COMMENTARY

Prevention of Perinatal Hepatitis B Transmission

Sarah Schillie, MD, MPH, MBA

Disclosures

September 08, 2015

Editorial Collaboration

Medscape &

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Hello. I am Sarah Schillie, a physician in the Division of Viral Hepatitis at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia. I am happy to speak with you today as part of the CDC Expert Commentary Series on Medscape.

Today I will be discussing the results of a study in the journal Pediatrics[1] that examined outcomes of infants born to women infected with hepatitis B virus (HBV). Perinatal exposure is an important mode of HBV transmission, resulting in chronic disease in approximately 90% of infected infants. Immunoprophylaxis consisting of HBV vaccine and HBV immune globulin given within 12 hours of birth, and completion of the three-dose HBV vaccine series, are the cornerstones of perinatal HBV infection prevention. Immunoprophylaxis for infants born to hepatitis B surface antigen-positive mothers reduces up to 95% of perinatal HBV infections.

However, despite recommended immunoprophylaxis, the study showed that perinatal HBV transmission still occurs in approximately 1% of vaccinated infants born to infected mothers. Infection occurs more commonly among infants born to mothers who are younger, who are Asian/Pacific Islander, who are HBV e-antigen positive, or who have high viral loads, as well as among infants who receive fewer than three HBV vaccine doses.

Perinatal HBV transmission may be further reduced by identifying pregnant women at the greatest risk of transmitting the virus to their infants and providing these women with antiviral therapy prior to delivery. Those at most risk include mothers with high viral loads or who are HBV e-antigen positive.

Preventing perinatal HBV transmission is a critical part of the national strategy to eliminate HBV infection in the United States. It's important for healthcare providers to understand that HBV in pregnant women poses a serious risk for chronic HBV infection, liver failure, and hepatocellular carcinoma in their infants. Following national guidelines that include the universal screening of pregnant women for HBV during pregnancy, case management of mothers with HBV and their infants, provision of timely immunoprophylaxis consisting of HBV vaccine and HBV immune globulin for infants born to infected mothers, as well as routine vaccination of all infants with the HBV vaccine series with the first dose administered shortly after birth, are of paramount importance.

Web Resources

Hepatitis B Perinatal Transmission

Sarah Schillie, MD, MPH, MBA, is a medical epidemiologist with the CDC's Division of Viral Hepatitis, Vaccine Research and Policy Unit. She is a graduate of the University of Missouri School of Medicine and Columbia University's Mailman School of Public Health. Her areas of professional interest include perinatal hepatitis B infection, occupational risk for bloodborne pathogen transmission, and infection control in healthcare settings.

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