By Cynthia English, RN BSN, Communicable Disease Specialist, Saint Louis County (MO) Department of Public Health

Hepatitis B infection in a pregnant woman poses a serious risk to her infant at birth. Without post-exposure prophylaxis (PEP), approximately 40% of infants born to hepatitis B-infected mothers in the United States will develop chronic hepatitis B infection, approximately one-fourth of whom will eventually die from chronic liver disease[1]. The U.S. Department of Health and Human Services’ (HHS) Office of HIV/AIDS and Infectious Disease Policy held a technical consultation with a group of diverse stakeholders to explore strategies to eliminate perinatal hepatitis B transmission in the United States on September 29, 2015.

In 1990, the National Perinatal Hepatitis B Prevention Program (PHBPP) was developed by the CDC. Many effective tools for reducing perinatal transmission of hepatitis B already exist, including maternal screening, infant PEP with hepatitis B immune globulin and hepatitis B vaccine, and universal infant vaccination recommendations. PHBPP provides case management to mother-infant couplets to ensure proper screening, administration of PEP, and timely completion of the vaccine series and post-vaccination serology testing. However, despite these efforts, an estimated 10,000 infants in the United States became infected with the virus in the past decade[2]. Additional strategies are needed to take this number to zero.

It is a goal of the Action Plan for the Prevention, Care and Treatment of Viral Hepatitis to eliminate perinatal hepatitis B transmission in the United States. In response to this goal, over 40 individuals including healthcare providers, hepatitis B experts and advocates, clinical laboratories, community health organizations, professional health organizations, and HHS met to discuss strategies aimed at the elimination of mother-to-infant transmission of the hepatitis B virus.

NACCHO member Cynthia English, RN, is a Communicable Disease Specialist with the Saint Louis County Department of Public Health and serves as a Perinatal Hepatitis B Case Manager for St. Louis County, Missouri. She attended the Technical Consultation as a representative of NACCHO’s Immunization Workgroup. Discussions at the event included ways to decrease cultural and socioeconomic barriers to care; improvements to laboratory testing and reporting procedures; improved training of healthcare providers in regard to interpretation of test results; improved transfer of medical information; strengthened protocols among healthcare providers and birthing facilities for implementation of recommended hepatitis B PEP protocols; and expanded research to determine perinatal hepatitis B prevention best practices.

The important roles that a variety of healthcare stakeholders have in the elimination of perinatal hepatitis B were highlighted during the Technical Consultation. A takeaway for local health departments is how they play a vital role in the recognition of the factors that contribute to the transmission of perinatal hepatitis B and develop plans of action to combat those factors. Further, local health departments can:

• Provide hepatitis B education for “at risk” groups;
• Supply healthcare providers with access to training materials regarding the interpretation of hepatitis B lab reports and the recommended prophylaxis for infants born to hepatitis B infected women;
• Encourage local hospitals to administer a birth dose of hepatitis B vaccine to all newborns prior to discharge; and
• Increase public awareness of hepatitis B and the importance of hepatitis B immunizations.

Continued networking with diverse stakeholders on a national level will serve to keep local health departments informed of current research findings and updates to perinatal hepatitis B prevention practices.

In December 2015, HHS published a meeting report for the Technical Consultation on the Elimination of Perinatal Hepatitis B in the U.S. Contained in the report is a “Summary of Recommendations” with sections focusing on engaging patients and communities disproportionately impacted by hepatitis B; strengthening systems to enhance prevention efforts; and expanding and refining research efforts. A copy of the report with a list of participants and more information about hepatitis B can be found at www.aids.gov/hepatitis.