The purpose of this pack is to prevent perinatal transmission by ensuring that babies born to mothers with hepatitis B infection receive their first dose of hepatitis B vaccine within 24 hours (preferably at birth) and that systems are in place for subsequent doses and follow up. Hepatitis B infection/positive is defined as mothers who are Hepatitis B surface antigen positive (HBsAg) in pregnancy.

This resource pack sets out the actions required, and contains the necessary documents which are essential in maintaining good communication with colleagues in primary care and public health to ensure that the mother’s health, that of her baby and her family is protected.

Perinatal transmission can be prevented by administration of a course of active immunisation (HB vaccine) which is indicated for all babies born to hepatitis B infected mothers, together with hepatitis B immunoglobulin (HBIG) at birth where indicated – see Green book Chapter 18 page 14 Table 18.5.
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/628602/Greenbook_chapter18.pdf

Other members of the family may be infectious carriers and even if the baby escapes infection at birth, he/she may still be at risk of infection at a later date. This is why it is extremely important to ensure that babies born to HBsAg positive mothers are fully vaccinated against hepatitis B. If the child is vaccinated, breastfeeding is safe.

The pdf of this entire document is available here

All babies are eligible for a hexavalent vaccine, which includes hepatitis B, for their primary immunisations.

Babies born to hepatitis B infected mothers must receive monovalent hepatitis B vaccine at birth and 4 weeks of age (additional vaccines) and then three doses of hexavalent vaccine at 8, 12 and 16 weeks of age (‘primaries’). They should receive a booster dose of monovalent hepatitis B vaccine at 12 months of age (additional vaccine). Serology is checked at 14 months of age to ensure that the baby has not become infected (see table below).

Timely vaccination at birth and at four weeks of age is critical for preventing infection in the infant.

The first dose of monovalent hepatitis B vaccine should be administered by hospital staff within 24 hours of birth and before the baby is discharged from hospital. Subsequent doses will be given by community vaccination teams, or paediatric team if the baby stays in the neonatal unit or paediatric unit beyond 4 weeks of age. If a Hepatitis B infected mother chooses to have a home birth, HPT will work with the Midwives to ensure the baby is vaccinated at birth.

Table 1. Hepatitis B immunisation schedule – for routine childhood programme and for babies born to Hepatitis B infected mothers

A. Ante-natal identification of infected mother

Paperwork to be completed by specialist midwife at this point:

1) Give the woman the NHS Scotland leaflet – Hepatitis B immunisation for babies born to mothers with hepatitis B – versions in English, easy read, Polish, Urdu and Chinese available on the NHS Inform website at ​Immunisations in Scotland | NHS inform
2) Send Health Protection Team the initial notification form (Initial Notification Form).
3) Ensure plan is documented on TRAK under Neonatal Management Plan a) hepatitis B vaccine schedule for all babies born to hepatitis B positive mothers and b) hepatitis B immunoglobulin (HBIG) if indicated.
4) Put sticker (labels) on notes to remind labour ward/postnatal midwife that hepatitis B vaccine is required (and use additional sticker where HBIG is also indicated).
5) Insert this resource pack in woman’s case notes to be used again at delivery.
6) Ensure that woman has either a referral to Dr Bathgate’s hepatitis clinic or is being followed up already at RIDU

B. Delivery of baby, vaccination, discharge and follow up

At birth

1. Labour ward midwife to ensure vaccine is available and to alert the staff member trained in hepatitis B vaccination (usually paediatrician) that baby needs 1st dose of paediatric hepatitis B vaccine within 24 hrs (preferably at birth) for all babies born to hepatitis B infected mothers, and HBIG if indicated.

2. Staff member who gives the vaccine to:

a) Access maternity TRAK and neonatal management plan
b) Ensure mother has received written information Hepatitis B immunisation for babies born to mothers with hepatitis B – versions in English, easy read, Polish, Urdu and Chinese available on the NHS Inform website at https://www.nhsinform.scot Gain consent from mother (consent form).
c) Administer the paediatric dose of hepatitis B vaccine (and HBIG where indicated).
d) Document processes and outcome (including brand, batch number and expiry date of vaccine and site of vaccination).

Documentation

Once vaccination has been given, midwife to:

3. Record information on 1st hepatitis B vaccine dose (and HBIG where indicated) on postnatal notification form and send or email to Child Health Information Systems (SIRS) CHIS.EastMidlothian@nhslothian.scot.nhs. And Health Protection Team (Public Health) health.protection@nhslothian.scot.nhs.uk at email addresses given on form, or using labels. This is very important as once SIRS/HPT receive information on first dose they will notify GP and parent/carer when subsequent doses are due.

4. Complete required details on either
• Letter A for babies receiving hepatitis B vaccine and HBIG (Letter A)
or
• Letter B for babies receiving hepatitis B vaccine only (no HBIG) (Letter B)

and send to mother’s GP. Give a copy to mother to give to GP when she registers her baby with the GP.

5. Document on baby section of the postnatal discharge part of TRAK that first dose of hepatitis B vaccine and HBIG (if indicated) has been given, with date.

6. Write vaccine schedule on yellow birth details form for health visitor

Co-ordinator of system: Health Protection Nursing Team

It is the responsibility of everyone involved in the care of the pregnant woman to
ensure that appropriate actions are taken and that communication with the woman
herself and with clinical colleagues is maintained.

If you have any queries about any aspect of this system, please contact:

Health Protection Team
NHS Lothian, Waverley Gate
2-4 Waterloo Place
Edinburgh
EH1 3EG
Tel 0300 790 6462
Email: health.protection@nhslothian.scot.nhs.uk