Hepatitis B vaccination in Pregancy period-Its safety profile??

Hepatitis B (HBV) infection during pregnancy can result in severe disease for the mother, fetal loss, or chronic infection for either the mother or the neonate. HBV infection results in a viremia that lasts for weeks to months and 1% to 5% of adult patients develop chronic infection and a persistent viremic carrier state with or without active liver disease. Unfortunately, neonates and children are much more susceptible to chronic infection with as many as 90% of infected neonates, 50% of infected infants and 20% of infected young children developing chronic infection.

HBV infections have been a hazard to persons who are exposed to infected blood and blood products. HBV transmission is not limited to blood and/or blood products; sexual transmission of HBV is recognized as a major mode of spread in the United States. HBV has been found in blood, semen, cervicovaginal secretions and cells, saliva, colostrum and other body fluids. HBV is 30 times more infectious than HTV.

Maternal-fetal transmission rates depend on the presence of HBs Ag and HBe Ag. If both antigens are present the perinatal transmission rate is 90%, whereas if only HBs Ag is present the transmission rate is 10%. Since the majority of neonatal and infant HBV infections are the result of maternal-fetal transmission, the obstetrician is a critical link in the strategy to prevent perinatal transmission. All pregnant women should have rou­tine prenatal screening for HBs Ag early in pregnancy.

Problem & clinical dilemma:-One patient with 26 wks of amenorrhea...her husband is Hbsag positive....she has received vaccine 2 doses before pregnancy... now wants booster dose...Can I give it now because hbsAg vaccine is DNA recombinant vaccine and safer during pregnancy???she is HbsAg negative No contraindications. She can receive   the third dose .Pregnant women who are HBs Ag negative but have any of the high-risk factors( as stated below)  should receive the HBV vaccination series (0, 1, 6-12 months). Though  HBsAg vaccine  in pregancy is  not a routine  procedure but in the cases stated below one can push the third dose but ,as I said not  to all preg women:-.It must be selective.  Only to women who fulfill any or multiple high  high-risk criteria:-:

Pregnant woman falls into one or more high-risk group.(this case is high risk group). For instance, all pregnant women are screened for not one but six STDs (chlamydia, gonorrhea, syphilis, HBV, HIV, HPV) and therefore become a candidates for HBV vaccine during pregnancy. Infants borm to HBs Ag negative mothers should receive a birth dose of HBV vaccine while in the hospital with the second dose 1 month later and the third dose 6-12 months later. Any women s who are HBs Ag negative and meet any of the following high-risk criteria should receive HBV vaccine

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Who are high risk women and susceptible to contact HBV in preg and may  invite damage the foetus too ??

All infants in the hospital nursery

All persons to age 19

Persons with occupational risks

healthcare workers

public service workers; police, firemen

laboratory workers

Persons with lifestyle risks

heterosexual persons with multiple partners (more than one partner in the preceding 6 months)

bisexual persons

diagnosis of any sexually transmitted disease

presentation for evaluation of a sexually transmitted disease

intravenous drug abusers

Special patient groups

persons with hemophilia

patients undergoing dialysis

patients with chronic liver disease

Environmental risk factors

household and sexual contacts of person with HBV

patients and staff of institutionalized carrier facilities

prison inmates

immigrants and refugees

international travelers to endemic areas.

Infants of women who are HBs Ag positive should receive HB immu­noglobulin (HBIG) 0.5 mL intramuscularly and HBV vaccine at the same time, but at a different site within 12 hours of birth. The site for injection in the neonate is the anterolateral area of the thigh. The efficacy is more than 90%.