Infants born to hepatitis B-infected mothers receive postexposure prophylaxis to reduce their risk for perinatal hepatitis B virus (HBV) infection. Postexposure prophylaxis consists of hepatitis B (HepB) vaccine and hepatitis B immune globulin administered within 12 hours of birth, followed by completion of the 3-dose or 4-dose HepB vaccine series. Postvaccination serologic testing (PVST) assesses an infant's response to HepB vaccination and has typically occurred at age 9–18 months. This report provides a CDC update recommending shortening the interval for PVST from age 9–18 months to age 9–12 months. Providers should order PVST (consisting of hepatitis B surface antigen [HBsAg] and antibody to HBsAg [anti-HBs]) for infants born to HBsAg-positive mothers at age 9–12 months (or 1–2 months after the final dose of the vaccine series, if the series is delayed). This recommendation was prompted by the discontinuation of production of Hib/HepB vaccine (Comvax) and new data from the Enhanced Perinatal Hepatitis B Prevention Program supporting PVST 1–2 months after receipt of the last HepB vaccine dose, and at age ≥9 months.
An estimated 25,000 infants are born to HBsAg-positive mothers each year in the United States. Perinatal HBV infection, acquired in utero or during delivery, results in chronic HBV infection in 90% of infected infants. Approximately 25% of infants with HBV infection acquired perinatally will die prematurely as a result of complications of cirrhosis or liver cancer (1). Before the widespread availability of postexposure prophylaxis, up to 90% of infants born to HBsAg-positive mothers developed HBV infection. Postexposure prophylaxis is highly effective in preventing perinatal HBV transmission. In recent years in the United States, approximately 1% of infants receiving postexposure prophylaxis develop infection.
PVST consists of two tests: measurement of HBsAg and anti-HBs (1). Infants born to HBsAg-positive mothers who are HBsAg negative with anti-HBs levels ≥10 mIU/mL after having received a complete, 3-dose or 4-dose HepB vaccine series are identified as vaccine responders and considered seroprotected. Infants who are HBsAg negative with anti-HBs levels <10 mIU/mL require revaccination with a second 3-dose HepB vaccine series, followed by retesting for anti-HBs 1–2 months after the final vaccine dose.
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