Ann Intern Med. 2014 Jun 17;160(12):828-35. doi: 10.7326/M13-2529.
Prevention of vertical transmission of hepatitis B: an observational study.
Abstract
BACKGROUND:
For mothers with chronic hepatitis B virus (HBV) infection, the Centers for Disease Control and Prevention recommends immunoprophylaxis to decrease perinatal transmission. However, its effectiveness and risk factors for failure have not been well-studied in community practice.
OBJECTIVE:
To investigate the effectiveness of a contemporary immunoprophylaxis protocol.
DESIGN:
Observational study.
SETTING:
An HBV perinatal immunoprophylaxis program within Kaiser Permanente Northern California.
PATIENTS:
4446 infants born to 3253 HBV-positive mothers between 1997 and 2010.
MEASUREMENTS:
Adherence to immunoprophylaxis, follow-up testing rates, maternal risk factors for HBV transmission, and transmission rates.
RESULTS:
The infant infection rate was 0.75 per 100 births from 1997 to 2010 (Poisson 95% CI, 0.48 to 1.10). Rates per 100 births were 3.37 (CI, 2.08 to 5.14) for e antigen-positive mothers and 0.04 (CI, 0.001 to 0.24) for e antigen-negative mothers. Among mothers with viral load testing, the lowest level associated with transmission was 6.32 × 107 IU/mL. Infection rates per 100 births were 3.61 (CI, 0.75 to 10.56) among the 83 births to mothers with viral loads of 5 × 107 IU/mL or greater and 0 among the 831 births to mothers with viral loads less than 5 × 107 IU/mL, regardless of e antigen status.
LIMITATIONS:
Testing for HBV immunity and infection was less complete in earlier years. Viral load testing was only consistently available starting in 2007.
CONCLUSION:
Prenatal HBV screening followed by postnatal prophylaxis is highly effective in preventing vertical transmission of HBV. A negative e antigen status or a viral load less than 5 × 107 IU/mL (90.9% of women tested) identifies women at extremely low risk for transmission after immunoprophylaxis who are unlikely to benefit from further interventions.
PRIMARY FUNDING SOURCE:
Kaiser Permanente Community Benefit and National Institutes of Health.
- PMID:
- 24862434
- [PubMed - indexed for MEDLINE]
- PMCID:
- PMC4086733
- [Available on 2014/12/17]
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