Immunisation of neonates at high risk of hepatitis B in England and Wales: national surveillance.

Polakoff, Sheila; Vandervelde, Elise M.

doi:10.1136/bmj.297.6643.249

Cited by 17 publications

(10 citation statements)

References 13 publications

(4 reference statements)

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“…On the other hand 27 of 30 (90%) examined for anti-HBs were positive 2-6 years after the last dose of vaccine, and the three anti-HBs negatives were also HBsAg negative. This seroconversion rate is similar to that of other published studies [Stevens et al, 1985;Wong et al, 1984;Polakoff and Vandervelde 1990;Okun et al, 19901. Six of our infants received vaccine only; three of three tested were HBsAg negative, and two of two tested were without antibodies.…”

Section: Discussionsupporting

confidence: 92%

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

Chernesky¹,

Blajchman²,

Castriciano³

et al. 1992

Obstetrical & Gynecological Survey

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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.

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Section: Discussionsupporting

confidence: 92%

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

Chernesky¹,

Blajchman²,

Castriciano³

et al. 1992

Obstetrical & Gynecological Survey

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“…5 In an earlier study for the Public Health Laboratory, 89 of 102 babies from an original cohort of 155 received three doses of vaccine 7. In the Netherlands, where there is a centrally organised service with different vaccination schedules, uptake of three doses of vaccine rose from 80% to 94% between 1989 and 1991 6.…”

Section: Discussionmentioning

confidence: 99%

“…This coverage was achieved in an inner city area where routine immunisation uptake, for example, DPT and MMR is traditionally poor7 8; uptake of third DPT was 91% and MMR 85% in Hackney in 1995. In contrast to other studies, uptake of hepatitis B immunisation was greater overall than that of routine immunisations 4…”

Section: Discussionmentioning

confidence: 99%

“…In non-residents uptake of hepatitis B was much higher than that of routine immunisations. One possible explanation of the latter is that the organisation and delivery of the hepatitis B immunisation programme overcame the barriers to effective immunisation, which exist in inner cities 7. These include a high prevalence of ethnic minority families, one parent families, young mothers, and mobility.…”

Section: Discussionmentioning

confidence: 99%

“…The main barrier to immunisation in ethnic minority families is said to be poor understanding of English 7. Immunisation requires valid consent,2 which must be adequately informed.…”

Section: Discussionmentioning

confidence: 99%

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Overcoming barriers to hepatitis B immunisation by a dedicated hepatitis B immunisation service

Larcher

Bourne²,

Aitken³

et al. 2001

Archives of Disease in Childhood

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Aims-To determine the eVectiveness of a selective hospital based hepatitis B immunisation programme and the barriers to be overcome in obtaining a successful outcome. Methods-Retrospective case note review of 265 infants born over a five year period to hepatitis B carrier mothers at a university aYliated hospital in Hackney, London. Results-A total of 242 infants (91%) were fully vaccinated; 217 (82%) had serology; 31 required booster doses. Percentages failing to reach second, third vaccinations, and serology on schedule rose exponentially (7%, 18%, 33% respectively). Mobility was high (25%) and significantly aVected outcome. A total of 95% Hackney resident babies were fully vaccinated compared with 78% non-residents. Uptake of routine immunisations was higher in Hackney residents than non-residents and greater in those who were eligible for hepatitis B vaccine. Name changes occurred in 35%. Translation requirements were high (85% for Turkish, Vietnamese, and Asian families). Requirements for specific postnatal counselling of mothers and hepatology referral fell significantly during the course of the study. Only seven of 22 babies born in 1995 in Tower Hamlets compared with 53 of 58 Hackney babies received a full vaccination course in non-hospital based primary care. Conclusion-In inner city areas with high prevalence of hepatitis B carriage, mobility, and diverse ethnicity, a dedicated centralised immunisation service can be highly eVective, provided that adequate support services (translation, counselling, and parental referral) are available.

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Prevention of perinatal transmission of hepatitis B Virus (HB V): A comparison of two prophylactic schedules

Wheeley

Jackson

Boxall

et al. 1991

Journal of Medical Virology

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Perinatal transmission of hepatitis B virus (HBV) from HBsAg carrier mothers who were HBeAg+, antiHBe+, or negative for both HBe markers, was interrupted using either 4 doses of vaccine, or one dose of hepatitis B immunoglobulin (HBIG) at birth, combined with 4 doses of vaccine. In those infants who received HBIG at birth, the antiHBs titre was significantly higher at 1 and 2 months old, but at 6, 9, and 18 months old, there was no significant difference. Among the infants of carrier mothers who did not display HBeAg (i.e., were antiHBe+, or negative for both HBe markers), a transient subclinical infection would have been expected in around 10% had there been no intervention. No evidence of such infection was detected, and no difference in outcome was found between the two treatment groups. Amongst infants born to HBeAg+ carrier mothers, infection occurred in 1 out of 8 who had received HBIG and vaccine, and in 3 of 8 who had received vaccine only. The difference in outcome was not statistically significant, but the numbers analysed were small. The infections which occurred in spite of prophylaxis may be attributable to in utero infection, poor response to vaccine by the infant, or to the mother having a particularly high HBV-DNA level. HBIG given at birth to infants of HBeAg+ carrier mothers may enhance the protection of infants who are destined to be poor responders to vaccine.

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Immunisation of neonates at high risk of hepatitis B in England and Wales: national surveillance.

Cited by 17 publications

References 13 publications

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

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

Overcoming barriers to hepatitis B immunisation by a dedicated hepatitis B immunisation service

Prevention of perinatal transmission of hepatitis B Virus (HB V): A comparison of two prophylactic schedules

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