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Perinatal Hep B

Introduction - Perinatal Hepatitis BUpdated 11-14-24

Hepatitis B virus (HBV) infection in a pregnant person can be passed to their child at birth. This is called perinatal transmission.

All pregnant people who are at risk for HBV infection and have not been vaccinated previously should be vaccinated.

HBV infection in infants can lead to long-term serious health effects if left untreated. Infants with HBV infection have a 90% chance of developing a chronic HBV infection, cirrhosis of the liver, or cancer.

Vaccination is the best way to prevent HBV infection.

Information for the Public
Perinatal Hepatitis B Overview

Perinatal hepatitis B is a serious condition that can be transferred from a pregnant person to their infant during pregnancy or childbirth.

Key Strategies to Prevent Perinatal Transmission:

Screening and Treatment for Pregnant Persons:

  • Early detection: Get tested for hepatitis B early in pregnancy, preferably the first trimester. This will help identify if you’re infected and allow for timely intervention to protect your baby.
  • In some cases, pregnant persons with high levels of HBV may be treated with antiviral medication to reduce the risk of transmission.

Vaccination:

  • Infant vaccination: Infants born to pregnant persons with hepatitis B will need to receive hepatitis B vaccine and immune globulin (HBIG) shortly after birth to prevent infection.
  • Partner vaccination: Household and sexual contact should be vaccinated against hepatitis B to reduce the risk of transmission.
Vaccine Information

CDC recommends infants born to persons with hep B receive hepatitis B vaccine (Engerix or Recombivax) and hepatitis B immune globulin (HBIG) within 12 hours of birth.  This combination provides protection against hep B infection.

Hepatitis B vaccine without HBIG is 75% effective at preventing perinatal HBV transmission, but when combined with HBIG, the effectiveness is 94%

Completion of the 3 – dose vaccine series is critical to ensure lifelong protection against hep B.

Testing to make sure the infant is protected from hepatitis B is recommended after completing the vaccine series.

Breastfeeding is still encouraged. Hep B cannot be transmitted from mother to infant through breast milk.

Information for Providers
Overview

HBV infection in a pregnant person poses a serious risk to an infant at birth. Without timely postexposure immunoprophylaxis, approximately 90% of infants born to HBsAg-positive people in the US will acquire chronic HBV infection, approximately one-fourth of whom will eventually die from chronic liver disease.

Guidelines for Prenatal Providers

Prenatal care providers play an essential role in the prevention of perinatal transmission of hepatitis B. Providers should:

  • Test all pregnant persons for hepatitis B surface antigen (HBsAg) during each pregnancy, preferably in the first trimester.
    • Test all pregnant people who are HBsAg-positive for HBV DNA. This information will help the clinician make the decision to prescribe maternal antiviral therapy to prevent perinatal HBV transmission.
    • Re-test HBsAg-negative pregnant people before delivery if they have clinical hepatitis or if they were at risk for hepatitis B exposure during pregnancy.
  • Provide a copy of the original laboratory report indicating the pregnant person's HBsAg-positive status to the hospital or birthing facility where the delivery is planned and to the health care provider who will care for the infant.
  • Refer all HBsAg-positive pregnant people to a liver specialist for evaluation and possible antiviral treatment.
  • The American Association for the Study of Liver Diseases (AASLD) suggests maternal antiviral therapy when the maternal HBV DNA is greater than 200,000 IU/mL.
  • Retest pregnant persons with discrepant hepatitis b surface antigen (HBsAg) lab results for the following:
    • HBV DNA
    • Total anti-HBc
    • IgM anti-HBc
  • Recommend HBsAg testing and/or vaccination for family members and sexual partners.
  • Educate patients on perinatal hepatitis B & encourage patients to breastfeed their infant, as breastfeeding is safe for mothers infected with HBV. The risk of HBV mother-to-child transmission through breastfeeding is negligible if infants born to HBV-positive mothers receive the HBIG/HBV vaccine at birth.
Guidelines for Birthing Hospitals

ACIP recommends birthing hospitals implement protocols and procedures to prevent perinatal transmission. Failure to vaccinate and provide HBIG to infants born to HBsAg-positive persons can result in perinatal HBV transmission. Here are three steps to prevent perinatal transmission:

Review HBsAg laboratory report upon admission

  • Review patient’s HBsAg lab at admission to confirm the lab is from the current pregnancy and the interpretation of test results is correct.
  • Ensure the lab report is in the maternal & infant’s medical record.

Test pregnant persons with unknown HBsAg status

  • If the patient does not have a HBsAg laboratory report, perform HBsAg testing immediately.

Administration of hepatitis B vaccine & HBIG

HBsAg-positive mother Administer HBIG & hep B vaccine in separate limbs within 12 hours of birth.
HBsAg status- unknown mother Infants weighting ≥2000 grams should receive hep B vaccine within 12 hours of birth.
  • If the mother is found to be HBsAg-positive, administer HBIG immediately, but no later than 7 days after birth. If the infant has been discharged, contact the parent to arrange for the infant to return to the hospital for vaccination.
Infants weighing < 2000 grams should receive both HBIG and hepatitis B vaccine within 12 hours of birth.
HBsAg-negative mother Administer the hepatitis B vaccine within 24 hours of birth.

Refer to CDC’s guide for the management of infants born to HBsAg-positive persons for more information. 

Report all infants born to HBsAg-positive persons to the Perinatal Hepatitis B Prevention Unit via fax at (213) 351-2781, or email at vpdc-phb@ph.lacounty.gov.

Guidelines for Pediatric Providers

Hepatitis B Vaccine for Infants

  • CDC recommends infants born to HBsAg – positive persons receive single antigen dose of hepatitis B vaccine (Engerix or Recombivax) and HBIG withing 12 hours at birth.
  • Infants born to HBsAg-positive persons should complete the hepatitis B vaccination series to ensure protection against hepatitis B.
  • Administer the final dose no earlier than 6 months of age (minimum age of 164 days includes 4-day grace period)

Post-Vaccination Serologic Testing

Request the following labs:

    • HBsAg
    • Anti – HBs, quantitative
  • NOTE: Antibody to hepatitis B core antigen (anti-HBc) testing of infants is not recommended because passively acquired maternal anti-HBc might be detected in infants born to a person who is HBsAg-positive up to age 24 months.
  • HBsAg-negative infants with anti-HBs levels ≥10 mIU/mL are protected and need no further medical management.
  • HBsAg-negative infants with anti-HBs <10 mIU/mL should be revaccinated with a single dose of HepB vaccine and receive postvaccination serologic testing 1–2 months later (new recommendation). Infants whose anti-HBs remains <10 mIU/mL following single dose revaccination should receive two additional doses of HepB vaccine to complete the second series, followed by postvaccination serologic testing 1–2 months after the final dose.

For guidance on interpreting PVST results, review CDC’s Management of Infants Born to Women with Hepatitis B Virus Infection for Pediatricians.

For more information, see CDPH’s guidelines for pediatric providers to prevent chronic hepatitis B in children.

Reporting

Hospitals

Report all births of HBsAg – positive pregnant persons or unknown HBsAg status to the Perinatal Hepatitis B Prevention Unit (PHBPU) at Los Angeles County Department of Public Health Vaccine Preventable Disease Control Program within 24 hours of birth. Fax the Delivery Report to (213) 351-2781 or send via secure email to vpdc-phb@ph.lacounty.gov.

Laboratories can also contact the Perinatal Hepatitis B Prevention Unit at 213-351-7400 or vpdc-phb@ph.lacounty.gov.



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    • Public Health has made reasonable efforts to provide accurate translation. However, no computerized translation is perfect and is not intended to replace traditional translation methods. If questions arise concerning the accuracy of the information, please refer to the English edition of the website, which is the official version.

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