• Check mother’s hepatitis B status before delivery

Antenatal

• Midwife to inform obstetrician, neonatologist, Public Health team and GP of plan to immunise
• Hepatitis B immunoglobulin (HBIG) issued by Public Health England (PHE) via local consultant microbiologist
  • order well in advance of birth
  • if twins order 2 doses

Labour

• When an HBsAg positive mother arrives in labour or for caesarean section, labour ward must inform on-call neonatal team 

Postnatal

• For all newborns, check screening results of mother’s antenatal tests
• If antenatal testing not done, request urgent maternal HBsAg test 
• Mother may breastfeed

Table 1: To which babies

• Give low-birth-weight and premature babies full neonatal dose hepatitis B vaccine
• Give HBIG and hepatitis B vaccine to babies with birth weight <1.5 kg born to mother with hepatitis B, regardless of mother’s HBeAg status 

When

• Give within 24 hr of birth, ideally as soon as possible after delivery
• When indicated HBIG should be given with hepatitis B vaccine ideally within 24 hr of birth, but no later than 7 days

What

• Give hepatitis B vaccine 0.5 mL IM. Caution: brands have different doses [e.g. Engerix-B® 10 microgram (recommended), HBvaxPro® 5 microgram 0.5 mL]
• HBIG 250 units additionally given to babies of highly infectious mothers (see Table 1) 
• Monitor babies born <28 weeks’ gestation for 72 hr after HBIG

How

• Use 2 separate injection sites for hepatitis B vaccine and HBIG, in anterolateral thighs (not buttocks) 
• Low-birth-weight babies can be given the injection in divided doses, within 7 days of birth, but should still receive a full 250 units
• Give hepatitis B vaccine IM, except in bleeding disorder where it may be given deep subcutaneously

Relationship to other immunisations

• No need to delay BCG following HBIG
• Hepatitis B vaccine may be given with other vaccines but use separate site. If same limb used, give vaccines >2.5 cm apart

Documentation

• Record immunisation in Red Book
• Notify Child Health Information Services using unscheduled immunisation form
• Advise GP when next doses due

Further doses

• Second dose at 1 month
• Give appointment for next dose or ensure agreement to give vaccine at GP practice or immunisation team

1 yr follow-up

• Book 1 yr hospital blood test before neonatal discharge
• Check child’s HBsAg status at aged 1 yr 
  • if HBsAg positive refer to infectious disease or liver team for further management

Table 2: Hepatitis B vaccine schedule for routine and at risk baby immunisation programmes

* Babies born to hepatitis B negative mothers but going home to a household with another hepatitis B infected person may be at immediate risk of infection - give a monovalent dose of hepatitis B vaccine before discharge

Antenatal

• High-risk groups:
  • intravenous drug users (IVDU) or women with partners who are IVDU
  • from a country of intermediate or high prevalence (≥2%) of chronic hepatitis C, including Africa, Asia, the Caribbean, Central and South America, Eastern and Southern Europe, Middle East and Pacific Islands
  • living in homeless hostel/rough sleeping

Procedure

• Pregnant women at risk for hepatitis C infection should be screened at antenatal visits
• If the initial results are negative in women with ongoing risk factors this should be repeated in the third trimester
• In the third trimester, if maternal HCV Ab is positive (indicating past or current infection), request Hep C RNA NAAT (viral load)
• If maternal bloods show infection, discuss with mother/family regarding testing of baby at aged 18 months and inform neonatal team

Follow-up

• Discuss with neonatal unit consultant and arrange follow-up in clinic at aged 18 months
• Discharge baby summary to GP to include containing information on further investigations and follow-up plan
• Inform mother and family of arranged follow-up appointments

Documentation

• Document hepatitis C follow-up visits in Red Book to ensure health visitor aware and baby followed up

Breastfeeding

• Mother may breastfeed

Adoption and fostering

• If high risk factor (see Antenatal) for HCV and/or maternal status not known
• Aged <18 months 
  • check hepatitis C antibody status at screening or first contact at Looked After Clinic
    • if serology positive, repeat serology at 18 months and refer to paediatric infectious diseases if this is positive
• Aged ≥18 months
  • check hepatitis C antibody status at screening or first contact at Looked After Clinic
    • if positive, refer to paediatric infectious disease consultant