Prenatal Screening for and Prevalence of Hepatitis B Surface Antigen in Pregnant Women and Prevention of Transmission to Infants Born to Infected Mothers-Guam, 2014

Overview

Journal J Pediatric Infect Dis Soc

Publisher Oxford University Press

Specialties Infectious Diseases
Pediatrics

Date 2017 Oct 10

PMID 28992071

Citations 5

Authors

Winston E Abara

Susan Cha

Tasneem Malik

Mia S DeSimone

Sarah Schillie

Melissa Collier

Bernadette Schumann

Michael Klemme

Mary Kamb

Affiliations

Soon will be listed here.

Abstract

Background: Perinatal transmission is the major mode of hepatitis B virus (HBV) transmission and drives HBV endemicity in the US territory of Guam. We assessed correlates of prenatal hepatitis B surface antigen (HBsAg) screening and HBsAg positivity among pregnant women and evaluated the care of infants of HBsAg-positive women.

Methods: Demographic and clinical data were abstracted from the maternal medical records of 966 randomly selected live infants born in 2014. Frequencies were calculated, and prevalence ratios (PRs) and 95% confidence intervals (CIs) were estimated using Poisson regression.

Results: Among the mothers of the 966 infants, 78.2% were Pacific Islanders, 56.9% were >25 years old (born before universal infant hepatitis B vaccination in Guam), 89.0% received prenatal care (PNC), 96.7% underwent prenatal HBsAg screening, and 2.0% were HBsAg positive. Approximately 15% of the women who did not have PNC were not screened for HBsAg. Receipt of PNC was associated with HBsAg screening (adjusted PR, 1.13 [95% CI, 1.04-1.23]), and HBsAg positivity was associated with a maternal age of >25 years (adjusted PR, 6.80 [95% CI, 1.32-35.08]). All 18 infants of the HBsAg-positive mothers received hepatitis B vaccine, and 17 (94.4%) received hepatitis B immunoglobulin.

Conclusion: Although the prenatal HBsAg screening prevalence in this sample was high, the maternal HBsAg prevalence among women in this sample was more than 14 times and 2 times the prevalence among US-born Pacific Islander/Asian women and all women in the continental United States, respectively. Improving access to PNC, ensuring that all pregnant women in Guam (especially those born before universal hepatitis B vaccination) are screened for HBsAg, and adopting postexposure prophylaxis for infants of HBsAg-positive mothers as standard clinical practice are important for preventing perinatal HBV transmission and reducing HBV endemicity.

Citing Articles

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References

Schweitzer A, Horn J, Mikolajczyk R, Krause G, Ott J . Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013. Lancet. 2015; 386(10003):1546-55. DOI: 10.1016/S0140-6736(15)61412-X. View

Smith E, Jacques-Carroll L, Walker T, Sirotkin B, Murphy T . The national Perinatal Hepatitis B Prevention Program, 1994-2008. Pediatrics. 2012; 129(4):609-16. DOI: 10.1542/peds.2011-2866. View

Roberts H, Kruszon-Moran D, Ly K, Hughes E, Iqbal K, Jiles R . Prevalence of chronic hepatitis B virus (HBV) infection in U.S. households: National Health and Nutrition Examination Survey (NHANES), 1988-2012. Hepatology. 2015; 63(2):388-97. DOI: 10.1002/hep.28109. View

Terrault N, Bzowej N, Chang K, Hwang J, Jonas M, Murad M . AASLD guidelines for treatment of chronic hepatitis B. Hepatology. 2015; 63(1):261-83. PMC: 5987259. DOI: 10.1002/hep.28156. View

Edmunds W, Medley G, Nokes D, Hall A, Whittle H . The influence of age on the development of the hepatitis B carrier state. Proc Biol Sci. 1993; 253(1337):197-201. DOI: 10.1098/rspb.1993.0102. View

Willis B, Wortley P, Wang S, Jacques-Carroll L, Zhang F . Gaps in hospital policies and practices to prevent perinatal transmission of hepatitis B virus. Pediatrics. 2010; 125(4):704-11. DOI: 10.1542/peds.2009-1831. View

Nguyen K, Nguyen T, Shen D, Xia V, Tran D, Banh K . Prevalence and presentation of hepatitis B and C virus (HBV and HCV) infection in Vietnamese Americans via serial community serologic testing. J Immigr Minor Health. 2014; 17(1):13-20. DOI: 10.1007/s10903-013-9975-5. View

Wiseman E, Fraser M, Holden S, Glass A, Kidson B, Heron L . Perinatal transmission of hepatitis B virus: an Australian experience. Med J Aust. 2009; 190(9):489-92. DOI: 10.5694/j.1326-5377.2009.tb02524.x. View

Shepard C, Simard E, Finelli L, Fiore A, Bell B . Hepatitis B virus infection: epidemiology and vaccination. Epidemiol Rev. 2006; 28:112-25. DOI: 10.1093/epirev/mxj009. View

10.

Jung M, Kuniholm M, Ho G, Cotler S, Strickler H, Thyagarajan B . The distribution of hepatitis B virus exposure and infection in a population-based sample of U.S. Hispanic adults. Hepatology. 2015; 63(2):445-52. PMC: 4718892. DOI: 10.1002/hep.28328. View

11.

. Prevention of perinatal transmission of hepatitis B virus: prenatal screening of all pregnant women for hepatitis B surface antigen. MMWR Morb Mortal Wkly Rep. 1988; 37(22):341-6, 351. View

12.

Beasley R, Hwang L, Lee G, Lan C, Roan C, Huang F . Prevention of perinatally transmitted hepatitis B virus infections with hepatitis B immune globulin and hepatitis B vaccine. Lancet. 1983; 2(8359):1099-102. DOI: 10.1016/s0140-6736(83)90624-4. View

13.

Lin C, Hsieh H, Huang Y, Huang Y, Ku M, Hung H . Hepatitis B virus infection among pregnant women in Taiwan: comparison between women born in Taiwan and other southeast countries. BMC Public Health. 2008; 8:49. PMC: 2275262. DOI: 10.1186/1471-2458-8-49. View

14.

Fan L, Owusu-Edusei Jr K, Schillie S, Murphy T . Cost-effectiveness of active-passive prophylaxis and antiviral prophylaxis during pregnancy to prevent perinatal hepatitis B virus infection. Hepatology. 2015; 63(5):1471-80. DOI: 10.1002/hep.28310. View

15.

Wen W, Chang M, Zhao L, Ni Y, Hsu H, Wu J . Mother-to-infant transmission of hepatitis B virus infection: significance of maternal viral load and strategies for intervention. J Hepatol. 2013; 59(1):24-30. DOI: 10.1016/j.jhep.2013.02.015. View

16.

Schillie S, Walker T, Veselsky S, Crowley S, Dusek C, Lazaroff J . Outcomes of infants born to women infected with hepatitis B. Pediatrics. 2015; 135(5):e1141-7. DOI: 10.1542/peds.2014-3213. View

17.

Hennessey K, Mendoza-Aldana J, Bayutas B, Lorenzo-Mariano K, Diorditsa S . Hepatitis B control in the World Health Organization's Western Pacific Region: targets, strategies, status. Vaccine. 2013; 31 Suppl 9:J85-92. DOI: 10.1016/j.vaccine.2012.10.082. View

18.

Abara W, Collier M, Teshale E . Impact of universal infant hepatitis B vaccination in the US-affiliated Pacific Islands, 1985-2015. Vaccine. 2017; 35(7):997-1000. PMC: 10168596. DOI: 10.1016/j.vaccine.2017.01.020. View

19.

Haddock R, Paulino Y, Bordallo R . Viral hepatitis and liver cancer on the Island of Guam. Asian Pac J Cancer Prev. 2013; 14(5):3175-6. PMC: 4372300. DOI: 10.7314/apjcp.2013.14.5.3175. View

20.

Maddrey W . Hepatitis B: an important public health issue. J Med Virol. 2000; 61(3):362-6. DOI: 10.1002/1096-9071(200007)61:3<362::aid-jmv14>3.0.co;2-i. View