Gaps in the prevention of perinatal transmission of hepatitis B virus between recommendations and routine practices in a highly endemic region: a provincial population-based study in China

Abstract

BackgroundHepatitis B virus (HBV) infection is endemic in China; perinatal transmission is the main source of chronic HBV infection. Simultaneous administration of hepatitis B immune globulin (HBIG) and hepatitis B vaccine is highly effective to prevent perinatal transmission of HBV; however, the effectiveness also depends on full adherence to the recommended protocols in daily practice. In the present investigation, we aimed to identify gaps in immunoprophylaxis of perinatal transmission of HBV between recommendations and routine practices in Jiangsu Province, China.MethodsTotally 626 children from 6 cities and 8 rural areas across Jiangsu Province, China, born from February 2003 to December 2004, were enrolled; 298 were born to mothers with positive hepatitis B surface antigen (HBsAg) and 328 were born to HBsAg-negative mothers. Immunoprophylactic measures against hepatitis B were retrospectively reviewed for about half of the children by checking medical records or vaccination cards and the vaccine status was validated for most of children.ResultsOf 298 children born to HBV carrier mothers, 11 (3.7%) were HBsAg positive, while none of 328 children born to non-carrier mothers was HBsAg positive (P < 0.01). The rates of anti-HBs ≥ 10 mIU/ml in children of carrier and non-carrier mothers were 69.5% and 69.2% respectively (P = 0.95). The hepatitis B vaccine coverage in two groups was 100% and 99.4% respectively (P = 0.50), but 15.1% of HBV-exposed infants did not receive the timely birth dose. Prenatal HBsAg screening was performed only in 156 (52.3%) of the carrier mothers. Consequently, only 112 (37.6%) of HBV-exposed infants received HBIG after birth. Furthermore, of the 11 HBV-infected children, only one received both HBIG and hepatitis B vaccine timely, seven missed HBIG, two received delayed vaccination, and one missed HBIG and received delayed vaccination.ConclusionsThere are substantial gaps in the prevention of perinatal HBV infection between the recommendations and routine practices in China, which highlights the importance of full adherence to the recommendations to eliminate perinatal HBV infection in the endemic regions.

Breastfeeding Is Not a Risk Factor for Mother-to-Child Transmission of Hepatitis B Virus

“…The substantial gaps in the immunoprophylaxis of the infants between the recommendations and routine practices were attributable to the unavailability of HBIG, incomplete knowledge on the prophylaxis of the health care providers, and low prenatal HBsAg screening rate, particularly in rural areas [20]. Additionally, we observed that the children who received HBIG had a lower rate of chronic infection than those who did not receive HBIG (1.7% vs. 3.1%).…”

Hepatitis B virus surface antigen and antibody markers in children at a major paediatric hospital after the pentavalent DTP-HBV-Hib vaccination

“…The three children who had HBsAg carriage may therefore have had mothers who were also carriers. The main challenge here is to ensure that protocols developed for pregnant women who are HBsAg carriers are adhered to 13 , and the universal screening of pregnant women for HBsAg should be aggressively pursued and vaccination of all infants at birth considered. 32 There is also the possibility that these children may have been infected within the first 6 months of life as documented in Senegal.…”

“…Such gaps may lead to reduced adherence to protocols that provide maximum efficiency and will in such instances reduce the frequency of seroprotection. 13 A systematic approach to the evaluation of ongoing infant HBV vaccination programmes will ensure that maximum benefits are derived. This is emphasized by the findings that infants in Cameroon did not respond well to the same HBV vaccination regimen as compared to those in the Gambia 6 , and also that genetic factors may account for non-response.…”

Effect of elective cesarean section on the risk of mother-to-child transmission of hepatitis B virus

“…The untimely use of first dose vaccine and the low rate of HBIG administration indicated that there are considerable gaps in the immunoprophylaxis against hepatitis B between the national recommendations and routine practices in China [20]. Therefore, more measures should be taken in the future to achieve full adherence to the recommended prophylaxis in preventing mother-to-child transmission of HBV.…”