HBV Pregnancy/ Neonatal

Question 1

Pregnant with HBV infection

What are indications for HBV vaccine?

Answer 1

HBSAg pos, HBeAg pos
HBsAg pos, HBeAg neg, anti HBe neg
HBsAg pos, anti-HBe pos
Acute Hepatitis B in pregnancy
HBsAg pos, HBV DNA >100000 at any time
HBsAg pos, baby weighs <1500g

Question 2

Following are indications for HBV immunisation

HBSAg pos, HBeAg pos
HBsAg pos, HBeAg neg, anti HBe neg
HBsAg pos, anti-HBe pos
Acute Hepatitis B in pregnancy
HBsAg pos, HBV DNA >1000000 at any time
HBsAg pos, baby weighs <1500g

HBIG is indicated for all of these, except one. Which one?

Answer 2

HBsAg pos, anti-HBe pos

indicates low infectivity

May need HBIG if HBV DNA VL >1000000, or if baby weighs <1500g

Question 3

Baby requires HBV vaccine and HBIG

When doe these need to be given?

Answer 3

Vaccine within 24 hours

HBIG within 24 hours of vaccine. Given in different site to vaccine

Question 4

Baby requires HBV vaccine

How does this fit into vaccine schedule?

Answer 4

0 - birth - additional
4 weeks - additional
8 weeks - DTaP/ IPV/ Hib/ HepB
12 weeks - DTaP/ IPV/ Hib/ HepB
16 weeks - DTaP/ IPV/ Hib/ HepB
1 year - additional 
3 years and 4 months

Question 5

Baby born to HBV infected mother

When do we test baby for infection?

Answer 5

At 1 year old

Test earlier if baby unwell, or abnormal LFTs

Parents may request earlier testing

Question 6

HBV Profiles

HBsAg detected
Anti-HBc IgM neg
HBeAg pos
Anti-HBe neg
HBV DNA 1, 000, 000
ALT 17

Is tenofovir indicated?

Is HBIG indicated?

Answer 6

Tenofovir - yes
Indicated if VL >200,000

HBIG yes

Question 7

HBV Profiles

HBsAg detected
Anti-HBc IgM neg
HBeAg neg
Anti-HBe pos
HBV DNA 13,000
ALT 25

Is tenofovir indicated?

Is HBIG indicated?

Answer 7

Tenofovir - no
Indicated if VL >200,000

HBIG no

Question 8

HBV Profiles

HBsAg detected
Anti-HBc IgM neg
HBeAg neg
Anti-HBe pos
HBV DNA 350,000
ALT 39

Is tenofovir indicated?

Is HBIG indicated?

Answer 8

Tenofovir - yes
Indicated if VL >200,000

HBIG no
VL need to be >1,000, 000
(1x10e6)

Question 9

HBV Profiles

HBsAg detected
Anti-HBc IgM pos
HBeAg pos
Anti-HBe neg
HBV DNA 10000
ALT 17

Is tenofovir indicated?

Is HBIG indicated?

Answer 9

Tenofovir - no
Indicated if VL >200,000

HBIG yes

Question 10

HBV Profiles

HBsAg detected
Anti-HBc IgM neg
HBeAg neg
Anti-HBe neg
HBV DNA 150000
ALT 62

Is tenofovir indicated?

Is HBIG indicated?

Answer 10

Tenofovir - yes
Indicated if VL >200,000

HBIG yes
anti-HBe absent