Prevention of vertical transmission of hepatitis B: an observational study.

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  • Author(s): Kubo A; Shlager L; Marks AR; Lakritz D; Beaumont C; Gabellini K; Corley DA
  • Source:
    Annals of internal medicine [Ann Intern Med] 2014 Jun 17; Vol. 160 (12), pp. 828-35.
  • Publication Type:
    Journal Article; Observational Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't
  • Language:
    English
  • Additional Information
    • Source:
      Publisher: American College of Physicians--American Society of Internal Medicine Country of Publication: United States NLM ID: 0372351 Publication Model: Print Cited Medium: Internet ISSN: 1539-3704 (Electronic) Linking ISSN: 00034819 NLM ISO Abbreviation: Ann Intern Med Subsets: MEDLINE
    • Publication Information:
      Publication: <2001->: Philadelphia, PA : American College of Physicians--American Society of Internal Medicine
      Original Publication: Philadelphia [etc.] American College of Physicians.
    • Subject Terms:
      Hepatitis B Vaccines*; Hepatitis B/*prevention & control ; Infectious Disease Transmission, Vertical/*prevention & control; Female ; Hepatitis B/epidemiology ; Hepatitis B/transmission ; Hepatitis B Surface Antigens/blood ; Hepatitis B virus/isolation & purification ; Humans ; Infant, Newborn ; Male ; Perinatal Care ; Pregnancy ; Risk Factors ; Viral Load
    • 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.
    • Comments:
      Comment in: Ann Intern Med. 2014 Nov 18;161(10):762-3. (PMID: 25402524)
      Comment in: Ann Intern Med. 2014 Nov 18;161(10):763. (PMID: 25402525)
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    • Grant Information:
      R44 CA094612 United States CA NCI NIH HHS; KL2TR000143 United States TR NCATS NIH HHS; K07CA166143-01A1 United States CA NCI NIH HHS; R43 CA094612 United States CA NCI NIH HHS; K07 CA166143 United States CA NCI NIH HHS; KL2 TR000143 United States TR NCATS NIH HHS
    • Accession Number:
      0 (Hepatitis B Surface Antigens)
      0 (Hepatitis B Vaccines)
    • Publication Date:
      Date Created: 20140528 Date Completed: 20140729 Latest Revision: 20220318
    • Publication Date:
      20231215
    • Accession Number:
      PMC4086733
    • Accession Number:
      10.7326/M13-2529
    • Accession Number:
      24862434