How can Hepatitis B (HBV) transmission be prevented?

Hepatitis B Transmission Prevention

Hepatitis B transmission can be effectively prevented through a comprehensive strategy centered on vaccination of all household and sexual contacts, immediate postpartum prophylaxis for infants born to infected mothers, barrier protection during sexual activity with non-immune partners, and strict avoidance of sharing items that may contact blood. 1, 2

Primary Transmission Routes

HBV spreads through percutaneous, mucosal, or nonintact skin exposure to infectious blood or body fluids. 1

Key transmission modes include:

• Sexual contact (both heterosexual and men who have sex with men) - the most efficient mode among adults 1
• Percutaneous exposure to blood (e.g., injection drug use, needlestick injuries) 1
• Perinatal transmission from infected mother to infant 1
• Household contact through sharing personal items contaminated with blood (toothbrushes, razors) 1, 2

Body fluids with high infectivity: Blood (most concentrated), semen, vaginal secretions, and to lesser extent saliva, tears, bile, and other body fluids. 1

Low-risk fluids: Urine, feces, vomitus, sputum, sweat, and breast milk do NOT efficiently transmit HBV unless contaminated with blood. 1

Vaccination Strategy for Contacts

All household and sexual contacts of HBsAg-positive persons must be tested immediately for HBsAg, anti-HBs, and anti-HBc, but do NOT delay the first vaccine dose—administer it immediately after collecting blood for testing. 3

Vaccination Protocol:

• Standard schedule: 0,1, and 6 months with age-appropriate doses 3
• Accelerated schedule (when rapid protection needed): 0,1,2, and 12 months 3
• Post-vaccination testing: Check anti-HBs levels 1-2 months after completing the series for all contacts of HBsAg-positive persons 3
• Non-responders (anti-HBs <10 mIU/mL): Administer complete second three-dose series and retest 3

Vaccination of sexual partners has been shown to be 95% effective in preventing sexual transmission when combined with HBIG for newborns. 1

Perinatal Transmission Prevention

HBsAg-positive pregnant women MUST inform their healthcare providers so that HBIG and hepatitis B vaccine can be administered to their newborn immediately after delivery. 1, 2

Critical Steps:

• Universal prenatal screening of all pregnant women for HBsAg 1
• HBV DNA testing for HBsAg-positive pregnant women, with maternal antiviral therapy suggested when HBV DNA >200,000 IU/mL 1
• Immediate postpartum prophylaxis: HBIG + hepatitis B vaccine within 24 hours of birth for medically stable infants ≥2,000 grams 1, 2
• Complete vaccination series and follow-up testing at 9-15 months of age 1, 2, 3

This combination prophylaxis is 95% efficacious in preventing perinatal transmission, though efficacy may be lower for mothers with very high HBV DNA levels (>8 log10 IU/mL). 1, 2

Sexual Transmission Prevention

For steady sexual partners: Test and vaccinate if seronegative. 1

For casual sex partners or partners not fully vaccinated: Use barrier protection (condoms) consistently. 1, 2

Reducing the number of sexual partners minimizes transmission risk. 2

Common pitfall: Failing to inform prospective sexual partners about HBV status prevents them from taking appropriate precautions. 2

Household Transmission Prevention

Specific precautions that HBV carriers must take:

• Cover all open cuts and scratches to prevent spread of infectious secretions or blood 1, 2
• Clean blood spills with bleach solution (HBV can survive on environmental surfaces for at least 1 week) 1, 2
• Do NOT share personal items that could become contaminated with blood: toothbrushes, razors, nail clippers 1, 2
• Properly dispose of blood, body fluids, and medical waste 2

All household members should be tested and vaccinated if negative for HBV markers. 1, 2

What Does NOT Transmit HBV

HBV is NOT spread by:

• Breastfeeding, kissing, hugging, or coughing 2, 4
• Sharing food, utensils, or drinking glasses 2
• Casual touching 2

Children with HBV can participate in all activities, including contact sports, and should NOT be excluded from daycare or school. 2

Special Populations

Healthcare Workers:

HBeAg-positive healthcare workers should not perform invasive procedures without prior counseling and advice from an expert review panel, and must notify prospective patients of their HBV status. 1

High Viral Load Carriers:

Carriers with high HBV DNA levels are significantly more likely to be infectious, requiring more stringent precautions. 1, 2

Other Restrictions:

HBV-infected persons must NOT donate blood, plasma, organs, tissue, or semen. 2

Inform all healthcare and dental providers of HBsAg-positive status when seeking care. 2

Alcohol and Vaccination Considerations

Limit alcohol consumption to <20 g/day for women and <30 g/day for men to reduce risk of liver disease progression. 2

Consider hepatitis A vaccination if chronic liver disease is present. 2

Post-Vaccination Monitoring

Testing for vaccine response is critical for high-risk groups:

• Infants of HBsAg-positive mothers: Test at 9-15 months after vaccination 1, 2, 3
• Healthcare workers: Test 1-2 months after completing vaccination 1, 2
• Dialysis patients: Annual testing recommended 1, 2

If anti-HBs <10 mIU/mL in infants, give one additional vaccine dose and retest; if still inadequate, complete a second full series. 3

Critical Implementation Gap

Despite clear guidelines, prevention counseling and contact vaccination occur infrequently in clinical practice. Only 43% of providers report providing prevention counseling, and only 13% of eligible adult contacts and 20% of child contacts receive vaccination. 5 This represents a major failure in hepatitis B control efforts that requires collaborative efforts between providers and public health to improve delivery of these preventive services. 5