing.
• Use the tools and resources below to ensure proper case management:
  • OB Provider Hepatitis B Management Tip Sheet
  • Screening and Referral Algorithm for HBV Infection in Pregnant People
  • Interpretation of Hepatitis B Serologic Results
  • Discrepant HBsAg Lab Results and Next Steps

Review prenatal HBsAg status of all pregnant people and administer PEP, when indicated.

• Test all pregnant people for HBsAg status upon admission for delivery if HBsAg status is unknown or maternal HBsAg test result is unavailable, if the patient has risk factors for hepatitis B infection or if the patient had clinical hepatitis since the previous test.
• Document and place copy of maternal HBsAg results in labor / delivery record, delivery summary, and infant’s medical record.
• Report all births to HBsAg-positive and people of unknown HBsAg status to the NH DHHS, Perinatal Hepatitis B Prevention Program Coordinator.
  • Perinatal Hepatitis B Prevention Program Infant Information Report Form
• Administer hepatitis B immune globulin (HBIG) and hepatitis B vaccine in separate limbs within 12 hours of birth to infants born to HBsAg-positive people and to people of unknown hepatitis B surface antigen status if there is other evidence of maternal hepatitis B virus infection, unless contraindicated.
  • For all other infants born to people of unknown HBsAg status at the time of delivery, while maternal HBsAg results are pending:
    • Infants weighing < 2000g- Give HBIG and hepatitis B vaccine in separate limbs within 12 hours of birth, unless contraindicated
    • Infants weighing >/= 2000g, give hepatitis B vaccine within 12 hours of birth and give HBIG if maternal test is HBsAg-positive (HBIG must be given within 7 days of birth), unless contraindicated.
    • If a definitive diagnosis cannot be established (e.g., person refuses additional testing), consider managing conservatively and administering HBIG within 7 days of birth 
• Use the tools and resources below to ensure proper case management:
  • Birth Hospital Procedures to Prevent Perinatal Hepatitis B at Delivery-HBsAg Available
  • Birth Hospital Procedures to Prevent Perinatal Hepatitis B at Delivery-HBsAg Unavailable
  • Guidelines for Standing Orders in L&D and Nursery Units to Prevent Perinatal Transmission of HBV to Neonates

Ensure infants born to people with hepatitis B virus (HBV) infection complete their hepatitis B vaccine series on time and have post-vaccination serology testing done at 9-12 months of age.

• Identify all HBV-exposed infants.
• Provide all HBV-exposed infants with the two to three additional doses of the hepatitis B vaccine series on time to complete the hepatitis B vaccine series (refer to tip sheet below for guidance).  
• Test all HBV-exposed infants at 9-12 months of age (HBsAg and anti-HBs only).  
  • Testing should be done 1-2 months after completion of the vaccine series (but not before 9 months of age). 
  • Test ONLY for hepatitis B surface antigen (HBsAg) and antibodies to hepatitis B surface antigen (anti-HBs). Do NOT test for antibodies to hepatitis B core antigen (anti-HBc).
• Report all test results to the Perinatal Hepatitis B Prevention Program Coordinator.
• Follow-up with additional vaccines and/or testing when indicated.
• Use the Pediatric Provider Hepatitis B Tip Sheet to ensure proper case management. 

The CDC's MMWR, Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices, provides the current recommendations for identification and management of  HBsAg-positive pregnant people and infants born to people who are HBsAg-positive.