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What Obstetricians must Know

As you carry out prenatal care:

Test pregnant women during each pregnant for Hepatitis B surface antigen (HBsAg), even if they were previously vaccinated or tested. Suggest on lab requisition ‘prenatal’.

Perinatal Algorithm- Screening and Referral Algorithm forHepatitis B Virus (HBV) Infection among Pregnant Women

Send a copy of the initial HBsAg test result for existing pregnancy v prenatal records to the delivery hospital.

Submit a report of every HBsAg+ pregnant women (with each pregnancy) to the DOH (Perinatal Hepatitis B avoidance Program and HAHSTA in ~ 48 hours.

Conduct famous load and also e-antigen trial and error as indicated to overview care and consider prenatal antiviral therapy. Inform and counsel HBsAg+ women about their status and also refer for appropriate care with infectious an illness specialist. Rise viral fill of the mother has been connected with raised likelihood of transmission of perinatal Hepatitis B.

Contact the expected shipment hospital to interact the mother’s HBsAg+ status (with initial lab work). Convey the need for Hepatitis B vaccination and Hepatitis B Immune Globulin (HBIG) because that the infant within 12 hrs of birth. Partner with mother’s selected pediatrician to promote the Hepatitis B vaccine birth sheep for every mothers.

Assess HBsAg an unfavorable pregnant woman’s risk for hepatitis B infection (may have high risk sex-related partner). Retest high threat pregnant HBsAg+ ladies in your last trimester. Counsel HBsAg an unfavorable mothers on techniques to protect against HBV transmission.

Counsel HBsAg+ pregnant woman on approaches to protect against HBV infection on every visit. Talk around importance of bear dose and HBIG management as well as post-vaccine serology testing (PVST) for infant at 9 - 12 month of age. Adult learners frequently need come hear info several times prior to full expertise is achieved. Have clients restate expertise of counseling.

Vaccinate pregnant women v Tdap and flu each pregnancy.

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What Hospital/ parenting Staff must Know

For every intra-partum admission:

Flag or highlight HBsAg (antigen) positive results top top both labor and delivery record and on infant’s delivery and also problem review sheet. Connect the positive HBsAg+ condition to neonatal team and also nursing staff before delivery.Educate mothers on HBsAg optimistic status ~ above each distribution admission in major language spoken. Give literature in your language obtainable through various websites:Report every unknown and also confirmed optimistic HBsAg (antigen) deliveries to the state Perinatal Hepatitis B Nurse case Coordinator for instance management through:

The PHBPP instance Coordinator complies with the child to ensure interaction with pediatric provider, stylish dosing the Hepatitis B vaccine, and also post-vaccine serology trial and error completion in ~ 9 – 12 months of age.

For each infant admission:

Give all infants single-antigen Hep B vaccine within 12 hours of birth. Adopt a universal birth dose plan according come the AAP and also recommendations.Obtain original HBsAg (antigen) laboratory results of mommy for existing pregnancy and place copy in the document of every infants.Upon determining confident HBsAg status, administer HBIG and Hepatitis B solitary antigen vaccine in ~ 12 hours of birth. Record date and time of management and incorporate in report come PHBPP nurse case manager.Obtain in-house lab report of unknown HBsAg maternal status babies and provide HBIG prior to discharge if discovered to be HBsAg positive. Embrace an HBIG administration policy before discharge if lab results take longer than 24 hours.Provide documentation the Hepatitis B vaccine (and HBIG management record if given) as well as original maternal HBsAg lab results to mommy upon discharge to administer to pediatrician of choice.

What Pediatric/Family practice Providers have to Know

The Hepatitis B birth Dose

Pediatricians and also family practice physicians have a crucial role in Hepatitis B prevention. Promo of the Hepatitis B bear dose because that all infants in your care is a step to bring about the palliation of perinatal transmission of the Hepatitis B virus. Follow to the’s Advisory Committee ~ above Immunization techniques (ACIP), the birth dose offers a safety net for babies as clinical errors cause infant susceptibility come perinatal hepatitis B transmission.

The adhering to are several of the ways babies who room not vaccinated at birth become infected:

The mother is HBsAg negative but the infant is exposed come HBV epidemic post-natally from an additional family member or caregiver. This occurs in two-thirds that the situations of childhood transmission.The mrs is tested in at an early stage pregnancy because that HBsAg and also is uncovered to it is in negative. She establishes HBV infection later in pregnancy yet it is not detected, also though that is encourage by the high-risk ladies be retested later on in pregnancy. The epidemic is no clinically recognize by she health care provider so her child does not get hepatitis B vaccine or HBIG at birth.A chronically infected pregnant woman is tested but with the dorn test, HBsAb (antibody to hepatitis B surface ar antigen), rather of HBsAg. This is a common mistake since these 2 test abbreviation differ by just one letter. Her erroneously ordered test result is "negative," therefore her medical professional believes her child does not require post-exposure prophylaxis.The pregnant woman is tested and found to be hepatitis B surface antigen (HBsAg) positive, however her status is not communicated to the child nursery. The infant receives no hepatitis B vaccine no one HBIG protection at birth.The pregnant mrs is no tested because that HBsAg either prenatally or in the hospital at the moment of delivery. Her child does not get hepatitis B vaccine in the hospital even though the vaccine is recommended in ~ 12 hours of bear for babies whose mothers' test results are unknown.The pregnant mrs is HBsAg+ however her test outcomes are misinterpreted or mis-transcribed right into her prenatal document or she infant's chart. Her infant does not receive HBIG or hepatitis B vaccine.

Timely Dosing

Timely administration of the Hepatitis B vaccine for babies is important in developing immunity in all infants. For babies born come HBsAg+ mothers, the is recommended by the ACIP the all three doses of Hepatitis B be perfect by the six month visit. Combination vaccines have the right to be used to finish the series. Document of vaccines administered need to be command to the district of Columbia Immunization info System (DOCIIS) registry within 7 days.

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Post Vaccine Serology Testing

Infants who space born of mothers who space HBsAg+ require to gain tested for both Hepatitis B surface Antigen (HBsAg) and also Hepatitis B surface Antibody (HBsAb). This will tell whether the child is immune, still susceptible, or infected with the hepatitis B virus. Start early to tell parental that critical blood test will be excellent at age 9 - 12 month to give essential information about the baby’s food of treatment. Across the nation only 63 % the parents complete post-vaccine serology trial and error (PVST). Helping to identify barriers to testing at an early stage can rise the likelihood the serology experimentation will it is in completed. This is the only method to make sure infants have received efficient treatment and also are safeguarded from come hepatitis B infection.