Neonatal HBV: Difference between revisions

Latest revision as of 06:36, 6 December 2020

Background

Epidemiology

Transmitted perinatally during delivery (rarely transmitted in utero)
- Highest risk is with acute infection during the third trimester
Transmission from HBsAg-positive mothers is 30% if HBeAg-negative and 85% if HBeAg-positive

Clinical Manifestations

80-90% of infected infants will develop chronic infection
Mostly asymptomatic

Prevention

Mother should take tenofovir starting at 28-32 weeks gestation if viral load is greater than 200,000 IU/mL, until 3 months postpartum
- See also hepatitis B in pregnancy
If mother has active hepatitis B (that is, HBsAg is positive) or if her status is unknown, then consider post-exposure prophylaxis with hepatitis B immune globulin and hepatitis B vaccine given within 12 hours of life
- Vaccine prevents about 90% of infections, with HBIG adding a bit more
- HBIG can be given up to 7 days of life but is most effective when given earlier
- Vaccine and HBIG should be given in separate limbs
- Overall, decreases transmission from 30-85% down to 1-2%
No need for Cesarean section to prevent transmission
Monitoring
- Completion of routine vaccination schedule
  - If the birth weight is less than 2000 g, the birth dose should not count towards their vaccine series
- Postvaccination HBsAg serology is recommended for children born to HBsAg-positive mothers
  - Usually at age 9 to 12 months
  - HBsAg negative with HBsAb ≥10 mIU/mL: no further management
  - HBsAg negative with HBsAb <10 mIU/mL: give another dose of vaccine and repeat testing in 1 to 2 months
    - If still <10 mIU/mL, then give two additional doses to complete a full second series and repeat testing in 1 to 2 months
  - HBsAg positive: refer for management
- Even if not infected, maternal HBcAb may persist in the baby up to 24 months of age
Recommend breastfeeding if the infant received appropriate prophylaxis
Remember to screen other family members for hepatitis B
Also see article on neonatal HIV

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+==Background==
-* If mother has hepatitis B, or her status is unknown, then consider post-exposure prophylaxis with [[hepatitis B immune globulin]] and [[hepatitis B vaccine]] given within 12 hours of life
-** Vaccine prevents about 90% of infections, with HBIG adding a bit more
+===Epidemiology===
-** HBIG can be given up to 7 days of life but is most effective when given earlier
-* Also see article on [[neonatal HIV]]
+*Transmitted perinatally during delivery (rarely transmitted in utero)
+**Highest risk is with acute infection during the third trimester
+*Transmission from HBsAg-positive mothers is 30% if HBeAg-negative and 85% if HBeAg-positive
+==Clinical Manifestations==
+*80-90% of infected infants will develop chronic infection
+*Mostly asymptomatic
+==Prevention==
+*Mother should take [[tenofovir]] starting at 28-32 weeks gestation if viral load is greater than 200,000 IU/mL, until 3 months postpartum
+**See also [[Hepatitis B in pregnancy#Management|hepatitis B in pregnancy]]
+*If mother has active [[hepatitis B]] (that is, HBsAg is positive) or if her status is unknown, then consider post-exposure prophylaxis with [[hepatitis B immune globulin]] and [[hepatitis B vaccine]] given within 12 hours of life
+**Vaccine prevents about 90% of infections, with HBIG adding a bit more
+**HBIG can be given up to 7 days of life but is most effective when given earlier
+**Vaccine and HBIG should be given in separate limbs
+**Overall, decreases transmission from 30-85% down to 1-2%
+*No need for Cesarean section to prevent transmission
+*Monitoring
+**Completion of routine vaccination schedule
+***If the birth weight is less than 2000 g, the birth dose should not count towards their vaccine series
+**Postvaccination HBsAg serology is recommended for children born to HBsAg-positive mothers
+***Usually at age 9 to 12 months
+***HBsAg negative with HBsAb ≥10 mIU/mL: no further management
+***HBsAg negative with HBsAb <10 mIU/mL: give another dose of vaccine and repeat testing in 1 to 2 months
+****If still <10 mIU/mL, then give two additional doses to complete a full second series and repeat testing in 1 to 2 months
+***HBsAg positive: refer for management
+**Even if not infected, maternal HBcAb may persist in the baby up to 24 months of age
+*Recommend breastfeeding if the infant received appropriate prophylaxis
+*Remember to screen other family members for [[Hepatitis B virus|hepatitis B]]
+*Also see article on [[neonatal HIV]]
+==Further Reading==
+*Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. ''MMWR Recomm Rep''. 2018;67(RR-1):1-31. doi: [https://doi.org/10.15585/mmwr.rr6701a1 10.15585/mmwr.rr6701a1]
 [[Category:Infectious diseases]]