Management of Infants Born to Women with 

Hepatitis B Virus Infection for Pediatricians 

Management of Perinatally Hepatitis B Virus (HBV)-Exposed Infants 

with Birth Weights ≥2,000 grams (≥4.4 lbs) 

Administer hepatitis B immune globulin (HBIG) and single-antigen vaccine in separate limbs 

at birth (≤12 hours). 

Complete vaccine series with 2 additional doses of single-antigen vaccine (3 total doses) OR 

with 3 additional doses of combination vaccine (4 total doses). 

≤12 hours of birth 1 mo 2 mos 4 mos 6 mos 

Single-Antigen 

Vaccine Series* 1st dose 2nd dose 3rd dose 

Single-Antigen 

and Combination 

Vaccine Series* 

1st dose (singleantigen vaccine) 2nd dose 3rd dose 4th dose 

*Administer the fnal dose no earlier than 6 months of age (minimum age 164 days includes 4-day grace period). Complete postvaccination serologic testing 

(PVST) at 9–12 months of age (or 1–2 months after fnal dose, if series delayed) by testing for ONLY hepatitis B surface antigen (HBsAg) and antibodies to 

hepatitis B surface antigen (anti-HBs). Do NOT test for antibodies to hepatitis B core antigen (anti-HBc). 

Management of Perinatally Hepatitis B Virus (HBV)-Exposed Infants 

with Birth Weights <2,000 grams (<4.4 lbs) 

Administer HBIG and single antigen vaccine in separate limbs at birth (≤12 hours). 

Complete vaccine series with 3 additional doses of single antigen or combination vaccine 

(4 total doses). 

≤12 hours of birth 1 mo 2 mos 3 mos 4 mos 6 mos 

Single-Antigen 

Vaccine Series* 1st dose 2nd dose 3rd dose 4th dose 

Single-Antigen and 

Combination Vaccine 

Series* 

1st dose (singleantigen vaccine) 2nd dose 3rd dose 4th dose 

*Administer the fnal dose no earlier than 6 months of age (minimum age 164 days includes 4-day grace period). Complete postvaccination serologic testing 

(PVST) at 9–12 months of age (or 1–2 months after fnal dose, if series delayed) by testing for ONLY hepatitis B surface antigen (HBsAg) and antibodies to 

hepatitis B surface antigen (anti-HBs). Do NOT test for antibodies to hepatitis B core antigen (anti-HBc). 

Interpreting Post Vaccination Serologic Test (PVST) Results 

Immune Still Susceptible 

HBsAg-Negative 

Anti-HBs-Positive 

Antibody Level ≥10mIU/mL 

No further follow up necessary 

Report results to your Perinatal 

Hepatitis B Prevention Program 

(PHBPP) coordinator. 

https://www.cdc.gov/vaccines/vpd/hepb/hcp/ 

perinatal-contacts.html 

HBsAg-Negative 

Anti-HBs-Negative 

Antibody Level <10mIU/mL 

Needs additional follow

 up and vaccines 

Contact your PHBPP coordinator

 for assistance 

https://www.cdc.gov/vaccines/vpd/hepb/hcp/ 

perinatal-contacts.html 

Infected 

HBsAg-Positive 

Anti-HBs-Negative 

Antibody Level <10mlU/mL 

Needs additional follow up 

Contact your PHBPP coordinator 

for assistance 

https://www.cdc.gov/vaccines/vpd/hepb/hcp/ 

perinatal-contacts.html 

CS 325363-A September 29, 2021 
Hepatitis B Virus FAQs 

What is hepatitis B virus (HBV)? 

Hepatitis B is an infectious liver disease. The infection 

can be acute or chronic. Chronic infections can lead 

to cirrhosis, liver cancer, and premature death. Though 

usually asymptomatic, most infants (90%) who are 

infected with HBV will develop chronic infection and 25% 

will die prematurely from liver cancer or cirrhosis. HBV is 

transmitted through contact with infectious blood or body 

fuids or from a person who is infected (HBsAg+) to their 

newborn during delivery. 

Can perinatal transmission be prevented? 

Yes, perinatal transmission can be prevented by 

screening for HBsAg during every pregnancy. Infants 

born to HBsAg+ women should receive HBIG and a 

dose of single-antigen hepatitis B vaccine ≤12 hours 

of birth, followed by a complete series of hepatitis B 

vaccine, which is up to 94% effective in preventing 

perinatal transmission. 

What if my practice identifies a Perinatally 

HBV-exposed newborn that did not receive 

HBIG before hospital discharge? 

The infant should receive an urgent referral to receive 

HBIG, which can be administered up to 7 days after 

birth. If more than 7 days have passed, HBIG is unlikely 

to be effective in preventing transmission. However, it 

is still important for the infant to complete the hepatitis 

B vaccine series, and providers should adhere to the 

minimum intervals between doses. 

What is postvaccination serologic testing (PVST) 

and why is it necessary? 

Postvaccination serologic testing (PVST) is recommended 

for infants and children born to women with hepatitis B 

infection. Serologic testing confrms whether the child has 

developed immunity or has been infected with HBV. PVST 

should include hepatitis B surface antigen (HBsAg) and 

hepatitis B surface antibody (anti-HBs) only. PVST should 

occur between 9–12 months of age or 1–2 months after 

vaccine series completion, if the series is delayed. Note: 

Tests for antibodies to hepatitis B core antigen (anti-HBc) 

should not be ordered. 

Why aren’t antibodies to hepatitis B core antigen 

(anti-HBc) included in PVST? 

A positive anti-HBc test result indicates a past or current 

hepatitis B infection. In infants, a positive anti-HBc test 

may result from measuring passively acquired maternal 

antibodies that are detectable in HBV-exposed infants up 

to 24 months of age. 

Why must providers wait until the infant is 9 

months of age to perform PVST? 

Testing performed before 9 months of age can provide 

inaccurate anti-HBs results by detecting passive 

antibodies from HBIG administered at birth rather 

than actual response to the hepatitis B vaccine. Also, 

for infants who receive HBIG at birth, there can be a 

prolonged HBV incubation period. Waiting until 9 months 

of age can maximize detection of late HBV infection 

if present. 

If vaccine series completion is delayed and I 

am concerned that the infant will NOT return for 

PVST, can I perform testing immediately after 

completing the vaccine series? 

No, transient HBsAg positivity has been reported for up 

to 18 days after vaccination. To assure accurate PVST 

results, the test must be conducted at 9–12 months of 

age or 1–2 months after vaccine series completion if the 

series is delayed. 

Can PVST be delayed until the infant is older? 

No, anti-HBs concentrations decline rapidly within the frst 

year after the series is completed. Delaying PVST beyond 

the recommended time frame may yield a negative/nonreactive anti-HBs result, making it diffcult to determine if 

immunity has waned or vaccine has failed. This ambiguity 

may lead to unnecessary revaccination. For this reason, 

providers are encouraged to test at 9–12 months of age 

or 1–2 months after vaccine series completion if the series 

is delayed. 

Is assistance available for management of HBVexposed infants? 

Yes, CDC provides funding and technical assistance for 

perinatal hepatitis B prevention programs (PHBPPs) in 

all 50 states and 14 other jurisdictions. All Perinatally 

HBV-exposed infants should be managed by the PHBPP. 

To fnd contact information for the perinatal hepatitis B 

prevention program coordinator in your area, please go to: 

https://www.cdc.gov/vaccines/vpd/hepb/hcp/perinatalcontacts.html 

PHBPP Coordinator contact information: CDC Tip Sheet is adapted with permission from the Georgia Department of 

Public Health publication, “A Pediatric Guide: Caring for Infants Born to Hepatitis 

B-Infected Mothers.” 

*Reference: MMWR, January 12, 2018, Vol 67,(1);1–31, Prevention of Hepatitis B 

Virus Infection in the United States: Recommendations of the Advisory Committee on 

Immunization Practices. https://www.cdc.gov/mmwr/volumes/67/rr/rr6701a1.htm