Hepatitis B is an inflammatory liver disease caused by the hepatitis B virus. This results in liver cell damage that can lead to cirrhosis and an increased risk of liver cancer. About 1.25 million people in the United States have chronic hepatitis B infection. In 2011, there were 266 reported cases of pregnant women with hepatitis B in Ohio. Hepatitis B is a very infectious virus that is a major cause of illness and possible death from liver disease and liver cancer. The goal of the Perinatal Hepatitis B Prevention Program (PHBPP) is to reduce the spread of the infection from the mother to her baby at birth. Preventing hepatitis B infection in early childhood is important. Babies who become infected at birth have a 90 percent risk of developing chronic infection (infected for life), and up to 25 percent of those will die an early death of chronic hepatitis related disease. More than 90 percent of these chronic infections can be prevented if the baby is treated soon after birth with a dose of hepatitis B immune globulin (HBIG) and hepatitis B vaccine.
Hepatitis B is a Class B reportable disease, to be reported to the Ohio Department of Health (ODH) by the doctor who orders the laboratory test and the laboratory that runs the test. When notification is made and it is determined a woman with hepatitis B is pregnant, a new case is opened. Case management is then done by the PHBPP nurse at the Local Health Department (LHD).
When the case is obtained during the woman’s pregnancy, testing and hepatitis B vaccine, if needed, is recommended for all members living in the household and for the woman’s sexual partners. This testing and vaccination is provided free through the LHD by the PHBPP. If a child previously born to the pregnant, hepatitis B positive woman has not had all three vaccinations for hepatitis B, the series needs to be completed. Once all three shots have been given, the child should have a blood test to make sure they have received the protection needed. If not, they can receive up to three additional doses.
When the baby is born to a hepatitis B infected mother, or if the mother’s hepatitis B results are unknown, the baby is considered high-risk for hepatitis B. The baby should get HBIG and hepatitis B vaccine within 12 hours of birth. HBIG gives the baby protection from the virus right away; the hepatitis B vaccine helps the baby develop his or her own antibodies, or resistance to the virus. The HBIG and hepatitis B vaccine are provided, free of charge, to the hospital and then to the family, by the PHBPP at ODH. The vaccine given in the hospital is the first of three does of the hepatitis B vaccine the baby needs. The high-risk baby should receive the second dose of vaccine at one month of age and the third dose at six months of age. After all three doses, and after the baby is nine months old, blood should be drawn and tested to see if the baby has the protection needed. If not, up to three more doses of vaccine can be given. The test also lets the doctor know if the baby may have developed hepatitis B disease. The test consists of hepatitis B surface antigen and hepatitis B surface antibodies.
Once the baby is born, the hospital informs the PHBPP coordinator at ODH who sends the information to the LHD, so they can start case management. The doctor, nurse or clinic to see the baby once home from the hospital is informed of the baby being high-risk for hepatitis B. They are informed that the baby received HBIG and hepatitis B vaccine in the hospital and that the baby needs the other two doses at one and six months of age, and blood tests after nine months of age (and at least three months from the last shot of hepatitis B vaccine). Many doctors will do this blood test at one year of age when they may be doing other blood tests.