Public Health: Hepatitis B Babies
Tarrant County Public Health
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{Tarrant County Public Health - Safeguarding Our Community}

 

Hepatitis B Babies

 

Hepatitis B can be tricky.  Infants and children are special victims.  The risk of becoming a “chronic carrier” after the initial infection is inversely related to age.  The younger the age at the time of the initial infection, the greater is the chance of developing chronic active Hepatitis B.

 

Adults who contract Hepatitis B get over it more than 90 percent of the time as indicated by the development of surface and core antibodies against the organism and the disappearance of the Hepatitis B antigen from circulating blood.  The opposite is true for infants.  Chronic HBV infection occurs in as many as 90 percent of infants infected by perinatal transmission.

 

Children of unidentified chronically infected HBV positive mothers are at high risk of becoming infected with HBV themselves through person-to-person transmission during the first five years of life. Thirty percent of children one to five years of age infected after birth will develop chronic active Hepatitis B; whereas, only two to six percent of older children, adolescents, and adults will develop chronic active Hepatitis B after developing the infection. An estimated one third of the 1.25 million Americans with chronic active HBV acquired their infections as infants or young children.

 

The risk of death due to HBV-related liver cancer or cirrhosis is approximately 25 percent for persons who become chronically infected during early childhood. Approximately 3,000 to 4,000 persons die of HBV-related cirrhosis in the United States each year. In addition, approximately 1,000 to 1,500 persons die each year from HBV-related hepatic cancer.

 

Each year in the United States, the number of pregnant women who are known to be chronically infected (Hepatitis B surface antigen (HBsAg)-positive) is approximately 9000.  The real number may be much larger. According to data from national and several local surveys indicate that the true number may be as many as 20,000.

 

Tarrant County Public Health has an established program to provide aggressive case management for pregnant women who have test positive for Hepatitis B antigen during the course of prenatal care. The goal of the Perinatal Hepatitis B Prevention Program is to eliminate perinatal Hepatitis B virus (HBV) infections in Texas. Prevention activities were initiated in Tarrant and Dallas counties in 1992 and were expanded statewide in 2000.

 

Prenatal testing of pregnant women can readily identify chronic Hepatitis B carriers and assure vaccination and administration of Hepatitis B immune globulin to their infants at birth.  This is a highly effective form of therapy. Immunotherapy for infants of HBV-infected mothers prevents up to 97 percent of perinatal HBV infections.  

 

Tarrant County Public Health’s Perinatal Hepatitis B Prevention Program provides Hepatitis B serology testing and vaccinations for susceptible sexual and non-sexual household contacts of HBsAg- positive women. There is no cost involved for eligible clients. It is the responsibility of local and regional health departments to coordinate perinatal Hepatitis B prevention activities within their jurisdictions. The program has nurse case managers located at four community centers throughout the county.  Perinatal Hepatitis B Prevention Program elements include:

 

  • HBsAg screening of all women
  • Identification and reporting of all HBsAg-positive women
  • Education of HBsAg-positive pregnant women
  • Identification, screening, and vaccination of susceptible household and sexual contacts
  • Case management of infants born to HBsAg-positive women, including prophylactic treatment for the infant with Hepatitis B vaccine, Hepatitis B immune globulin (HBIG), and post vaccination serology testing.
  • Providing outreach and education to physicians, labor and delivery staff, newborn nursery staff, and infection control personnel
  • Conducting periodic chart audits of hospitals to determine compliance with the screening law

 

The current caseload for Tarrant County is over one hundred clients. Thirty new cases have been reported since the beginning of this year. Case management is accomplished through a variety of methods and resources. Positive clients are contacted, offered services and are educated about the importance of preventing transmission to the newborn infant and other family members. We provide Hepatitis B testing and vaccinations for all household and sexual contacts. Children, who have been previously vaccinated, are also tested to confirm adequate protection levels from the vaccine. 

 

For the newborn infant, we contact the delivery hospital and primary care provider to confirm the administration of prophylactic treatment and the provision of all three Hepatitis B shots along with all the routinely recommended immunizations. After the vaccination series is completed, providers are informed about the recommended post vaccination serology test.

 

Parents are contacted when vaccinations or serology tests need to be completed.  If the family has a primary care provider, ongoing contact is made with the primary provider to ensure that the infant receives appropriate follow-up.

 

Hepatitis B virus is the most common cause of chronic viremia known, with an estimated 200 to 300 million chronic carriers worldwide. It is the cause of up to 80 percent of hepatocellular carcinomas and is second only to tobacco among human carcinogens. More than 250,000 people die worldwide each year of Hepatitis B associated acute and chronic liver disease.  The only way to distinguish HBV from other disease is to conduct laboratory tests.  (See the table: Interpretation of Serological Tests)

 

Transmission or Hepatitis B occurs by percutaneous or mucosal exposure to HBsAg-positive body fluids from persons who are HBV infected. Since HBV can survive for up to 40 days on environmental surfaces at room temperature, indirect inoculation of HBV can occur via inanimate objects.  Modes of transmission from infected or contaminated sources includes:

 

·        Having unprotected sex (vaginal or anal)

·        Being born to a mother who has hepatitis B (perinatal transmission)

·        Sharing needles and syringes during injectable drug  use

·        Contact with blood or open sores

·        Sharing razors, toothbrushes, or wash cloths

·        Pre-chewing foods for babies or sharing chewing gum

·        Using unsterilized needles for body piercing, tattooing, and acupuncture

·        Hemodialysis    

 

Immunotherapy for infants born to Hepatitis B surface antigen (HBsAg) positive women includes administration of 0.5 ml of Hepatitis B immune globulin and 0.5 ml of Hepatitis B vaccine, within 12 hours of birth. (See Table Hepatitis B Vaccination Schedule) HBIG may be given up to seven days after delivery. Subsequent doses of Hepatitis B vaccine should be administered to the infant at one and six months of age.

 

HBIG administered at birth is the most important medication to administer as it provides immediate protection against the HBV. The first Hepatitis B vaccine starts producing long term protection over a course of approximately two weeks. However, full vaccine produced immunity may not be achieved until all three vaccinations are received including the booster dose at six months.  When the infant is 12 to 15 months of age, a post-vaccine serology test should be performed to determine the success or failure of the vaccine intervention.

 

For proof of effective immunization physicians should test the immunized infant’s blood for anti-HBs (antibodies to Hepatitis B surface antigen) and HBsAg. A positive anti-HBs test result and a negative HBsAg result show that the infant is protected against HBV. The anti-HBs quantitative titer should be 10mIU/mL or above. A negative anti-HBs and a positive HBsAg shows that the infant is infected with HBV and should receive follow-up monitoring and eventual for chronic active hepatitis.

 

For infants whose blood test negative for both anti-HBs and HBsAg, administration of a second series of vaccine is indicated. If the anti-HBs quantitative titer is less than 10mIU/mL additional vaccines may be indicated. A second post-vaccine serology test should be performed two months after completion of the second series.

 

Hepatitis B identified prenatally or at delivery is reportable to the local health department within one work day. Written or verbal reports can be made to the Tarrant County Public Health Epidemiology Division at 817-321- 5350, fax 817-321-5353. Reports can also be made directly to the case management program at 817-321-4882. Infants born to positive mothers outside of Tarrant County can be reported to directly to the Texas Department of  State Health Services at 1-800-252-9152, extension 6002.

 

  

Additional Resources

 

Interpretation of Serology Tests
 

Test

Results

Interpretation

HBsAg

anti-HBc

anti-HBs

Negative

Negative

Negative

Susceptible

(Never infected or

 vaccinated)

HBsAg

anti-HBc

anti-HBs

Negative

Negative (* Positive)

~Positive (> 10 mIU/mL)

Immune

*(due to natural   infection)

 ~(due to vaccination)

HBsAg

anti-HBc

IgM anti-HBc

anti-HBs

Positive

Positive

Positive

Negative

Acutely Infected

HBsAg

anti-HBc

anti-HBs

IgM anti-HBc

Positive

Positive

Negative

Negative

 

Chronically Infected

HBsAg

anti-HBc

anti-HBs

Negative

Positive

Negative

*Four Possible

  Interpretations

*may be recovering from acute HBV  

infection, may be distantly immune and test not sensitive enough to detect very low levels of anti-HBs in serum, may be susceptible with a false positive anti-HBc, may be undetectable level of  HBsAg present in blood and the person is actually a carrier

 

              

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hepatitis B Vaccination Schedule

 

Hepatitis B vaccination

Schedule

Mother’s HBsAg

status- positive

(high risk)

Mother’s HBsAg status- unknown

Mother’s HBsAg

status- negative

First Dose

 

 

 

 

 

 

Second Dose

 

 

 

 

 

Third Dose

 

 

Serology Testing

Within 12 hours of birth  + HBIG

 

 

 

 

 

1 month of age

 

 

 

 

 

6 months of age

 

 

12-15 months of age

*test for HBsAg and anti-HBs

Within 12 hours of birth *If mother positive at  delivery (+ HBIG no later than  1 week after birth,  put infant on high risk  schedule)

 

 

1-2 months of age

 

 

 

 

 

6 months of age

 

 

*serology tests may

   be needed

Birth

*or at 1-2 months

 

 

 

 

 

1-2 months after first dose

*or at 4 months

 

 

6-18 months

 

 

*no tests are 

  needed

 

 

 

 

 

 

 

 

 

 

 

 





Content Last Modified on 9/23/2011 3:43:16 PM





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