Abstract
Background
Without appropriate prophylaxis, the rate of vertical transmission of hepatitis B virus (HBV) can be as high as 95%. Alberta’s provincial prenatal program screens all pregnant women for HBV, and provides prophylaxis to infants born to HBV-infected women. Canadian data on the outcomes of such programs are limited.
Methods
We conducted a retrospective review of data from pregnant Albertan women who were Hepatitis B Surface Antigen (HBsAg) positive from 1997–2004. We describe the frequency of hepatitis B immunoglobulin (HBIG) and vaccine administration, follow-up serology and pregnancy outcomes.
Results
In total, 1,485 HBsAg-positive pregnant women were identified; an average of 186 women annually (range: 125–216). Of the 980 infants eligible to have completed prophylaxis and serological follow-up, 82.0% were appropriately immunized and serologically tested, 11.3% had complete immunization but no serology testing and 6.6% were incompletely immunized. Of infants with complete immunization and follow-up, 3.7% failed to mount an immune response and 2.1% were infected.
Conclusion
A high proportion of infants born to carrier mothers are receiving appropriate post-natal prophylaxis in Alberta. Future research should examine maternal factors that may increase the vertical transmission of HBV.
MeSH terms: Hepatitis B virus, immunization, serologic tests, prenatal care, vertical transmission
Résumé
Contexte
Sans prophylaxie appropriée, le taux de transmission verticale du virus de l’hépatite B (VHB) peut atteindre 95 %. Dans le cadre du programme prénatal provincial de l’Alberta, toutes les femmes enceintes sont testées pour le VHB, et la prophylaxie est offerte aux nourrissons de femmes infectées par le virus. Les données canadiennes sur les résultats de tels programmes sont limitées.
Méthode
Nous avons mené une étude rétrospective auprès des femmes enceintes de l’Alberta qui étaient porteuses de l’antigène de surface de l’hépatite B (AgHBs) entre 1997 et 2004. Nous avons décrit la fréquence de l’administration de l’immunoglobuline anti-hépatite B (HBIg) et du vaccin contre le VHB, les résultats des tests sérologiques et les résultats de grossesse.
Résultats
Sur l’ensemble des femmes enceintes testées, 1 485 porteuses de l’AgHBS ont été identifiées, soit en moyenne 186 femmes par année (125 à 216). Des 980 nourrissons admissibles à la prophylaxie complète et au suivi sérologique, 82 % avaient reçu tous les vaccins ainsi que les tests sérologiques, 11,3 % avaient reçu les vaccins mais aucun test sérologique, et 6,6 % n’avaient pas été complètement immunisés. Sur les nourrissons immunisés et ayant fait l’objet d’un suivi sérologique, 3,7 % n’avaient pas manifesté de réponse immunitaire, et 2,1 % étaient infectés.
Conclusion
En Alberta, une proportion élevée de nourrissons de mères infectées par le VHB reçoit la prophylaxie postnatale appropriée. D’autres études sont nécessaires pour déterminer les facteurs maternels qui augmentent le risque de transmission du VHB de la mère à l’enfant.
References
- 1.NACI. Canadian Immunization Guide. 6th edition 2002. [Google Scholar]
- 2.Tran TT, Martin P. Hepatitis B: Epidemiology and natural history. Clin Liver Dis. 2004;8(2):255–66. doi: 10.1016/j.cld.2004.02.008. [DOI] [PubMed] [Google Scholar]
- 3.Stevens CE, Taylor PE, Tong MJ, Toy PT, Vyas GN, Nair PV, et al. Yeast-recombinant hepatitis B vaccine. Efficacy with hepatitis B immune globulin in prevention of perinatal hepatitis B virus transmission. JAMA. 1987;257(19):2612–16. doi: 10.1001/jama.1987.03390190090026. [DOI] [PubMed] [Google Scholar]
- 4.Beasley RP, Hwang LY, Lee GC, Lan CC, Roan CH, Huang FY, et al. Lancet. 1983. Prevention of perinatally transmitted hepatitis B virus infections with hepatitis B imuneglobulin and hepatitis B vaccine; pp. 1099–102. [DOI] [PubMed] [Google Scholar]
- 5.Alberta Bloodborne Pathogens Surveillance Working Group, Alberta Bloodborne Pathogens Surveillance Report. Alberta Health and Wellness: Edmonton, AB, 2003.
- 6.Minuk G, Uhanova J. Chronic hepatitis B in Canada. Can J Infect Dis. 2001;12(6):351–56. doi: 10.1155/2001/650313. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Zhang J, Zou S, Giulivi A. Hepatitis B in Canada. CCDR. 2001;27(S3):10–12. [Google Scholar]
- 8.Henning KJ, Pollack DM, Friedman SM. A neonatal hepatitis B surveillance and vaccination program: New York City, 1987 to 1988. Am J Public Health. 1992;82(6):885–88. doi: 10.2105/AJPH.82.6.885. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Kohn MA, Farley TA, Scott C. The need for more aggressive follow-up of children born to hepatitis B surface antigen-positive mothers: Lessons from the Louisiana Perinatal Hepatitis B Immunization Program. Pediatr Infect Dis J. 1996;15(6):535–40. doi: 10.1097/00006454-199606000-00012. [DOI] [PubMed] [Google Scholar]
- 10.Chernesky MA, Blajchman MA, Castriciano S, Basbaum J, Spiak C, Mahoney JB. Analysis of a pregnancy-screening and neonatal-immunization program for hepatitis B in Hamilton, Ontario, Canada, 1977–1988. J Med Virol. 1991;35(1):50–54. doi: 10.1002/jmv.1890350111. [DOI] [PubMed] [Google Scholar]
- 11.Okun NB, Larke RP, Waters JR, Joffres MR. Success of a program of routine prenatal screening for hepatitis B surface antigen: The first 2 years. CMAJ. 1990;143(12):1317–21. [PMC free article] [PubMed] [Google Scholar]
- 12.Wong S, Chan LY, Yu V, Ho L. Hepatitis B carrier and perinatal outcome in singleton pregnancy. Am J Perinatol. 1999;16(9):485–88. doi: 10.1055/s-1999-6802. [DOI] [PubMed] [Google Scholar]
- 13.del Canho R, Grosheide PM, Mazel JA, Heijtink RA, Hop WC, Gerards LJ, et al. Ten-year neonatal hepatitis B vaccination program, The Netherlands, 1982–1992: Protective efficacy and long-term immunogenicity. Vaccine. 1997;15(15):1624–30. doi: 10.1016/S0264-410X(97)00080-7. [DOI] [PubMed] [Google Scholar]
- 14.Mandelbrot L, Newell M-L. Vertical transmission of hepatitis viruses. In: Newell M-L, McIntyre J, editors. Congenital and Perinatal Infections: Prevention, Diagnosis and Treatment. Cambridge, UK: Cambridge University Press; 2000. pp. 164–204. [Google Scholar]
- 15.Lee SD, Lo KJ, Tsai YT, Wu JC. Maternal hepatitis B virus DNA in mother-infant transmission. Lancet. 1989;1(8640):719. doi: 10.1016/S0140-6736(89)92227-7. [DOI] [PubMed] [Google Scholar]
- 16.Burk RD, Hwang LY, Ho GY, Shafritz DA, Beasley RP. Outcome of perinatal hepatitis B virus exposure is dependent on maternal virus load. J Infect Dis. 1994;170(6):1418–23. doi: 10.1093/infdis/170.6.1418. [DOI] [PubMed] [Google Scholar]
- 17.del Canho R, Grosheide PM, Schalm SW, de Vries RR, Heijtink RA. Failure of neonatal hepatitis B vaccination: The role of HBV-DNA levels in hepatitis B carrier mothers and HLA antigens in neonates. J Hepatol. 1994;20(4):483–86. doi: 10.1016/S0168-8278(05)80494-5. [DOI] [PubMed] [Google Scholar]
- 18.Corneil T, Gilbert M, Buxton J, Krajden M, McNabb G, McIntyre C. The Use of Routine HBeAg Testing in Pregnant Women in British Columbia to Identify Those Infants at Highest Risk for Vertical Transmission; 2004. [Google Scholar]
- 19.Reproductive Health Report Working Group, Alberta Reproductive Health: Pregnancies and Births 2004. Alberta Health and Wellness: Edmonton, AB.
- 20.van Zonneveld M, van Nunen AB, Niesters HG, de Man RA, Schalm SW, Janssen HL. Lamivudine treatment during pregnancy to prevent perinatal transmission of hepatitis B virus infection. J Viral Hepat. 2003;10(4):294–97. doi: 10.1046/j.1365-2893.2003.00440.x. [DOI] [PubMed] [Google Scholar]