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. 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. 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.
- Centers for Disease Control and Prevention. Viral Hepatitis – Hepatitis B Information. Retrieved January 11, 2016 from http://www.cdc.gov/hepatitis/hbv/perinatalxmtn.htm
- Ko, S. C., Fan, L., Smith, E. A., Fenlon, N., Koneru, E. A., & Murphy, T. V. (2014). Estimated Annual Perinatal Hepatitis B Virus Infections in the United States, 2000–2009. J Pediatric Infect Dis Soc, 3(4), 1-8.