Hepatitis B is a DNA virus with estimated 240 million chronically
infected individuals worldwide.1
In New Zealand, it is estimated that overall 5.7% of the population is
The prevalence in antenatal population is not well characterized; there
is a suggestion that antenatal prevalence is about 1%. 3
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:
Hepatitis B DNA viral load 5
Hepatitis B e antigen status: 90% in HepBeAg positive vs 30% in HepBeAg
Mode of delivery: No trials to support a difference between vaginal or
c-section in hepatitis B vertical transmission rates 7
Breast-feeding: There is no evidence that breast-feeding increase the
risk of HepB transmission.8 HepB DNA can be detected in breast
For Known HepBsAg positive mother
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
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
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.
Action to be taken
Give hepatitis B immunoglobulin 100–110 IU neonatal and
hepatitis B vaccine 5 µg
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.
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
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
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.
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
See flow chart for process –
consent vaccinations and Hep B Immunoglobulin (HBIG).
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.
Gloves for all cares, where
contact with body fluid is anticipated.
Baby may have breast milk.
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.