Many U.S. Babies Do Not Receive Recommended Therapy to Prevent Hepatitis B Infection

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Many U.S. Babies Do Not Receive Recommended Therapy to Prevent Hepatitis B

Infection

SUMMARY: About 14% of babies born to mothers with hepatitis B virus (HBV) and

about 20% born to women of unknown HBV status in the U.S. do not receive

recommended vaccinations or other therapies to prevent them from acquiring the

virus, according to a CDC analysis of practices at more than 200 hospitals

described in the April 2010 issue of Pediatrics.

By Liz Highleyman

HBV can be transmitted from mother to child during pregnancy or delivery, but

the risk can be minimized with post-exposure prophylaxis (PEP) using hepatitis B

vaccination, injected antibodies (HBV immune globulin or HBIG), or both.

The Centers for Disease Control and Prevention (CDC) recommends that pregnant

women should be tested for HBV and that infants born to HBV positive mothers

should receive their first dose of the HBV vaccine at birth, with additional

" booster " shots at 1 and 6 months. Beyond this recommendation, HBV vaccination

is included in the schedule of routine infant immunizations.

Bayo Willis and CDC colleagues assessed hospital policies and practices to

prevent perinatal transmission of HBV and to identify gaps that could be

addressed to improve outcomes.

Despite availability of PEP, approximately 40-90 perinatal HBV infections are

reported to the CDC each year, and experts think the true number of annual

perinatal infections may be 10-20 times higher, the researchers noted as

background. These infections may occur as a result of various errors including

lack of maternal prenatal hepatitis B surface antigen (HBsAg) testing and

reporting, failure to test all women who are admitted to delivery hospitals

without prenatal HBsAg test results, lapses in reporting and documentation of

test results in maternal and newborn medical records, and failure to administer

timely post-exposure prophylaxis.

In March 2006, the investigators sent a policy survey to nursing supervisors or

clinical nurse managers of childbirth departments at a representative sample of

242 delivery hospitals in the 50 states, Washington, DC, and Puerto Rico that

oversaw at least 100 births per year. They also review paired mother-infant

medical records for 25 consecutive live births between October 2005 and March

2006.

Results

190 of the 242 hospitals (78.5%) responded to the survey and provided medical

records for 4762 mothers and 4786 infants.

63.0% to 80.6% of surveyed hospitals reported having various policies related

to infant hepatitis B prevention:

63.0% screened pregnant women for HBV upon admission if they had no existing

known test result.

67.0% had a policy requiring HBV vaccination of all newborns before hospital

discharge;

77.2% had a policy to administer HBIG to infants born to mothers with HBV;

80.6% had a policy to give the HBV vaccine to infants born mothers with

hepatitis B.

18 women had a documented positive prenatal HBsAg test and 3 tested positive

upon hospital admission (combined prevalence 0.9%).

62.1% of infants born to the 18 women with positive HBsAg prenatal tests

received both the HBV vaccine and HBIG within 12 hours after birth.

However, 13.7% of these eligible infants were not vaccinated and 19.7% did not

receive HBIG before hospital discharge.

Among infants born to 320 women with unknown HBsAg status, 52.4% were

vaccinated within 12 hours after birth.

Within this group of infants, 20.1% were not vaccinated before discharge.

Among infants born to mothers known to be HBsAg negative, 69.1% received the

hepatitis B vaccine before hospital discharge.

Overall, 68.7% of infants received the first dose of hepatitis B vaccine at

birth.

The strongest predictor of vaccine administration was having a written hospital

policy for newborn hepatitis B vaccination.

" Given the existence of highly effective PEP, perinatal HBV transmission can be

almost entirely prevented, but gaps in the delivery hospital prevention policies

and practices persist, " the study authors concluded. " Universal newborn

hepatitis B vaccination, together with timely administration of appropriate

prophylaxis to infants who are born to HBsAg-positive women and women of unknown

HBsAg status, are essential hospital clinical practices for preventing perinatal

HBV infections. "

" Efforts to avoid medical errors through appropriate implementation and

monitoring of hospital practices are needed to eliminate perinatal HBV

transmission, " they added.

Immunization Services Division and Global Immunization Division, National Center

for Immunization and Respiratory Diseases, Centers for Disease Control and

Prevention (CDC), Atlanta, GA; National Center for HIV/AIDS, Viral Hepatitis,

STD and TB Prevention, Division of Viral Hepatitis, CDC, Atlanta, GA.

4/13/10

Reference

BC Willis, P Wortley, SA Wang, and others. Gaps in hospital policies and

practices to prevent perinatal transmission of hepatitis B virus. Pediatrics

125(4): 704-711 (Free full text). April 2010.