Perinatal immunoprophylaxis in babies born to hepatitis B virus-positive mothers in Queensland Australia: A data linkage study

Abstract

Vertical transmission from mother-to-child is an important mode of hepatitis B virus (HBV) infection, accounting for up to half of all incident cases globally. We evaluated the uptake of HBV neonatal vaccination and immunoglobulin delivery in Queensland, Australia, between 2001 and 2013. We identified HBV-positive mothers using linked notifiable conditions, hospitalisation, and perinatal administrative data. Perinatal receipt of monovalent HBV vaccine and hepatitis B immunoglobulin were examined. Of 710,859 live births, with 5,753 infants (0.81%) born to identified HBV-positive mothers; 91.7% received HBV neonatal vaccine. Immunoglobulin uptake was 20.0% in 2012 and 36.6% in 2013. Uptake was higher when the mother's HBV-positive status was recorded in perinatal records (69.6% if maternal HBV status recorded on perinatal data collection vs 9.5% otherwise). Delivery of neonatal HBV vaccination in Queensland was high. Improved identification and documentation of HBV-positive mothers' status during the antenatal period was associated with increased immunoglobulin administration.

Pregnancy – a key moment for engaging women with hepatitis B in care

“…A collaborative referral pathway has improved care for pregnant women with hepatitis B at our health service and successfully linked more than half to ongoing hepatitis B care. Previous Australian studies have assessed hepatitis B management in pregnancy and infant immunoprophylaxis, but to our knowledge, none have addressed the role antenatal care could play in linking women to ongoing hepatitis B care 7,8 . Most women in the study were born overseas and therefore face additional language, social and economic barriers to healthcare.…”

“…Previous Australian studies have assessed hepatitis B management in pregnancy and infant immunoprophylaxis, but to our knowledge, none have addressed the role antenatal care could play in linking women to ongoing hepatitis B care. 7,8 Most women in the study were born overseas and therefore face additional language, social and economic barriers to healthcare. Addressing these barriers by creating novel pathways to care is a step towards health service equity for this important patient group.…”

Mapping the delivery of interventions for vaccine-preventable infections in pregnancy in Victoria, Australia

“…Coverage estimates of vaccines in pregnancy vary, with historically higher uptake of pertussis vaccine than influenza vaccine among pregnant women (Rowe et al 2019). Estimates of hepatitis B birth dose vaccine uptake for infants have recently shown variation between Victorian hospitals, and infants born in private hospitals were less likely to receive a timely hepatitis B birth dose vaccine (Deng 2021), with 1 in 20 infants born to women with CHB not receiving a birth dose within 24 h. Despite effective PMTCT interventions, hepatitis B MTCT continues to occur (Shen et al 2019;Deng 2021).…”

Women with hepatitis B: how mothers with chronic hepatitis B understand and experience the prevention of mother-to-child transmission interventions in Victoria, Australia

“…Despite the availability of effective PMTCT interventions, hepatitis B MTCT continues to occur both in Australia and globally. MTCT factors identified include poor adherence to PMTCT-CHB guidelines; inadequate viral load testing during pregnancy; minimal postvaccination serological testing for children born to mothers with CHB; poor CHB status and vaccination uptake recording and reporting; and incorrect understanding of hepatitis B transmission routes by obstetricians (Giles et al 2004(Giles et al , 2013Markey et al 2017;Shen et al 2019;Deng 2021). Additionally, provision of antenatal and postnatal care is fragmented with hepatitis B antenatal screening usually completed within primary care, perinatal and neonatal care in hospitals, postnatal care by maternal and child health services, and infant vaccination by GPs or councils in community settings.…”

“…Other than NSW, there are no centrally coordinated hepatitis B perinatal programs in Australia and, therefore, the incidence of hepatitis B MTCT in Australia remains unknown. There is some evidence of hepatitis B MTCT in Victoria and Queensland (Shen et al 2019;Deng 2021).…”