Hepatitis B and pregnancy 

Hepatitis B prevention program for pregnant people and their families 

Pregnant people who are infected with hepatitis B and their infants may be automatically enrolled in the program after Public Health is notified by their provider, clinic, hospital, or lab.

Services include:

• hepatitis B vaccine and testing reminder calls or letters to moms, parents, and guardians
• coordinating clinic appointments for enrolled clients
• client hepatitis B education and resources

For questions and client services call 206-296-4774 and ask for the perinatal hepatitis B team. 

Hepatitis B Immunoglobulin (HBIG)

HBIG is an injectable medication that provides antibodies to fight the hepatitis B virus (HBV). HBIG works with the body's natural defenses to prevent or make an HBV infection less severe. Babies exposed to HBV during pregnancy and at birth get an injection of HBIG to protect them until they can complete the hepatitis B vaccine series. HBIG provides only temporary protection and does not replace hepatitis B vaccine. 

Resources for healthcare providers 

Universal prenatal testing to identify hepatitis B infection early in pregnancy is key to preventing the spread of disease. It’s also essential for healthcare providers to notify Public Health. Unless they get proper post-exposure prevention, up to 90% of babies born to mothers with hepatitis B get infected, and 85% to 95% of those will be chronically infected. Up to one in four chronically infected babies will die from primary hepatocellular carcinoma or cirrhosis of the liver later in life. The universal birth dose of hepatitis B vaccine, given within 24 hours (regardless of birth parent hepatitis B status), acts as a safety net for all infants. 

Vaccination and testing 

• Pediatric providers should give dose 2 of hepatitis B vaccine at 1-2 months of age and dose 3 at 6 months of age. 
• Postvaccination serologic testing (PVST) at age 9-12 months (not before 9 months) is critical to determine immunity for infants exposed to hepatitis B at birth. Please use the pediatric guide (339 KB) for more on testing infants, interpreting lab results, and reporting to Public Health – Seattle & King County. 
• Pediatric providers should determine if infants will be leaving the country or King County during vaccination or testing and make a plan with the family. Guides for infants being cared for in China are available in English (793 KB) and Chinese (694 KB). 

Learn more from the links below:

• Seven strategies to help prenatal care providers prevent perinatal hepatitis B transmission (483 KB)
• Four strategies guide hospitals to prevent perinatal hepatitis B transmission (430 KB)
• Five tasks help pediatric care providers prevent babies born to HBsAg-positive persons from becoming lifelong (chronic) carriers (287 KB)
• Guidelines from WA State Dept. of Health (2.9 MB) 

Healthcare provider reporting information 

In Washington, healthcare providers are legally required to report hepatitis B infections to Public Health (HBsAG-positive). Each pregnancy with a positive hepatitis B infection (HBsAG-positive) is also must be reported to Public Health within 3 days. 

Reporting of a HBsAg-positive pregnant person to Public Health – Seattle & King County can be done in the following ways: 

• Call Communicable Disease Control, Epidemiology, & Immunization at 206-296-4774,
• Call the 24-hour report line at 206-296-4782, push "3" to report PHBPP information, or 
• Download, complete, and fax the confidential case report form (1 MB) to 206-296-4803. 

Interim advisory for birth centers

Birthing/childbirth centers are owned and operated by licensed midwives and certified nurse midwives. The guidelines for administering hepatitis B vaccine and Hepatitis B Immune Globulin (HBIG) as a part of post exposure prophylaxis remain similar to birth hospitals. 

To obtain HBIG, midwives should contact their medical supply distributor and speak to their account representative. Hepatitis B vaccine may also be obtained through direct purchasing or through unique collaborations with a pediatric medical providers who readily stock the vaccine. 

Please refer to the guidelines from the WA State Dept. of Health (503 KB) for more information about hepatitis B vaccine brands, storage and handling, and administration guidance for both hepatitis B vaccine and HBIG. 

Birth centers having difficulties obtaining post-exposure prophylaxis for a delivery may contact the Perinatal Hepatitis B Prevention Program at 206-296-4774 for assistance.