207 HEPATITIS B TESTING AND VACCINATION

207.1 A provider that attends to, treats, or examines a pregnant woman or provides perinatal treatment shall:

1. (a) Take a blood sample during the first prenatal visit and submit the sample to a laboratory approved by the Department for testing for Hepatitis B Surface Antigen (HBsAg);
2. (b) Take a blood sample at the time of delivery if the woman has not had prior perinatal services or no documentation of HBsAg status, and submit the sample to a laboratory approved by the Department for testing HBsAg;
3. (c) Maintain a record of the woman's Hepatitis B status in her patient file; and
4. (d) Make a report according to the requirements of Subsection 201.5.

207.2 A provider that delivers a newborn shall:

1. (a) Document the mother's Hepatitis B status in the newborn's records;
2. (b) Immunize the newborn for the Hepatitis B virus; and
3. (c) Make a report according to the requirements of Subsection 207.7.

207.3 A newborn whose mother tests positive for HBsAg shall:

1. (a) Receive Hepatitis B immunoglobulin (HBIG) and Hepatitis B vaccine within twelve (12) hours of birth according to the recommendations of the Advisory Committee on Immunization Practices (ACIP);
2. (b) Receive a complete Hepatitis B series according to the schedule found at 22-B DCMR § 135; and
3. (c) Receive post-vaccination testing for the presence of HBsAg and Hepatitis B Surface Antibody (HBsAb) three (3) months after the last dose of Hepatitis B vaccine but not earlier than nine (9) months of age and no later than nineteen (19) months of age.

207.4 A newborn whose mother's HBsAg status is unknown shall:

1. (a) Receive Hepatitis B vaccine without HBIG within twelve (12) hours of birth;

2. (b) Receive HBIG as soon as possible but no later than seven (7) days after birth if the newborn's mother tests positive for HBsAg;

3. (c) Receive a complete Hepatitis B series according to the schedule found at 22-B DCMR § 135; and
4. (d) Receive post-vaccination testing for the presence of HBsAg and Hepatitis B Surface Antibody (HBsAb) three (3) months after the last dose of Hepatitis B vaccine but not earlier than nine (9) months of age and no later than nineteen (19) months of age.207.5 A full-term medically stable newborn weighing two thousand grams (2000g) or more born to a mother who is HBsAg-negative shall:- (a) Receive Hepatitis B vaccine before hospital discharge; and
5. (b) Receive a complete Hepatitis B series according to the schedule found at 22-B DCMR § 135.207.6 A pre-term newborn weighing less than two thousand grams (2000g) born to a mother who is HBsAg-negative shall:- (a) Receive the first dose of Hepatitis B vaccine one (1) month after birth or at hospital discharge; and
6. (b) Receive a complete Hepatitis B series according to the schedule found at 22-B DCMR § 135.207.7 In addition to the reporting requirements of Subsection 201.5, a provider shall also report the following in the manner and form the Director requires:- (a) The date and time that Hepatitis B vaccine was administered;
7. (c) The date and time that Hepatitis B immunoglobulin was administered;
8. (d) The manufacturer of the vaccine; and
9. (e) The vaccine lot number.207.8 A newborn's parent or legal guardian shall be deemed to have consented to Hepatitis B vaccination, unless the newborn's parent or legal guardian submits a signed request for exemption that states the reasons for the exemption. A newborn may be exempted from vaccination if:

(a) The newborn's mother tested negative for HBsAg;

(b) The newborn's parent or legal guardian objects in good faith and in writing that immunization would violate his or her religious beliefs; or

(c) The newborn's parent or legal guardian provides the written certification of a physician that immunization is medically inadvisable.

207.9 Information disclosed to the Department pursuant to this section shall be kept confidential and shall not be disclosed to a third party, except as provided in this subsection. The Department may use and disclose information received pursuant to this section as follows:

(a) The Director may use patient-specific immunization information:

(1) To produce aggregate immunization coverage reports and to track Hepatitis B levels;

(2) To ensure that newborns receive Hepatitis B immunization;

(3) To conduct follow-up on infants born to HBsAg positive mothers; and

(4) For statistical and public health purposes.

(b) Except as provided in subsection (a), the Director may disclose a person's individually identifiable information to a third party only with written consent of the person, or the person's parent or guardian if the person is under eighteen (18) years of age or an unemancipated adult.

SOURCE: Final Rulemaking published at 55 DCR 5980 (May 23, 2008).