Hepatitis B is a concerning virus that affects the liver. It’s estimated that about 257 million people are living with chronic hepatitis B infection worldwide. But can you actually be born with hepatitis B? The short answer is yes. Mother-to-child transmission is one of the main ways hepatitis B spreads globally.
Being born with hepatitis B or contracting it at a young age can increase risks for complications like cirrhosis and liver cancer later in life. That’s why understanding vertical transmission of hepatitis B is so important. This guide covers everything you need to know about being born with hepatitis B, including:
- Hepatitis B can be passed from an infected mother to her baby during pregnancy, childbirth or breastfeeding. This is called vertical transmission.
- All pregnant women should get screened for hepatitis B. Babies born to HBV-positive mothers need immunoglobulin and vaccine at birth.
- Without preventative treatment, up to 90% of babies born to hepatitis B positive mothers will develop chronic infections.
- Children with chronic hepatitis B are at higher risk for complications like cirrhosis and liver cancer as they age.
- Babies who receive timely prophylactic treatment have over a 90% chance of being protected from vertical transmission.
- Ongoing monitoring and precautions are needed for children born with hepatitis B to prevent transmission.
- Research is ongoing for treatments to help children clear hepatitis B infections. Public health efforts also focus on preventing vertical transmission.
What Is Hepatitis B and How Does It Spread?
Hepatitis B is a viral infection that causes inflammation of the liver. The hepatitis B virus (HBV) is transmitted through contact with infectious bodily fluids. This can occur in several ways:
- Mother-to-child – An infected mother can pass HBV on to her baby during pregnancy, delivery or breastfeeding. This is known as vertical transmission and is very common globally.
- Sexual contact – HBV can be transmitted through unprotected sex with an infected partner.
- Blood contact – Direct contact with infected blood can spread HBV. This includes needle sticks, transfusions or use of unsterilized medical equipment.
- Other body fluids – Saliva, semen and vaginal fluids can also transmit HBV in some cases.
There are several key points about HBV transmission:
- HBV is much more infectious than other blood-borne viruses like HIV or hepatitis C.
- Many people with chronic HBV infections show no symptoms but can still be contagious.
- HBV can survive outside the body on surfaces for over a week and still cause infection.
These factors make hepatitis B easily transmissible if precautions aren’t taken. Mother-to-child transmission plays a major role in spreading HBV in regions where infection rates are high.
Vertical Transmission of Hepatitis B
Vertical transmission refers to passing infectious diseases from a mother to her child. This can occur during pregnancy, delivery or breastfeeding. For hepatitis B, the main transmission routes are:
- In utero – HBV may cross the placenta during pregnancy and infect the unborn baby. But this is responsible for only about 10-20% of vertical transmissions.
- During delivery – Most infections happen when the baby has contact with maternal blood and bodily fluids while passing through the birth canal.
- Postpartum – Breastfeeding can also transmit HBV if the mother’s milk contains HBV infected blood.
Without any interventions, vertical transmission rates for hepatitis B are:
- 10% when mothers have acute HBV infections
- 70-90% when mothers have chronic HBV infections
Chronic infections are much more likely to spread HBV vertically because there are higher amounts of virus circulating in the mother’s blood and body fluids.
Why Is Vertical Transmission of Hepatitis B Dangerous?
Being infected with hepatitis B at birth or during early childhood is very risky because:
- Increased likelihood of chronic infection – Babies and young children are more likely to develop lifelong chronic HBV infections compared to adults. Up to 90% of babies infected at birth will develop chronic hepatitis B.
- Higher risks later in life – Children with chronic HBV have a 15-25% lifetime risk of dying prematurely from cirrhosis or liver cancer. The younger a child is infected, the higher their risk of complications.
- Asymptomatic infections – Children with chronic HBV rarely show symptoms until much later in life when liver damage occurs. This means infections often go undetected.
- Ongoing transmission – Children with chronic hepatitis B that goes untreated can unknowingly transmit HBV to others. Vertical transmission contributes to high rates of HBV in certain regions.
For these reasons, preventing mother-to-child transmission of hepatitis B through screening and immunization is critical.
Screening for Hepatitis B During Pregnancy
Many medical organizations recommend routine hepatitis B screening for all pregnant women. This is done through a simple blood test that looks for antibodies and antigens related to HBV.
Prenatal HBV screening accomplishes several things:
- Identifies pregnant women who have chronic HBV infections
- Detects acute HBV infections that occur during pregnancy or delivery
- Determines if pregnant women are susceptible to HBV if not vaccinated
Testing all expectant mothers enables proper precautions based on their HBV status:
- HBV-positive – Prophylactic treatment can be given to the newborn to prevent vertical transmission. The mother can also receive antiviral therapy if indicated.
- HBV-negative – Susceptible mothers should be vaccinated against HBV after delivery.
- Unknown status – Mothers should be vaccinated if their HBV status cannot be determined.
Prenatal screening is crucial for identifying babies at risk of vertical transmission and preventing infection. It’s recommended as part of routine prenatal care in most countries today.
Timing of Hepatitis B Screening
Pregnant women are typically screened for hepatitis B at the following times:
- First prenatal visit – Initial testing early in pregnancy identifies women who need prophylaxis or treatment.
- Third trimester – Repeat screening around weeks 28-36 of pregnancy detects any new HBV infections.
- Delivery admission – Checking HBV status again at delivery ensures proper newborn care.
Repeat testing in the third trimester and at delivery is very important to detect acute HBV infections acquired during late pregnancy. Transmission risks are highest with acute infections.
Preventing Vertical Transmission of Hepatitis B
Fortunately, it’s possible to prevent vertical transmission of HBV in over 90% of cases when the proper steps are taken. Preventing infection at birth or during early childhood is critical.
Immunoprophylaxis for Babies
Newborns receive a course of treatment called immunoprophylaxis immediately after birth if their mothers have hepatitis B. This involves:
Hepatitis B Immune Globulin (HBIG) – This provides temporary protection by giving the newborn antibodies against HBV. It helps destroy any virus that entered their bloodstream during delivery.
Hepatitis B Vaccine – The vaccine triggers the baby’s own immune response to produce antibodies. This gives long-term protection from the virus.
The vaccine is given as a series of 3-4 shots over 6 months. The first dose should be given within 12 hours of birth if possible. This protocol of HBIG and vaccination provides over 90% protection when administered appropriately.
Antiviral Treatment for Mothers
Pregnant women with very high HBV levels may also receive antiviral treatment during the third trimester. This lowers the maternal viral load and reduces transmission risk.
Tenofovir or telbivudine are preferred since they are safe during pregnancy. Treatment is continued for 4-12 weeks after delivery as well. Antivirals combined with neonatal immunoprophylaxis maximize protection.
Elective C-sections may be recommended for certain mothers with hepatitis B. This avoids the baby’s exposure to maternal blood and secretions during vaginal delivery.
However, C-sections are not mandatory for HBV positive mothers. The risks and benefits must be evaluated individually. Immunoprophylaxis for the newborn is the most crucial preventative measure.
Since HBV can be found in breastmilk, some experts advise against breastfeeding when mothers have very high viral loads. However, the benefits of breastfeeding often outweigh the small risks.
Most major health organizations state that hepatitis B is NOT a contraindication to breastfeeding. In the vast majority of cases, breastfeeding is still encouraged as long as immunoprophylaxis is given immediately after birth.
Monitoring Babies Born to HBV Positive Mothers
After receiving immunoprophylaxis, babies born to HBV-infected mothers need follow-up testing. Blood tests check if the newborn developed protective antibodies from vaccination.
Testing is recommended over the first 6-12 months at the following times:
- At age 1-2 months after complete vaccine series
- At age 9-12 months to check antibody levels
- Optional testing at age 4-6 months
This helps confirm the baby responded to vaccination and has ongoing protection against hepatitis B. About 95% of newborns will develop lasting immunity when properly immunized.
For the small number whose antibody levels are low, repeat vaccination and hepatitis B immune globulin may be warranted. Ongoing precautions are needed to prevent infection in early childhood for these children.
Treating Hepatitis B Infections in Children
Despite proper immunoprophylaxis measures, a small percentage of babies born to HBV positive mothers will still become infected. Treatment options for children with chronic hepatitis B include:
- Antiviral medications – Drugs like entecavir or tenofovir suppress viral replication. These have proven efficacy and safety in children. Treatment may continue indefinitely.
- Interferon injections – Interferon stimulates the immune system against hepatitis B. It may have greater risks than oral antivirals and requires frequent injections.
- Hepatitis B immunoglobulin – Provides antibodies against HBV. This may be used with antivirals in some cases.
- Liver transplant – For end-stage liver disease, transplantation may be necessary. This is a last resort option.
The goals of pediatric hepatitis B treatment are to:
- Achieve undetectable or very low viral loads
- Reduce liver inflammation and fibrosis
- Prevent development of cirrhosis and liver cancer
- Allow possible clearance of HBV in some cases
Starting treatment early is ideal before significant liver damage occurs. However, outcomes vary. Not all children are able to clear HBV infections even on antiviral therapy. Lifelong monitoring and management are often required.
Special Precautions for Children with HBV
In addition to medical care, special precautions are advised for kids with chronic hepatitis B to avoid transmitting the infection. Recommendations include:
- Tell childcare providers and schools about hepatitis B status
- Avoid sharing toothbrushes, eating utensils, razors or other personal items
- Use gloves and dilute bleach to clean up any blood
- Cover open cuts and skin lesions
- Tell providers about HBV status when getting medical or dental procedures
- Use condoms later in life during sexual activity
- Discuss hepatitis B risks with long-term partners
- Consider hepatitis A and hepatitis B vaccination for uninfected household members
Ongoing precautions, monitoring and open communication will help prevent HBV transmission from children to others. Support groups and education are also beneficial for families dealing with pediatric hepatitis B.
Public Health Work to Eliminate Vertical Transmission
Major public health efforts are focused on eliminating vertical transmission of hepatitis B globally through:
- Universal screening – Testing all pregnant women is the first key step.
- Expanding access to immunoprophylaxis – Providing vaccine and HBIG shortly after birth for at-risk newborns is essential.
- Improving vaccine coverage – Population-wide HBV vaccination helps lower infection rates.
- Antiviral treatment access – Allowing pregnant women with high viral loads to receive antiviral therapy during pregnancy can lower transmission risk.
- Health education – Increasing awareness and resources for mothers with hepatitis B is needed.
- Harm reduction services – These help prevent parenteral HBV infections among at-risk groups like people who inject drugs.
With concerted efforts, eliminating vertical transmission is an achievable goal. This will greatly reduce the global burden of hepatitis B complications and deaths.
Frequently Asked Questions
Can hepatitis B be cured?
Unlike hepatitis C, currently there is no cure for chronic hepatitis B infections. But antiviral treatment can control HBV long-term by suppressing viral replication and preventing liver damage. Rarely, some individuals spontaneously clear hepatitis B without treatment.
What are the symptoms of hepatitis B in babies and children?
Most babies and children with chronic HBV infections are asymptomatic and do not show any overt symptoms. Occasionally, some may experience mild flu-like symptoms like fatigue, abdominal pain or joint pain. Symptoms typically don’t appear until later in life when liver complications arise.
Are hepatitis B infections treated differently in children vs adults?
Treatment guidelines are fairly similar for children and adults with chronic hepatitis B. Oral antivirals like tenofovir or entecavir are first-line since they are effective and safe long-term. Pegylated interferon is used less often for children due to the need for frequent injections.
Should women with hepatitis B get pregnancy care from specialists?
Pregnant women with HBV do not necessarily need specialized care. But it is important that obstetric providers understand the risks of vertical transmission and protocols for reducing this risk. Coordinating with a liver or infectious disease specialist is a good idea for mothers with very high viral loads.
What is the life expectancy for someone infected with hepatitis B at birth?
With appropriate monitoring and management, most people infected with hepatitis B at birth can live long healthy lives, especially if they clear the infection. But without proper medical care, around 25% will die prematurely from cirrhosis or liver cancer. Early detection and antiviral treatment are key.
Mother-to-child transmission is an important cause of hepatitis B infection worldwide. Being born with hepatitis B or infected during early childhood increases risks for chronic infection and serious complications later in life. But 95% of cases can be prevented with proper immunoprophylaxis at birth. Ongoing monitoring and precautions are also necessary for children infected with HBV. Increased screening, vaccination, and prophylactic treatment will hopefully eliminate vertical transmission of this dangerous virus globally in coming decades.