Updated CDC guidelines for neonatal HBV testing prevent misclassification

PHILADELPHIA — Shortening the time frame in which an infant receives post-vaccination serologic testing for hepatitis B from 9 to 18 months to 9 to 12 months may increase adherence for testing in accordance with CDC guidelines and lessen the time in which nonresponders may come into close contact with the infection, according to a recent presentation at the annual meeting of the American Association of Nurse Practitioners.

“If the mother tests negative for hepatitis B earlier in her pregnancy but comes into contact and picks up the infection later, we absolutely want to make sure that the baby is vaccinated,” Mary Koslap-Petraco, DNP, PNP-BC, CPNP, FAANP, from Stony Brook University School of Nursing, told Infectious Diseases in Children. “It will dramatically decrease the chance that they will go on to be a hepatitis B carrier.”

This recommendation for a shorter duration for testing by the CDC was due to the discontinuation of Hib/HepB vaccine. This is especially important because perinatal hepatitis B causes a chronic infection in 90% of infants infected through delivery or while in utero. According Koslap-Petraco, nearly 25% of infants who acquire the infection perinatally will have an increased risk of premature death from liver cancer.

To evaluate the updated CDC guidelines regarding hepatitis B vaccination, which recommended shortening the interval for post-vaccination serologic testing (PVST) from 9 to 18 months to 9 to 12 months, Koslap-Petraco and colleagues determined how a busy practice may be able to implement this recommendation.

According to Koslap-Petraco and colleagues, the updated guideline may conserve case management services and other public health resources. When infants are tested at increasing intervals after their last vaccine, they may also be misclassified as non-responders because of lower levels of anti-HB. This can result in unnecessary revaccination. The researchers claim that the decreased time frame suggested by the CDC will reduce the chance of misclassification and prevent revaccination in infants who do not need it.

“That birth dose [of the vaccine] is so important. Make sure that baby gets that,” Koslap-Petraco said. “If they’re born to a positive mother, then of course the birth dose and the additional HepB [should be given] within 12 hours of birth. We want to make sure all babies get the birth dose and finish the series on time at 6 months of age.” — by Katherine Bortz

Reference:
Koslap-Petraco M, et al. Hepatitis B in newborns: The updated Centers for Disease Control and Prevention guidelines and how to implement them in your busy practice. Presented at: American Association of Nurse Practitioners National Conference; June 20-25, 2017; Philadelphia.

Disclosure: Infectious Diseases in Children could not obtain disclosure information prior to publication.