Hepatitis B Vaccination

 

Reviewed by Clinical Practice Committee
September 2015
Clinical Guidelines Back Newborn Services Home Page
Information Positive Mothers and those with Unknown Status Hib-HepB (Comvax) 2-in-1 Vaccine Other Related Documents

Hepatitis B - Introduction

Risk of vertical transmission

For a newborn born to HepBsAg positive mother, there is a risk of vertical transmission as high as 90% if no prophylaxis given.4 The risk of vertical transmission is associated with the following:

Other considerations

Prevention

For Known HepBsAg positive mother

  1. There is an evidence to suggest that hepatitis B immunoglobulin alone, hepatitis B vaccine alone and hepatitis B vaccine plus hepatitis B immunoglobulin given at birth prevents hepatitis B occurrence in Newborn
  2. For these newborns please follow the figure below

 

Management of a baby of an HBsAg-positive woman
Screen all women in early pregnancy for hepatitis B carriage

Woman is HBsAg positive No  Figure 8.2: arrow1   See ‘Infants’ in section 8.5.2
Yes
Figure 8.2: arrow2
All HBsAg-positive pregnant women should also be tested for HBeAg and should have HBV DNA measured. The results should be discussed with a specialist or, early in her pregnancy, the woman should be referred to a specialist for ongoing care. Give the baby hepatitis B protection as follows.
At age Action to be taken
Birth Give hepatitis B immunoglobulin 100–110 IU neonatal and hepatitis B vaccine 5 µg
6 weeks DTaP-IPV-HepB/Hib
3 months DTaP-IPV-HepB/Hib
5 months DTaP-IPV-HepB/Hib
9 months Take a blood test to check for hepatitis B infection (HBsAg) and for vaccine-induced immunity (anti-HBs).
  • If HBsAg is negative and anti-HBs level is >10 IU/L at age 9 months, immunity is proven.
  • If HBsAg is positive, the baby has become infected despite prophylaxis: refer to an appropriate specialist.
  • ​If HBsAg is negative and anti-HBs level is ≤10 IU/L at age 9 months, give 1 to 3 further doses of hepatitis B vaccine at least 4 weeks apart. Recheck serology 4 weeks after each dose to determine if further doses are necessary (ie, if anti-HBs is still ≤10 IU/L). If there is no seroconversion after the third further dose of hepatitis B vaccine, discuss with a specialist.
All other vaccines should be administered as per the Schedule.

Source: New Zealand immunization handbook 2014

For unknown HepBsAg status mother

  1. Newborn should receive hepatitis B vaccine at birth. Mother should be tested for hepatitis B serology and if HepBsAg positive the infant should also receive hepatitis B immunoglobulin within 48 hrs
  2. Follow routine vaccine schedule from 6 weeks
  3. If mother was determined to be HepBsAg positive then infant should have HepB serology tests at 9 months of age.10

For HepBsAg negative mother

  1. Follow routine vaccine schedule from 6 weeks. 10

For further information regarding hepatitis B immunization please check New Zealand immunization handbook

Hepatitis B - Information

Information
  • Spread through close physical contact with body fluids of an infected person.
  • The most infectious period is from several weeks before symptoms appear until several weeks or months later.
  • Carriers have the virus in their blood and can remain infectious for many years.
  • The younger a person is when Hep B infection occurs the more likely they are to become a chronic carrier.
Hepatitis B Immunoglobulin (HBIg)
  • Is prepared from plasmas that contain high levels of antibody to the surface antigen of the Hepatitis B virus. It is given to all babies (including premature infants) whose mothers are Hepatitis B antigen positive.
Storage of vaccine-

Hepatitis B - Mothers Antigen Positive and Status Unknown

Babies born to carrier mothers are at greater risk of catching Hep B virus during birth. Baby can be protected from Hepatitis B by having extra injections of Hep B vaccine and Immunoglobulin (HBIG) at birth. If the recommended immunisations are completed the baby’s risk of becoming infected is reduced by about 95%.

Parental consent/ prescribing of

Hep B vaccine.

  • See flow chart for parental consent and vaccinations to give.

Mothers Hepatitis B antigen (HBsAg) status unknown

  • See flow chart for process – consent vaccinations and Hep B Immunoglobulin (HBIG).
Efficacy
  • 85-95% and virtually complete protection in those who develop antibody levels of greater than or equal to 10mlU/ml (the protection level). At least 95% in children after 3 doses.
  • The red form HNN2 then goes into the multidisciplinary notes. Later one copy goes to the Medical Officer of Health, Community Health.
Ordering of Hep B Immunoglobulin
  • On the request form for Human Plasma Protein Products (S405). Send to Blood Bank by chute plus a phone call.

Hepatitis B - Nursing Care of Baby whose Mother is Hep B Antigen Positive or Status Unknown

Nursing care of baby
  • The Nurse will ensure the following steps are carried out in the nursing care for baby whose mother is Hepatitis B antigen positive or status unknown.

 

Step

Action

1

Strict handwashing.

2

Gloves for all cares, where contact with body fluid is anticipated.

3

Baby may have breast milk.

4

Babies greater than 32 weeks gestation bath as soon as possible, if condition stable, using chlorhexidine surgical scrub 4%:
  • Have bath water and towels on hand.
  • Nurse wears long sleeve gown and gloves.
  • Nurse wets hands, pours some chlorhexidine surgical scrub 4% into hands, lathers up solution. Then using hands cover all of baby's skin-hair (avoiding eyes and ears)
  • Place baby in bath water and rinse off the chlorhexidine.
  • Dry baby.