PUBLIC HEALTH
PERINATAL HEPATITIS B GUIDANCE 1 :
Maternal HBsAg Status
HBsAg positive
HBsAg status unknown/
pending
HBsAg status negative
Infants > 2,000 grams
Birth Dose HBV Vaccine
X
X
Preterm Infants < 2,000
grams*
Birth Dose HBV Vaccine
X
X
HBIG
X
**
X
HBIG
X
X
X
*A total of four HBV vaccines should be given, the first at birth, the second at one month to begin the full three dose series
**Can await HBsAg result if able to be done within seven days of birth and follow up is ensured if hospital discharge before administration
The above chart provides information on appropriate treatment
and follow up for newborns. All those who are born to a HBsAg
positive mother should receive intramuscular hepatitis B immune
globulin (HBIG) 0.5mL as soon as possible after birth (no more
than seven days after birth) and HBV vaccine within 12 hours of
birth. If given simultaneously, HBIG and HBV vaccine should be
administered in separate anatomical locations. For infants who
are less than 2,000 grams, they should receive a total of four HBV
vaccines due to a possibility that their immune system may not
respond appropriately to the initial vaccine. The second vaccine
should be given at one month. Both Recombivax HBV and Engerix-B
are appropriate for the initial HBV vaccines. Combination vaccines
should not be administered until after six weeks of age.
Perinatal hepatitis B infection can also be prevented by pro-
tecting at-risk adults from infection 3 . There are currently three
adult vaccinations to protect against hepatitis B virus. Traditionally,
Engerix-B Adult and Recombivax HB Adult can be given as a three-
part series at zero, one and six months for adults age 20 and older
(use the pediatric vaccine for those 19 and below) 4 . Post-vaccination
immunity studies show protection of 88-99% after the third dose
of Engerix-B in healthy adults 5 and 89-96% after the third dose
of Recombivax HB 6 . Immunity rates are lower after the first and
second dose, so completion of the three-dose series is imperative.
Health care providers may have faced the frustration of completing
a hepatitis B vaccine series and being told they are not immune.
Heplisav-B is a newer hepatitis B vaccine that is a two-dose vaccine
series, given at zero and one months. Clinical trials show seropro-
tection rates (anti-HBs at or above 10mIU) of 90-95% 7 . It may be
an alternative to the traditional vaccine and may be an option for
previous non-responders or those that prefer fewer vaccines or
another trip to the provider’s office to complete the vaccine series.
Twinrix is a combination hepatitis A and B vaccine that requires
three doses and zero, one and six months. Three complete doses are
recommended to ensure maximal protection against the hepatitis
B virus, and manufacturer-reported seroprotection rates for hep-
atitis B are 18% after dose one, 61% after dose two and 95% after
dose three 8 . The cost of these vaccines is comparable and should be
covered by most insurance plans. Many pharmacies are carrying
these adult vaccines.
Dr. Caloia is the Medical Director of the Louisville Metro Department of Public Health
and Wellness.
Dr. Stutts practices at the Department of Pediatrics, Division of Pediatric Gastro-
enterology, Hepatology and Nutrition, University of Louisville School of Medicine.
References:
1. Kentucky Department of Public Health. Perinatal Hepatitis B Management.
Accessed February 7, 2019 from https://chfs.ky.gov/agencies/dph/dehp/
idb/Pages/perinatal-hepatitis-b.aspx
2. Centers for Disease Control and Prevention. Perinatal Hepatitis B Program.
Accessed February 7, 2019 from https://www.cdc.gov/hepatitis/hbv/pdfs/
PerinatalAlgorithm-Prenatal.pdf
3. CDC. A comprehensive immunization strategy to eliminate transmission
of hepatitis B virus infection in the United States: recommendations
of the Advisory Committee on Immunization Practices (ACIP) part 1:
immunization of infants, children, and adolescents. MMWR. 2005; 54
(No. RR-16): 14.
4. Wexler, Deborah. Hepatitis B Vaccination for Adults—Who Needs it
and When? Immunization Acton Coalition Technically Speaking. 2016.
Accessed February 7, 2019 from http://www.immunize.org/technical-
ly-speaking/20161027.asp
5. EngerixB product insert Accessed February 7, 2019 from https://www.fda.
gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/
UCM224503.pdf
6. Recombivax product insert 12/2018. Accessed February 7, 2019 from
http://www.immunize.org/technically-speaking/20161027.asp
7. Heplisav-B product insert 3/2018. Accessed February 7, 2019 from https://
heplisavb.com/assets/pdfs/HEPLISAV-B-Prescribing-Information.pdf
8. Twinrix product insert Accessed February 7, 2019 from https://www.
gsksource.com/twinrix
JUNE 2019
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