Assessment of State Perinatal Hepatitis B Prevention Laws


      Identifying pregnant women with hepatitis B virus (HBV) infection for post-exposure prophylaxis of their infants is critical to preventing mother-to-child transmission of HBV infection. HBV infection in infancy results in premature death from chronic liver disease or cancer in 25% of affected infants. Universal screening of pregnant women for HBV infection is the standard of care, and in many states is supported by laws for screening and reporting these infections to public health. No recent assessment of state screening and reporting laws for HBV infection has been published.


      In 2014, the authors analyzed laws current through December 31, 2013 from U.S. jurisdictions (50 states and the District of Columbia) related to HBV infection and hepatitis B surface antigen screening and reporting requirements generally and for pregnant women specifically.


      All states require reporting of cases of HBV infection. Twenty-six states require pregnant women to be screened. Thirty-three states require public health reporting of HBV infections in pregnant women, but only 12 states require reporting pregnancy status of women with HBV infection.


      This assessment revealed significant variability in laws related to screening and reporting of HBV infection among pregnant women in the U.S. Implementing comprehensive HBV infection screening and reporting laws for pregnant women may facilitate identifying HBV-infected pregnant women and preventing HBV infection in their infants.
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        • Nelson N.P.
        • Jamieson D.J.
        • Murphy T.V.
        Prevention of perinatal hepatitis B virus transmission.
        J Pediatr Infect Dis Soc. 2014; 3: S7-S12
        • Advisory Committee on Immunization Practices
        A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States.
        MMWR Morb Mortal Wkly Rep. 2005; 54: 1-33
        • American College of Obstetrics and Gynecology educational bulletin
        Viral hepatitis in pregnancy.
        Int J Gynaecol Obstet. 1998; 63: 195-202
        • U.S. Preventive Services Task Force
        Screening for hepatitis B virus infection in pregnancy: U.S. Preventive Services Task Force reaffirmation recommendation statement.
        Ann Intern Med. 150. 2009: 869-873
        • Roush S.
        • Birkhead G.
        • Koo D.
        • et al.
        Mandatory reporting of diseases and conditions by health care professionals and laboratories.
        JAMA. 1999; 281: 164-170
        • Schillie S.
        • Murphy T.V.
        • Fenlon N.
        • Ko S.
        • Ward J.W.
        Update: shortened interval for postvaccination serologic testing of infants born to hepatitis B-infected mothers.
        MMWR Morb Mortal Wkly Rep. 2015; 64: 1118-1120
        • Recommendations of the Immunization Practices Advisory Committee
        Prevention of perinatal transmission of hepatitis B virus: prenatal screening of all pregnant women for hepatitis B surface antigen.
        MMWR Morb Mortal Wkly Rep. 1988; 37 (351): 341-346
        • Lok A.S.F.
        • McMahon B.J.
        AASLD Practice Guideline update. Chronic hepatitis B: update 2009.
        Hepatology. 2009; 50: 1-36
        • Bzowej N.H.
        Optimal management of the hepatitis B patient who desires pregnancy or is pregnant.
        Curr Hepat Rep. 2012; 11: 82-89
      1. Centers for Disease Control and Prevention, American College of Obstetics and Gynecologists. Screening and referral algorithm for hepatitis B virus (HBV) among pregnant women. Published March 2015. Accessed July 19, 2015.

        • Giles M.L.
        • Visvanathan K.
        • Lewin S.R.
        • Sasdeusz J.
        Chronic hepatitis B infection and pregnancy.
        Obstet Gynecol Survey. 2012; 67: 37-44
        • Smith E.A.
        • Jacques-Carroll L.
        • Walker T.Y.
        • et al.
        The National Perinatal Hepatitis B Prevention Program, 1994-2008.
        Pediatrics. 2012; 129: 609-616
      2. 42 CFR § 493.1241(c)(3).
      3. Walker TY, Smith EA, Fenlon N, et al. Characteristics of pregnant women with hepatitis B in five U.S. public health jurisdictions. Public Health Rep. In press.

        • Ikeda R.M.
        • Birkhead G.S.
        • Flynn M.K.
        • Thompson S.F.
        • Morse D.L.
        Use of multiple reporting sources for perinatal hepatitis B surveillance and follow-up.
        Am J Epidemiol. 1995; 142: 765-770
        • Lindley M.C.
        • Horlick G.A.
        • Shefer A.M.
        • et al.
        Assessing state immunization requirements for healthcare workers and patients.
        Am J Prev Med. 2007; 32: 459-465
      4. Kim Y. Statutory interpretation: general principles and recent trends. Congressional Research Service. Published August 31, 2008. Accessed January 9, 2015.

      5. Kan. Stat. Ann. §65-153f.

      6. 28 Pa Code §27.99.
      7. WAC 246-680-010. See also Arkansas “at or near the initiation of care” (Code Ark. R. 007.13.4-400); California “as early as possible during prenatal care” (Cal. Health & Safety Code §125085); Tennessee “at the time of first examination and visit or within ten (10) days after the first examination” (T.C.A. §68-5-602); Utah “at an early prenatal care visit” (UT ADC R386-702); Virginia “within 15 days after beginning such attendance” (12 VAC 5-90-130).
      8. Ark. Code Ann. § 20-16-507. See also Tennessee,“[i]f the first visit is at the time of delivery, or after delivery, the standard serological test … shall be performed at that time” (Tenn. Code Ann. § 68-5-602).
      9. N.J. Admin. Code § 8:43G-19.2. See also New York mandating if “a woman who has not been tested for HBsAg during pregnancy is admitted for delivery or if a womanʼs HBsAg test result is not at the time of admission for delivery, the healthcare facility shall: (1) submit immediately a satisfactory blood specimen from such a woman to a clinical laboratory that will test it for HBsAg” (10 N.Y. Comp. Codes R. & Regs. 69-3.3).

      10. Alaska Admin. Code tit. 7, § 12.403.

      11. V.T.C.A., Health & Safety Code §81.090.

      12. 10 N.Y. Comp. Codes R. & Regs. 69-3.2.
      13. Mo. Ann. Stat. § 210.030.
      14. Haw. Code R. 11-156-8.1.

      15. Fla. Admin. Code Ann. r. 64D-3.042.

      16. Ill. Admin. Code tit. 77 §690.451.

      17. D.C. Mun. Regs. tit. 22-B, § 201.

      18. 410 Ind. Admin. Code 1-2.3-47.
      19. 10-144 Code Me. R. Ch. 258, § 2.
        • European Association for the study of the Liver
        EASL Clinical Practice Guidelines: management of chronic hepatitis B virus infection.
        J Hepatol. 2012; 57: 167-185
        • Terrault N.A.
        • Bzowej N.H.
        • Chang K.-M.
        • Hwang J.P.
        • Jonas M.M.
        • Murad M.H.
        AASLD Guidelines for treatment of chronic hepatitis B.
        Hepatology. 2016; 63: 261-283
        • Liaw Y.-F.
        • Kao J.-H.
        • Piratvisuth T.
        • et al.
        Asian-Pacific consensus statement on the management of chronic hepatitis B: a 2012 update.
        Hepatol Int. 2012; 6: 531-561
        • Kubo A.
        • Shlager L.
        • Marks A.R.
        • et al.
        Prevention of vertical transmission of hepatitis B. An observational study.
        Ann Intern Med. 2014; 160: 828-835

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