Disclosures I have no industry affiliations.

Perinatal Management of Chronic Hepatitis B Natali Aziz, MD, MS Department of Obstetrics and Gynecology Stanford University School of Medicine Antepartum and Intrapartum Management June 7, 2012

Overview

Hepatitis B Virus

Background/Epidemiology Clinical features/Laboratory findings Transmission Antepartum Evaluation/Therapy Mode of Delivery/Labor Management Infant Immunoprophylaxis Breastfeeding/PP Maternal Management

1

Chronic Hep B Prevalence, 2006

Hepatitis B Virus Small, double-shelled virus Hepadnaviridae family Small circular DNA genome that is partially double-stranded Numerous antigenic components – HBsAg, hepatitis B core antigen (HBcAg), and hepatitis B e antigen (HBeAg)

Humans are the only known host Resilient virus CDC 2012 http://wwwnc.cdc.gov

– Infectious on surfaces for > 7 days at room temp www.cdc.gov/vaccines/pubs

Prevalence Hepatitis B in US Cases per 100,000 Population

80 Vaccine licensed

70

Incidence of Hepatitis B in US

HBsAg Infant screening immunization of pregnant recommended women recommended

60 OSHA Rule enacted

50

Adolescent immunization recommended

40 30 20 Decline among MSM & HCWs

10

Decline among IDU

*

0 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95

* Provisional date

Year

www.cdc.gov/hepatitis

2

Hepatitis B: Clinical Features

Hepatitis B Clinical Features

• Incubation period: Average 60-90 days • Clinical illness (jaundice):