Evaluation of the Compliance With Recommended Procedures in Newborns Exposed to HBsAg-Positive Mothers

Heininger, Ulrich; Vaudaux, Bernard; Nidecker, Myriam; Pfister, Riccardo; Posfay‐Barbe, Klara M.; Bachofner, Marius; Hoigné, Irene; Gnehm, Hanspeter E.

doi:10.1097/inf.0b013e3181bd7f89

Cited by 18 publications

(12 citation statements)

References 12 publications

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“…Although all the children in our study were vaccinated against hepatitis B, only 53.3% were administered HBIG, considerably lower than the rate in the developed countries [18], [19]. The substantial gaps in the immunoprophylaxis of the infants between the recommendations and routine practices were attributable to the unavailability of HBIG, incomplete knowledge on the prophylaxis of the health care providers, and low prenatal HBsAg screening rate, particularly in rural areas [20].…”

Section: Discussionmentioning

confidence: 60%

Breastfeeding Is Not a Risk Factor for Mother-to-Child Transmission of Hepatitis B Virus

Chen

Wen

et al. 2013

PLoS ONE

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BackgroundMany clinicians do not encourage breastfeeding in hepatitis B virus (HBV) carriers, since HBV DNA can be detected in breast milk and breast lesions may increase exposure of infants to HBV. The aim of this study was to determine whether breastfeeding may add risk for perinatal HBV transmission.Methodology/Principal FindingsTotally 546 children (1–7-year-old) of 544 HBV-infected mothers were investigated, with 397 breastfed and 149 formula-fed; 137 were born to HBeAg-positive mothers. All children had been vaccinated against hepatitis B but only 53.3% received hepatitis B immune globulin (HBIG). The overall prevalence of HBsAg+, HBsAg−/anti-HBc+, and anti-HBs (≥10 mIU/ml) in children was 2.4%, 3.1%, and 71.6% respectively. The HBsAg prevalence in breast- and formula-fed children was 1.5% and 4.7% respectively (P = 0.063); the difference was likely due to the higher mothers' HBeAg-positive rate in formula-fed group (formula-fed 49.0% vs. breastfed 15.9%, P<0.001). Further logistic regression analyses showed that breastfeeding was not associated with the HBV infection in the children, adjusting for the effect of maternal HBeAg status and other factors different between the two groups.Conclusions/SignificanceUnder the recommended prophylaxis, breastfeeding is not a risk factor for mother-to-child transmission of HBV. Therefore, clinicians should encourage HBV-infected mothers to breastfeed their infants.

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Section: Discussionmentioning

confidence: 60%

Breastfeeding Is Not a Risk Factor for Mother-to-Child Transmission of Hepatitis B Virus

Chen

Wen

et al. 2013

PLoS ONE

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“…Additionally, recent studies show that in developed countries, 98–100% of the HBV-exposed infants were protected against the chronic infection after passive-active immunoprophylaxis had been strictly followed [9-12]. This highlights the importance of the full adherence to the standard immunoprophylaxis in the prevention of perinatal HBV infections.…”

Section: Discussionmentioning

confidence: 99%

“…In developed countries, the vaccination schedule against hepatitis B has been followed well in the routine practices and the protective efficiency was 90–100% in infants born to HBV carrier mothers, as high as the protective rates achieved in the clinical trials [9-12]. In developing countries like China, where HBV infection is highly endemic, however, the protective efficiency in daily practice has been less studied.…”

Section: Introductionmentioning

confidence: 99%

Gaps in the prevention of perinatal transmission of hepatitis B virus between recommendations and routine practices in a highly endemic region: a provincial population-based study in China

Zhang

Luo

et al. 2012

BMC Infect Dis

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BackgroundHepatitis B virus (HBV) infection is endemic in China; perinatal transmission is the main source of chronic HBV infection. Simultaneous administration of hepatitis B immune globulin (HBIG) and hepatitis B vaccine is highly effective to prevent perinatal transmission of HBV; however, the effectiveness also depends on full adherence to the recommended protocols in daily practice. In the present investigation, we aimed to identify gaps in immunoprophylaxis of perinatal transmission of HBV between recommendations and routine practices in Jiangsu Province, China.MethodsTotally 626 children from 6 cities and 8 rural areas across Jiangsu Province, China, born from February 2003 to December 2004, were enrolled; 298 were born to mothers with positive hepatitis B surface antigen (HBsAg) and 328 were born to HBsAg-negative mothers. Immunoprophylactic measures against hepatitis B were retrospectively reviewed for about half of the children by checking medical records or vaccination cards and the vaccine status was validated for most of children.ResultsOf 298 children born to HBV carrier mothers, 11 (3.7%) were HBsAg positive, while none of 328 children born to non-carrier mothers was HBsAg positive (P < 0.01). The rates of anti-HBs ≥ 10 mIU/ml in children of carrier and non-carrier mothers were 69.5% and 69.2% respectively (P = 0.95). The hepatitis B vaccine coverage in two groups was 100% and 99.4% respectively (P = 0.50), but 15.1% of HBV-exposed infants did not receive the timely birth dose. Prenatal HBsAg screening was performed only in 156 (52.3%) of the carrier mothers. Consequently, only 112 (37.6%) of HBV-exposed infants received HBIG after birth. Furthermore, of the 11 HBV-infected children, only one received both HBIG and hepatitis B vaccine timely, seven missed HBIG, two received delayed vaccination, and one missed HBIG and received delayed vaccination.ConclusionsThere are substantial gaps in the prevention of perinatal HBV infection between the recommendations and routine practices in China, which highlights the importance of full adherence to the recommendations to eliminate perinatal HBV infection in the endemic regions.

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“…In a study in London in 2006, 97% of the children received their birth vaccination and 49% of the children had received four vaccines by the age of 15 months [18]. In a Swiss study from 2010, 99% of newborns received their vaccination within 24 hours [19]. In the same study, the vaccination series was completed in 83% of the children in that they had received at least two doses besides the birth dose.…”

Section: Lessons Learnedmentioning

confidence: 99%

Hepatitis B vaccination coverage and risk factors associated with incomplete vaccination of children born to hepatitis B surface antigen-positive mothers, Denmark, 2006 to 2010

2016

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In Denmark, universal screening of pregnant women for hepatitis B has been in place since November 2005, with the first two years as a trial period with enhanced surveillance. It is unknown what the change to universal screening without enhanced surveillance has meant for vaccination coverage among children born to hepatitis B surface antigen (HBsAg)-positive mothers and what risk factors exist for incomplete vaccination. This retrospective cohort study included 699 children of mothers positive for HBsAg. Information on vaccination and risk factors was collected from central registers. In total, 93% (651/699) of the children were vaccinated within 48 hours of birth, with considerable variation between birthplaces. Only 64% (306/475) of the children had received all four vaccinations through their general practitioner (GP) at the age of two years, and 10% (47/475) of the children had received no hepatitis B vaccinations at all. Enhanced surveillance was correlated positively with coverage of birth vaccination but not with coverage at the GP. No or few prenatal examinations were a risk factor for incomplete vaccination at the GP. Maternity wards and GPs are encouraged to revise their vaccination procedures and routines for pregnant women, mothers with chronic HBV infection and their children.

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Evaluation of the Compliance With Recommended Procedures in Newborns Exposed to HBsAg-Positive Mothers

Cited by 18 publications

References 12 publications

Breastfeeding Is Not a Risk Factor for Mother-to-Child Transmission of Hepatitis B Virus

Breastfeeding Is Not a Risk Factor for Mother-to-Child Transmission of Hepatitis B Virus

Gaps in the prevention of perinatal transmission of hepatitis B virus between recommendations and routine practices in a highly endemic region: a provincial population-based study in China

Hepatitis B vaccination coverage and risk factors associated with incomplete vaccination of children born to hepatitis B surface antigen-positive mothers, Denmark, 2006 to 2010

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