Timely Birth Dose Vaccine to Prevent Vertical Transmission of Hepatitis B: A Single Center Experience on the Road to the WHO Elimination Goals in Italy

Abstract

Italy was one of the first industrialized countries to implement a program of routine vaccination against hepatitis B virus (HBV) infection. However, currently, no HBV vaccine is administered at birth if the screened mother is HBsAg negative, whilst babies born to HBsAg positive mothers are given vaccine and hepatitis B immunoglobulin, within 12–24 post-delivery hours. A single center retrospective analysis of policies and practices to prevent mother-to-child transmission of HBV was carried out, to evaluate their adherence to HBV care guidelines. Paired maternal-infant medical records for consecutive live births, between January 2015 and December 2019, were reviewed at the AOU Città della Salute e Scienza di Torino, where a total of 235/35,506 babies (0.7%) were born to HBsAg positive mothers. Markers of active viral replication, i.e., HBV DNA level and/or HBeAg, were reported in only 66/235 (28%) of the mothers’ medical records. All newborns had immunoprophylaxis at birth: 61% at <12 h, 31% between 12 and 24 h, 7% between 24 and 36 h and 1% at >36 h. In 2019, two cases of vertical HBV transmission occurred, despite timely immunoprophylaxis, as their mothers’ viral load was detected too late for antiviral prophylaxis. Missed early identification of pregnant women with high viremia levels or late vaccinations may contribute to perinatal HBV infection. Immunoprophylaxis should be given to babies born to HBsAg positive mothers at the latest within 12 h. In Italy, policies aimed at achieving the WHO 2030 goal of eliminating viral hepatitis should be further implemented.

The First 30 Years of the Universal Hepatitis-B Vaccination-Program in Italy: A Health Strategy with a Relevant and Favorable Economic-Profile

“…and men who have sex with men [ 32 ], for whom the HBV vaccination is strongly recommended and free of charge [ 8 , 33 , 34 , 35 ]. Moreover, Pinon et al found a not-always-appropriate surveillance of HBsAg-positive women during pregnancy [ 36 ]. Despite Italy providing HBV screening to pregnant women, along with timely immune-prophylaxis and hepatitis-B vaccination at birth to newborns of seropositive women [ 37 ], health authorities should consider the possibility of investing more resources also in the screening of pregnant women, in order to prevent HBV vertical-transmission.…”

Inadequate Hospital Practices to Prevent Mother-to-Child Transmission of Hepatitis B Virus Infection: A European Survey

“…Data on the prevention strategies at birth highlighted that 91% of the departments provide for infants born to HBsAg positive mothers HBV vaccine plus HBIG within 12 hours from birth, according to guidelines (9,(11)(12)(13). Nevertheless, only 61% of 235 babies born to HBV positive mothers between 2015 and 2019 at the Italian hospital with the highest number of deliveries per year received immunoprophylaxis within 12 hours from birth (20).…”