Translation, Interpretation and Illumination

1. Translation, Interpretation and Illumination of Perinatal Hepatitis B

2. Hepatitis B Serology • Perinatal Hepatitis B Prevention Program Definition, Prevention, Key Points, Roles • Serology Revisited • Summary • Resources Overview

3. Virus replicates in the liver • Birth, bloodborne, & sexually transmitted • Acute vs. chronic infection • Infection in adults vs. children • Vaccine licensed 1982 Hepatitis B

4. HBsAg • Anti-HBs -tests are the most effective screening tool for HBV • Revisit • Total Anti-HBc • IgM anti-HBc • HBV DNA • HBeAg SEROLOGY

5. Hepatitis B surface antigen (HBsAg) -The HBsAg test is the ONLY way to definitively diagnose chronic HBV infection. -It can be present in both acute and chronic HBV infection. -Indicates patient is infected or infectious Serology

6. Hepatitis B surface antibody (anti-HBs) -Will tell if your patient is protected against HBV. -Anti-HBs can be produced in response to vaccination or recovery from an acute hepatitis B infection. Serology

7. HBV Serology: Quick Test Results*If HBsAg remains positive for 6 months

8. Montana Perinatal Hepatitis B Prevention Program

9. Clinical case definition: • -Perinatal hepatitis B in the newborn may range from asymptomatic to fulminant hepatitis. • Laboratory criteria for diagnosis: • -Hepatitis B surface antigen (HBsAg) positive • Case classification • -HBsAgpositivity in any infant aged >1-24 months who was born in the United States or in U.S. territories to an HBsAg-positive mother Perinatal Hepatitis B

10. Screen all pregnant women for HBsAg with each pregnancy • Give the birth dose of Hep B vaccine and HBIG to infants of HBsAg-positive women within 12 hours of delivery • Give the birth dose of hep B vaccine to all babies before hospital discharge Perinatal Hepatitis B Prevention

11. Maternal HBsAg Testing • Reporting and Tracking HBsAg(+) Pregnant Women • Vaccination of Infants at Birth • Follow-up vaccine doses and post-vaccination serology Key PointsMontana Perinatal Hepatitis B Prevention Program

12. Screen all pregnant women for HBsAg with each pregnancy • MCA: 50-19-103 Prenatal blood sample • MCA: 50-19-105 Reporting (+) Labs • ARM: 37.114.540 Hepatitis Type B • Retest high-risk women at the time of admission to the delivery hospital Maternal HBsAgTesting

13. All HBsAg+ pregnant women must be reported to the local or state health department • Household, sexual and needle sharing contacts should be identified and case managed by the local health department 2. Reporting and Tracking HBsAg(+) Women

14. If mother is HBsAg+ positive • HBIG and vaccine within 12 hours of birth • Infants weighing <2000gms* • If mother has unknown HBsAg status • Hep B vaccine birth dose <12 hours of age • Test mother to determine status* • HBIG (no later than 7 days after birth) • Infants weighing <2000gms* • If mother is HBsAg- negative • Universal birth dose and standing orders • Infants weighing <2000gms* 3. Vaccination of Infants at Birth

15. All infants should complete the vaccine series according to the recommended vaccination schedule • Infants of HBsAg+ mothers should be tested for HBsAg and anti-HBs (titer) • 1-2 months after the completion of the vaccine series • Between 9-18months of age, but no sooner than 9 months of age 4. Follow-up vaccine doses and post-vaccination serology

16. HBV Serology: Quick Test Results*If HBsAg remains positive for 6 months

17. Laboratory Staff • Prenatal Care Providers • Hospital Labor and Delivery Unit or Nursery Unit Staff • Pediatric Care Providers • Health Care Providers of Contacts to HBsAg+ Women • Local Health Departments Healthcare Worker Roles Montana Perinatal Hepatitis B Prevention Program

18. Flow of InformationMontana Perinatal Hepatitis B Prevention Program

19. Provide case management • To assure HBIG and notification to the birthing facility of pending delivery of HBsAg+ woman • To assure completion of vaccine series and post-vaccination serologic testing for infant • To provide education and follow-up for all household, sexual and needle sharing contacts of the mother • To report all data regarding the infant to the state health department Local Health Department Role

20. Revisit • Total Anti-HBc • IgM anti-HBc • HBV DNA • HBeAg Serology Revisited

21. Hepatitis B core antibody (anti-HBc)antibody

22. Acute • Clinical Case definition An acute illness with a) discrete onset of symptoms, and b)jaundice or serum ALT>200 IU/L • Laboratory criteria for diagnosis IgM anti-HBc positive orHBsAg positive and, IgM anti- HAV negative (if done) • Case classification Confirmed: a case that meets the clinical case definition, is laboratory confirmed, and is not known to have chronic Hepatitis B Hepatitis B

23. Chronic Hepatitis B • Clinical Evidence No symptoms required • Laboratory criteria for diagnosis IgM anti-HBc negative AND a positive result on one of the following tests: • HBsAg • HBeAg • HBV DNA OR HBsAg, HBV DNA, or HBeAg positive two times at least 6 months apart

24. HBV DNA (viral load) • Levels may be undetectable in a chronic case • Can detect and active infection • Primary use is to monitor anti-viral therapy • HBeAg • Used as a marker of infectivity and/or of the effectiveness of treatment • (there are some strains that do not make e-antigen) Serology

25. Screen all pregnant women for HBsAg with each pregnancy • Give the birth dose of Hep B vaccine and HBIG to infants of HBsAg-positive women within 12 hours of delivery • Give the birth dose of hep B vaccine to all babies before hospital discharge Summary: Perinatal Hepatitis B Prevention

26. HBV Serology: Quick Test Results*If HBsAg remains positive for 6 months

27. CDC Hepatitis B Professional Resources • http://www.cdc.gov/hepatitis/HBV/ProfResourcesB.htm Lab Tests Online • http://labtestsonline.org/understanding/analytes/hepatitis-b/tab/test Hepatitis B Foundation • http://hepb.org/index.html University of Washington Hepatitis Web Study • http://depts.washington.edu/hepstudy/hepB/clindx/serology/discussion.html Asian Liver Center at Stanford University, Physicians Guide to Hepatitis B • http://liver.stanford.edu/Media/publications/Handbook/2012Handbook.pdf Resources

28. Contact Information: Susan Reeser, RN, BSN Nurse Consultant/Perinatal Hep B Coordinator Immunization Program (406) 444-1805 Questions?