Quality statement 4: Complete course of neonatal hepatitis B vaccination and blood testing at 12 months

Quality statement

Babies born to hepatitis B surface antigen (HBsAg)-positive mothers receive a complete course of hepatitis B vaccination and, at age 12 months, receive a blood test for hepatitis B infection.

Rationale

Hepatitis B infection can be transmitted from mothers with hepatitis B to their babies. Babies who acquire the infection have a very high risk of developing chronic hepatitis B. Vaccination of babies is highly effective in preventing transmission. It is important that the babies of mothers with hepatitis B (whether they are delivered in hospital or at home) are given the first vaccine dose promptly and that the recommended vaccination course is completed at the right time, including, when appropriate, hepatitis B immunoglobulin, in line with Public Health England's Immunisation against infectious disease: the green book, chapter 18: Hepatitis B.

If vaccinations are delayed or missed, it is more likely that the child will become infected.

Quality measures

Structure

a) Evidence of local commissioning arrangements to ensure that babies born to HBsAg‑positive mothers are given a complete course of hepatitis B vaccination.

b) Evidence of local arrangements to ensure that there is an identified person responsible for coordinating the local hepatitis B vaccination programme for babies at risk of infection. This person should also be responsible for scheduling vaccinations and follow-up to ensure that babies at risk are vaccinated at the right time.

Data source: Local data collection.

Process

a) Proportion of babies born to HBsAg-positive mothers who receive the complete course of hepatitis B vaccination.

Numerator – the number in the denominator who receive a complete course of hepatitis B vaccination.

Denominator – the number of babies born to HBsAg-positive mothers.

Data source: Local data collection. NICE Reducing the differences in the uptake of immunisations: audit support tool, criterion 3.

b) Proportion of babies born to HBsAg-positive mothers who receive a blood test for hepatitis B infection at age 12 months.

Numerator – the number in the denominator who receive a blood test for hepatitis B infection.

Denominator – the number of babies at age 12 months born to HBsAg-positive mothers.

Data source: Local data collection. NICE Reducing the differences in the uptake of immunisations: audit support, criterion 3.

Outcome

Vertical transmission rates from mother to child.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (maternity, paediatric, primary care and community support teams) ensure that babies born to HBsAg-positive mothers are given a complete course of hepatitis B vaccination through a coordinated programme that includes an identified person who is responsible for scheduling vaccinations and follow-up to ensure that babies at risk are vaccinated at the right time.

Healthcare professionals give babies born to HBsAg-positive mothers a complete course of hepatitis B vaccination and then, at age 12 months, a blood test for hepatitis B infection.

Commissioners (clinical commissioning groups and NHS England area teams for screening and immunisation) work together to ensure that a coordinated hepatitis B neonatal vaccination programme is in place to vaccinate babies born to HBsAg-positive mothers, which includes scheduling of vaccinations and follow-up to ensure that babies at risk are vaccinated at the right time.

What the quality statement means for patients, service users and carers

Babies born to mothers with hepatitis B infection are given a complete course of hepatitis B vaccinations, and when they are aged 12 months they are given a blood test to check whether they have the infection.

Source guidance

Definitions of terms used in this quality statement

Complete course of hepatitis B vaccination and a blood test for hepatitis B

A complete course consists of an initial dose of vaccine and of hepatitis B immunoglobulin where indicated within 24 hours of birth, with further doses at 1 month, 2 months and 12 months and an additional booster at preschool age. A blood test for HBsAg should be performed at 12 months (at the time of the fourth dose) to check for vaccine failure.

The blood test at age 12 months should be performed regardless of the uptake of the vaccination course. [Public Health England's Immunisation against infectious disease: the green book, chapter 18: Hepatitis B. Public Health England's Public health functions to be exercised by NHS England: Neonatal hepatitis B immunisation programme (service specification 1)]

The transfer of care between maternity services and primary care can be a key issue and it is important that there is effective coordination and communication between services.

Equality and diversity considerations

The implications of hepatitis B neonatal vaccination should be understood by all women to enable them to make informed decisions. Information should be provided in an accessible format (particularly for women with physical, sensory or learning disabilities and women who do not speak or read English).

Pregnant women with complex social needs may be less likely to access or maintain contact with antenatal care services. Examples of women with complex social needs include, but are not limited to, women who:

  • have a history of substance misuse (alcohol and/or drugs)

  • have recently arrived as a migrant, asylum seeker or refugee

  • have difficulty speaking or understanding English

  • are aged under 20 years

  • have experienced domestic abuse

  • are living in poverty

  • are homeless.

It is therefore appropriate that special consideration is given to these groups of women.