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Vol 41 No 04 05-04-2021 Perinatal Hepatitis B Prevention Amid COVID-19.Pdf May 04, 2021, Vol. 41, No. 04 (Page 1 of 3) EPI-NEWS Serving Reno, Sparks and all of Washoe County, Nevada Telephone: 775-328-2447 | Fax: 775-328-3764 | [email protected] | washoecounty.us/health IN THIS ISSUE: HEPATITIS AWARENESS MONTH –PERINATAL HEPATITIS B PREVENTION AMID COVID-19 PERINATAL HEPATITIS B PREVENTION AMID COVID-19 Introduction exposed infants (e.g., providing education and May is Hepatitis Awareness Month. This is our annual supplying documentation to HBsAg-positive edition of Epi News that highlights the importance of pregnant women).2 screening patients for hepatitis, especially pregnant women to prevent perinatal transmission of the Labor and Delivery Care infection. WCHD’s Perinatal Hepatitis B Prevention The following groups should be tested at the time Program (PHBPP) helps to coordinate with healthcare of admission to the hospital for delivery: providers and birthing hospitals to prevent perinatal • Women who were not screened prenatally. transmission of hepatitis B. This guidance outlines • Women who engage in behaviors that put them steps that can be taken to prevent mother-to-child at high risk for infection. hepatitis B virus (HBV) transmission in the event of • Women with clinical hepatitis. COVID-19-related disruptions in routine preventive services before, during, and after labor and For those women who are identified as positive for delivery.1,2 hepatitis B, post-exposure prophylaxis (PEP) can be provided to the baby within 12 hours of birth to Hepatitis B Testing for Pregnant Women prevent disease transmission. Only 1% of infants All pregnant women should be tested routinely for receiving PEP develop hepatitis B, decreasing the HBsAg during an early prenatal visit (e.g., first incidence of liver cancer or cirrhosis. During the trimester) in each pregnancy, even if they have COVID-19 pandemic, it is recommended to: 2 been previously vaccinated or tested (see Table 1 • Identify HBsAg status of all women presenting and Figure 1 CDC Testing for HBV Infection During for delivery. Pregnancy Flowchart on page 2).1 This does not • If a woman’s HBsAg status is positive, HBIG replace a provider’s duty to report a positive and single antigen hepatitis B vaccine should be HBsAg woman to the health authority. administered to her infant within 12 hours of birth. Table 1. Three laboratories widely used in Washoe • If a woman’s HBsAg status is unknown, County offer prenatal panels. single antigen hepatitis B vaccine should be Panel-Prenatal Reflexive Panel (Test Code- administered to her infant within 12 hours of 0095044) ARUP birth. Administration of HBIG should be Laboratories Standalone-HBV Surface Antigen with Reflex determined per ACIP recommendations.1 to Confirmation, Perinatal (Test Code- • Provide the birth dose of hepatitis B vaccine to 2007573) all other newborns within 24 hours of birth to Panel-Prenatal Profile I with Hepatitis B prevent horizontal hepatitis B virus transmission Surface Antigen (Test Code-202945) LabCorp from household or other close contacts. Panel-Hepatitis Profile XIII (HBV Prenatal Profile) (Test Code 265397) Quest See Figure 2 & 3 CDC Procedures to Prevent Perinatal Obstetric Panel (Test Code-20210) Diagnostics Hepatitis B Virus Transmission at Delivery on page 3. Preparing for Delivery Pediatric Care of HBV-Exposed Infants During the COVID-19 pandemic, providers must After delivery, the PHBPP works with the mother and ensure that HBsAg-positive pregnant women are infant’s immunization provider to make sure the able to advocate for the proper care of their HBV- infant receives all of their recommended hepatitis B exposed infants in case labor and delivery occurs at vaccinations. Post-vaccination testing is completed to an unplanned facility or is attended by staff that ensure PEP and vaccinations were effective in are not knowledgeable about managing HBV- protecting against disease transmission and that the Please share this document with all physicians/staff in your office/facility infant developed immunity to hepatitis B. Testing is Duty of Healthcare Provider to Report performed at 9-12 months of age or 1-2 months after Per Nevada Administrative Code (NAC) their last dose of hepatitis B vaccine if the routine 441A.570 and 441A.230: schedule was not followed. During the COVID-19 1. To ensure exposed infants receive timely PEP, pandemic, it is recommended to:2 all HBsAg-positive pregnant women must be • Make every effort to ensure HBV-exposed infants reported to the Communicable Disease Program complete the hepatitis B vaccine series following prior to delivery. ACIP recommendations.1 Providers using single- component vaccine who are experiencing 2. If a pediatrician is aware of a child who may immunization service disruption should administer have a perinatal HBV-exposure, that provider hepatitis B vaccine as close to the recommended should also report to WCHD such case to intervals as possible, including series completion ensure the Hepatitis B positive mother has been at 6 months, and follow ACIP recommendations reported to WCHD and also ensure WCHD’s for post-vaccination serologic testing. PHBPP is aware of the exposed child. • If post-vaccination serologic testing is delayed If a provider orders hepatitis B testing for beyond 6 months after the hepatitis B series is females of childbearing age (10-55 years completed, the provider should consider old), he or she should also collect pregnancy administering a “booster” dose of single antigen status. If that female is HBsAg-positive, pregnancy hepatitis B vaccine and then ordering post- status should then be reported to the WCHD along vaccination serologic testing (HBsAg & antibody to with their HBsAg-positive report. HBsAg [anti-HBs]) 1-2 months after the “booster” dose. WCHD’s confidential fax for reporting is 1 Schillie, S, Vellozzie, C, Reingold, A, et al. Prevention of Hepatitis B Virus Infection in (775) 328-3764. the United States: Recommendations of the Advisory Committee on Immunization 2 Practices. MMWR Morb Mortal Wkly Rep 2018; 67(1);1-31. DOI: Interim Guidance for Routine and Influenza Immunization Services During the COVID-19 Pandemic: https://www.cdc.gov/vaccines/pandemic-guidance/index.html https://www.cdc.gov/mmwr/volumes/67/rr/rr6701a1.htm Please share this document with all physicians/staff in your office/facility Please share this document with all physicians/staff in your office/facility .
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