Analysis of a Pregnancy-Screening and Neonatal-Immunization Program for Hepatitis B in Hamilton, Ontario, Canada, 1977–1988

Abstract

Blood Transfusion Service screened 98,712 pregnant patients for hepatitis B surface antigen (HBsAg) and identified 120 positives (0.12%). The number of positives ranged from six to 16 per year. We were able to trace and enroll 65 mothers (54%) and 96 of their children in the follow-up study. The majority of the women were between 20 and 30 years of age (95.4%) and married (86%), and about one-half were employed outside the home. Sixty-five percent were white and 34% Asian, and 20 countries were listed as their places of origin. Hepatitis B immune globulin (HBIG) was available for neonatal immunization since 1977 and combined with vaccine since 1982. Of the 96 candidates for HBIG, 60 (63%) received HBIG within 24 hr, one after 3 months, four unknown, and 31 did not receive it. Of the 56 candidates for vaccination from 1982 to 1989,26 (46%) received three doses, seven had two doses, eight had one dose, one was unknown, and 14 had none. HBsAg tests were performed on 69 children (71.8%) and anti-HBs on 61 (63.5%). Four of the children are HBsAg positive, 31 have anti-HBs, and 31 have no detectable antibodies. All four HBsAg positives had not received vaccine, and only one had received HBIG. Of the children positive for hepatitis B surface antibodies, five had received no immunization and therefore had been subclinically infected. Of the 32 vaccinees tested for anti-HBs at least 2 years after immunization was complete, 27 (84.4%) had detectable antibodies. Thus, although several children did not receive appropriate immunization early in the program, the majority did receive both HBIG and vaccine, apparently preventing infection. The consequences of no immunization in these children were a 33.3% infection rate (7/21) and a 14% (3121 ) rate of chronic infection.

Outcomes from a Canadian Public Health Prenatal Screening Program for Hepatitis B

“…This is far higher than previous evaluations which reported three-dose vaccine coverage to be 59% in New York City 8 and 63% in Louisiana 9 and Ontario. 10 It is interesting to note that previous research in the mid-1980s from Alberta reported that 94% of infants born to carrier mothers had received appropriate vaccination, suggesting that the provincial prenatal screening and HBV prophylaxis program have consistently high uptake. 11 Despite this suc-cess, improvements can be made to ensure that all children are appropriately vaccinated.…”

Serological Features of Children Vertically Infected With Hepatitis B Virus: A Study in Amir Al-Momenin Ali Hospital of Zabol

“…12 In two reports in China, these rates were reported as 7.2% and 13.7%. 13,14 Another study by Zhu in China found that 14.7% of these children carried HBsAg. 15 These evidence shows that vertical transmission of HBV infection is a serious health concern among societies, and those infected with the virus via this route must be under close clinical surveillance.…”

Prevention of hepatitis B virus (HBV) infection in health-care workers after accidental exposure: A comparison of two prophylactic schedules

“…Active immunization with HB vaccine produces an HBsAg antibody response after a complete course in a high percentage of nonimmunocompromised recipients and it is hoped will lead to long-lasting protection [11]. The combinatio n of passive and active immunoprophylaxis in order to prevent HBV infection should only be considered in newborn infants of mothers who are HBsAg carriers [13][14][15][16]. The study confirmed that both schedtfles are effective in preventing symptomatic HBV infection after accidental exposure to HBsAg-positive blood.…”