Hepatitis B

Established in 1991, the Texas Perinatal Hepatitis B Prevention Program works alongside public and private healthcare providers and coalitions to prevent perinatal hepatitis B transmission. The Program assists with and provides surveillance, case management, promotion of the universal birth dose, and collaboration between local health departments, medical providers, and laboratories.  

The National Health and Nutrition Examination Survey (NHANES) estimated that in 2013 between 1,059 and 1,503 infants were born to women infected with hepatitis B. However, only 562 cases were reported to the Department of State Health Services. 

Our team works to support the awareness, prevention, and tracking of Hepatitis B. The Texas Perinatal Hepatitis B Prevention Program aims to: 

• Ensure that all pregnant women are tested for hepatitis B surface antigen (HBsAg). 

• Ensure reporting and tracking of HBsAg-positive pregnant women. 

• Ensure that delivery facilities/hospitals receive all prenatal HBsAg lab reports prior to delivery. 

• Ensure identification and management of infants born to HBsAg-positive mothers. 

• Ensure reporting of infants born to HBsAg-positive mothers. 

• Ensure identification and case management of infants born to mothers of unknown HBsAg status. 

• Ensure timely completion of the hepatitis B vaccine series for all infants born to HBsAg-positive mothers. 

• Ensure timely completion of postvaccination serologic testing (PVST) for all infants born to HBsAg-positive women. 

• Ensure vaccination of household contacts 24 months of age and younger. 

• Ensure program quality, monitoring, and evaluation. 

Hepatitis B virus (HBV) infection is a major cause of acute and chronic hepatitis, cirrhosis of the liver, and primary hepatocellular carcinoma (liver cancer). It is the most prevalent chronic infectious disease in the world, a common cause of morbidity and mortality worldwide, and a major health problem in the United States. According to the World Health Organization, an estimated 240 million people are chronically infected with hepatitis B and more than 600,000 people die every year due to complications of hepatitis B, including cirrhosis and liver cancer.

Although postexposure prophylaxis (PEP) is highly effective, approximately 1% of infants who receive PEP will still develop HBV infection and up to 5% may remain susceptible to infection. Ninety percent of infants who become infected during childhood will become chronically infected, thereby increasing their risk of early onset cirrhosis and hepatocellular carcinoma. Of children who become infected with HBV before 5 years of age, 30%-50% become chronically infected.

Perinatal hepatitis B is preventable by:

• Screening pregnant women at the first prenatal visit and at delivery
• Giving the birth dose of hepatitis B vaccine and hepatitis B immune globulin (HBIG) to babies born to HBsAg- positive women within 12 hours of delivery
• Giving the birth dose of hepatitis B vaccine to all babies before hospital discharge as a safety net

The purpose of the Texas Department of State Health Services' Perinatal Hepatitis B Prevention Program (PHBPP) is to:

• Identify hepatitis B surface antigen (HBsAg) positive pregnant women;
• Ensure that infants of HBsAg-positive pregnant women receive hepatitis B immune globulin (HBIG) and hepatitis B vaccine at birth;
• Ensure that infants complete the hepatitis B vaccine series and serological testing;
• Identify household and sexual contacts to HBsAg positive mothers;
• Vaccinate at risk contacts and conduct serological testing.

Testing at First Examination

Providers that are permitted by law to care for a pregnant woman during gestation or at delivery of an infant shall perform hepatitis B serologic testing at the first prenatal visit and upon delivery of an infant. The test results from pregnancy shall be retained for nine months and the report delivered to any successor in the case.

Distribution of Informational Materials at Time of Testing

Before the serologic sample is taken, the health care provider shall distribute to the patient printed materials about hepatitis B and document the distribution of these materials. If a screening test and a confirmatory test show that the woman is or may be infected with hepatitis B, the provider shall provide or make available to the woman disease-specific information on the disease diagnosed, including information relating to treatment, which must be in another language, if needed, and must be presented, as necessary, in a manner and in terms understandable to a person who may be illiterate if resources permit. Referral to an entity that provides treatment for hepatitis B is compliant.

Physicians, advanced practice nurses, physician assistant, and persons permitted by law to attend a pregnant woman during gestation or at the delivery of an infant (such as midwives) are required to report to DSHS each patient who has or is suspected of having hepatitis B.

Any person who is in charge of a clinic laboratory in which a laboratory examination of any human specimen yields serologic evidence of a notifiable condition shall report as required. Failure to report a notifiable condition is a Class B misdemeanor under the Texas Health and Safety Code §81.049.

The Health Insurance Portability and Accountability Act (HIPAA) allows reporting without authorization for public health purposes and where required by law.

Hepatitis B (acute and chronic) identified prenatally or at delivery shall be reported no later than one week after a case or a suspected case is identified.

Perinatal Hepatitis B infections in infants 24 months of age and younger shall be reported within one working day of identification as a confirmed or suspected case.

All persons required by law to report shall report to the local health department (LHD) where the office, clinic, or hospital is located. If there is no LHD appointed for their jurisdiction, the report shall be sent to the DSHS Health Service Region (HSR).

Control techniques including immunization, chemoprophylaxis, and other accepted measures shall be instituted as necessary to reduce morbidity and mortality.

All individual case reports received by the health authority or DSHS are confidential records.

To implement disease control measures authorized by the Texas Administrative Code, it may be necessary for the health authority or DSHS to investigate public or private health records including patient medical records pertinent to the notifiable condition for the purpose of implementing disease control measures. This information shall be kept confidential.

A covered entity may disclose protected health information to a public health authority authorized by law for activities to prevent or control disease such as surveillance, investigations, and interventions.

• The Texas Health and Safety Code
• The Texas Administrative Code