This article is more than 5 years old. Information may no longer be current.
Appropriate neonatal hepatitis B policies successfully controlled disease spread in high-risk population
Click Here to Manage Email Alerts
Hepatitis B infection rates remained similar among infants born in an Arkansas county despite a higher perinatal prevalence of the disease in a high-risk subset of the population, reinforcing the importance of neonatal hepatitis B virus screening and post-exposure prophylaxis.
Officials from the CDC and the Arkansas Health Department performed a retrospective investigation in Washington County after reported increases in perinatal HBV infection disproportionately affected a large immigrant population from The Republic of the Marshall Islands — a Pacific island nation where HBV is endemic.
Marshallese infants were identified by reviewing birth certificates for all births that took place between 2003 and 2005. The investigators then randomly selected hospital medical records for non-Marshallese infants, matching them at a one-to-four ratio based on demographic data, stratifying by year and hospital of birth.
Researchers concluded that Marshallese and non-Marshallese infants born to mothers who tested positive for hepatitis B surface antigen were equally likely to receive post-exposure prophylaxis with HBV vaccine (98% vs. 100%; P=0.98) and hepatitis B immunoglobulin (88% vs. 87%; P=0.91) within 12 hours of birth.
As a result, similar proportions of Marshallese and non-Marshallese infants tested positive for HBsAg at 9 to 25 months of follow-up (17% vs. 13%; P=0.78), despite disparities between the two groups in the proportion of infants born to mothers who tested positive for HBsAg (10% Marshallese vs. 0.1% non-Marshallese).
“Hospital standing orders to administer hepatitis B vaccine to all newborns prior to discharge appeared to provide a safety net against infection in this high-risk population,” Fischer et al wrote. “Since 2005, CDC and ACIP have recommended that all delivery hospitals have standing orders to administer hepatitis B vaccine to newborns prior to hospital discharge, but delivery hospitals do not uniformly have such standing orders.”
Another policy that is not currently included in the recommendations may also have contributed to successfully controlling the spread of this disease.
One of the two hospitals included in the investigation had a written directive to administer hepatitis B immunoglobulin within 12 hours of birth to all infants born, not only to women who tested positive for HBsAG, but also to those born to mothers whose HBsAG status was unknown.
An analysis of 32 infants (five with HBV, 27 without HBV) who underwent post-vaccination testing revealed that infants who tested HBsAG–positive at follow-up were significantly less likely to have received hepatitis B immunoglobulin in the 12 hours following birth compared with infants who tested HBsAG-negative (40% vs. 92.6%, P=.02), despite uniformity in HBV vaccination rates.
Based on these findings and the potential for serious morbidity associated with HBV, researchers emphasized the following recommendations:
- All pregnant women must be properly screened for HBV.
- All newborns should be administered HBV vaccine before discharge.
- Infants born to mothers who test positive for HBsAg should be provided PEP in a timely manner.
- Hospitals must report infant outcomes to health departments to aid in preventive efforts.
“Since perinatal HBV infections are almost always asymptomatic, it is imperative that clinicians test exposed infants for perinatal HBV infection for the infections to be identified and reported to the health department,” the investigators wrote. – by Nicole Blazek
Fischer G et al. Pediatr Infect Dis J. 2009;doi:10.1097/INF.0b013e3181196bf5c.
The researchers describe a successful program of perinatal hepatitis B immunization and its effect on two populations in Arkansas: infants born to immigrants from the Marshall Islands whose mothers had a high rate of hepatitis B carriage and non-Marshallese infants born to carrier mothers.
Infants in both groups had a high rate of receipt of hepatitis B vaccine at birth (98% and 100% respectively) but lower rates of receipt of hepatitis B immunoglobulin at birth (88% and 87%). Interestingly, the proportion of infants who became HBsAg positive (17% and 13%) was similar to the number of infants who did not receive hepatitis B immunoglobulin at birth. It would seem that further improvements in the ability to identify and track carrier mothers at birth and more reliably assure receipt of HBIG for their infants is warranted.
– Steven B. Black, MD
Professor, University of Kentucky
Bardstown, Kentucky