In 1992, the Connecticut Department of Public Health found that hiring a state-level perinatal coordinator led to significantly better compliance with the recommendation to administer hepatitis B immune globulin (HBIG) than followup by local health departments. They also found that completion of the three-dose vaccination series was higher in cases followed by the state coordinator than in those followed by local public-health officials (CDC, 1996).
Two major problems occur in the identification and management of possible cases (see Box 2-6). The first involves linking pregnancy status with positive HBsAg laboratory reports on females of child-bearing age in a timely manner. In 2005, the Advisory Committee on Immunization Practices called for improving prevention of perinatal and early childhood HBV transmission by improving laws and regulations to improve identification of HBsAg-positive and HBsAg-undetermined mothers (Mast et al., 2005).
CDC Perinatal Hepatitis B Virus Infection Case Definition
Perinatal hepatitis B in the newborn may range from asymptomatic to fulminant hepatitis.
HBsAg positivity in any infant aged >1–24 months who was born in the United States or in US territories to an HBsAg-positive mother
Comment: Infants born to HBsAg-positive mothers should receive hepatitis B immune globulin (HBIG) and the first dose of hepatitis B vaccine within 12 hours of birth, followed by the second and third doses of vaccine at 1 and 6 months of age, respectively. Postvaccination testing for HBsAg and anti-HBs (antibody to HBsAg) is recommended from 3 to 6 months following completion of the vaccine series. If HBIG and the initial dose of vaccine are delayed for >1 month after birth, testing for HBsAg may determine if the infant is already infected.
Abbreviations: CDC, Centers for Disease Control and Prevention; HBsAg, hepatitis B surface antigen; anti-HBs, antibody to HBsAg; HBIG, hepatitis B immune globulin.
SOURCE: CDC, 2009a.