Epidemiology and Recommendations for Providers
By: Malea Russell, MPH and Vivian Feng, MPH, CIC
Early Detection Matters
Eliminating viral hepatitis requires coordinated actions across the lifespan. All pregnant people should be tested for hepatitis B (HBV) and hepatitis C (HCV) during each pregnancy and those at increased risk should be tested periodically as long as the risk continues. Both HBV and HCV can be transmitted perinatally from mother to child and lead to a chronic infection if left untreated. Early detection through testing is crucial for effective treatment and prevention of liver-related complications.
Current Healthcare Provider Guidelines
Vaccination for hepatitis B remains the most effective prevention against infection. HBV vaccination should be administered to all women before pregnancy, or during pregnancy if not previously vaccinated. There is currently no vaccine available for hepatitis C.
Women of reproductive age with known HCV infection ideally should be treated before considering pregnancy, as there are no direct-acting antivirals (DAAs) approved by the FDA for treatment while pregnant or breastfeeding. Antiviral medication, guided by clinical testing, may need to be administered to HBV-positive pregnant women to reduce risk of perinatal transmission. Infants born to HBV-positive mothers should receive hepatitis B immune globulin and initiate the vaccine series at birth.
Infants born to HCV-positive mothers should receive an RNA test at 2–6 months, and infants who test positive can begin curative treatment as early as 3 years of age, if able to swallow a pill. For infants born to HBV-positive mothers, testing for infection and titers should occur after completion of the vaccine series, ideally at 9–18 months.
Perinatal HBV and HCV Clinical Recommendations
| Category | Perinatal HBV | Perinatal HCV |
|---|---|---|
| Screening / Testing | Screening for HBsAg is recommended for all pregnant women during each pregnancy, ideally in the first trimester.
Infants born to hepatitis B-positive mothers should be tested after completion of the hepatitis B vaccine series, usually at 9–18 months:
|
Testing is recommended for all pregnant women during each pregnancy, ideally in the first trimester.
Testing is recommended for all infants born to mothers who are RNA-positive or whose HCV status is unknown:
|
| Vaccination | Adults (18 or older) without prior immunity: 2–4 doses depending on health factors.
Children and adolescents: 3 doses (4 doses depending on birth weight) at:
|
N/A — No hepatitis C vaccine is currently available. |
| Treatment / Clinical Management | At birth, exposed infants receive hepatitis B immune globulin (HBIG) as prophylaxis and the birth dose.
For mothers, referral to hepatology for chronic hepatitis B if not currently linked to a provider. Antivirals can be administered during pregnancy, depending on hepatitis B testing results, to reduce perinatal transmission. |
Infants with a positive NAAT should be referred to a pediatric hepatologist for additional testing and treatment.
Direct-acting antivirals (DAAs) are approved for children age 3 years and older. DAA treatment is not FDA-approved while pregnant or breastfeeding but can be considered on an individual basis through shared decision-making or in the setting of a clinical trial. |
Public Health Surveillance
Both HBV and HCV are reportable conditions. The Allegheny County Health Department (ACHD) receives positive test results from healthcare providers and laboratories. ACHD initiates case investigations for each report, identifies risk factors, counsels individuals on how they can protect their health, provides infection control guidance, and provides additional testing and treatment guidance.
To identify at-risk infants, case data is routinely matched with birth records and pediatricians and caregivers are provided with testing and treatment guidance.
The primary goals of public health case investigation and perinatal follow-up are to:
- Monitor perinatal HBV/HCV exposures and infections in infants.
- Educate caregivers on hepatitis B and C.
- Inform healthcare providers and pediatricians of testing, treatment, and vaccination guidelines.
- Link positive infants and birth mothers to care.
- Reduce the incidence of perinatal hepatitis B and C infections and progression to chronic infections.
Epidemiology of Perinatal HBV and HCV in Allegheny County
Perinatal Hepatitis B
In 2025, 17 infants perinatally exposed to HBV required public health follow-up. ACHD monitors exposed infants until testing completion or until they are 24 months of age. Fourteen (82%) infants completed the HBV vaccine series in 2025. Of the infants with complete HBV vaccination, 12 (86%) completed post-vaccine serology testing at 9–18 months of age.
There were no positive perinatal HBV cases in 2024 or 2025. Compared to 2024, the 2025 birth cohort had a lower rate of vaccine series completion and a higher rate of testing completion.
Table 1. Perinatal Hepatitis B, 2024–2025, Allegheny County
| Birth Cohort | Infants Exposed to HBV | Cases for Follow-Up | Completed HBV Vaccine Series | Infants Tested at 9–18 Months | Infants Tested at 9–24 Months | HBV-Positive Cases |
|---|---|---|---|---|---|---|
| 2025 | 22 | 17 | 14 (82%) | 12 (86%) | 12 (86%) | 0 (0%) |
| 2024 | 25 | 21 | 21 (100%) | 6 (29%) | 7 (33%) | 0 (0%) |
Perinatal Hepatitis C
ACHD identified 32 infants born in 2025 who were perinatally exposed to HCV. Exposed infants are monitored until testing completion or until they are 36 months of age. Pediatricians or caregivers were successfully contacted for 21 (66%) infants.
The percent of infants tested at 2–36 months of age increased from 47% in 2023 to 78% in 2025. The percent of infants receiving an RNA test at 2–6 months of age increased in this same period from 17% to 59%.
Table 2. Perinatal Hepatitis C, 2023–2025, Allegheny County
| Birth Cohort | Infants Exposed to HCV | Cases for Follow-Up | Successful Contacts | Infants Tested at 2–6 Months | Infants Tested at 2–36 Months | HCV-Positive Cases |
|---|---|---|---|---|---|---|
| 2025 | 37 | 32 | 21 (66%) | 19 (59%) | 25 (78%) | 2 (8%) |
| 2024 | 39 | 32 | 21 (66%) | 9 (28%) | 19 (59%) | 0 (0%) |
| 2023 | 44 | 36 | 24 (67%) | 6 (17%) | 17 (47%) | 2 (12%) |
Key Considerations and Best Practices
The overall Allegheny County hepatitis B vaccination rate for the 2025–26 school year was 96.7 percent among K–12 students.
A longitudinal study by Williams et al. (2026) revealed that receipt of a hepatitis B vaccine birth dose was associated with consistently high vaccine series completion through 18 months across demographic groups, whereas omission of the birth dose coincided with declining completion over time and greater demographic disparities.
There are currently no available measures to prevent vertical transmission of hepatitis C due to limited safety data for DAAs during pregnancy or while breastfeeding.
According to the AASLD and IDSA, DAA treatment during pregnancy can be considered on an individual basis after a thorough discussion of potential risks and benefits and through shared clinical decision-making between patient and provider.
Recent and ongoing clinical trials have provided evidence that DAA treatment during pregnancy is effective at producing a maternal sustained virologic response and provides several benefits, including reduction of cholestasis and perinatal HCV transmission risk, with no significant safety concerns identified.
Additional Information and Resources
Providers interested in additional information or joining countywide viral hepatitis elimination efforts are encouraged to reach out to the Allegheny County Health Department (ACHD).
Email:
IDEPI@alleghenycounty.us
Additional Resource:
Hep C Free Allegheny
Authors:
Malea Russell, MPH and Vivian Feng, MPH, CIC are Applied Epidemiologists with the Bureau of Health Promotion and Disease Prevention’s Infectious Disease Epidemiology Program at the Allegheny County Health Department.