Prevention of perinatal hepatitis B virus infection : implications for mother and child : policy for the Netherlands

hepatitis B surface antigen (HBsAg) to their newborn infants is an important cause for the development of hepatitis B infections and for the maintenance of the hepatitis B virus reservoir in the world (l-3). Immunization of infants born to HBsAg-positive women has been shown to almost completely prevent perinatal infection (4-6). In 1982, a study was initiated in three test areas in the Netherlands to detennine whether screening to identify HBsAg carriers among pregnant women could be successfully introduced in prenatal care and whether the newborns of these HBsAg carriers could be protected from perinatal infection of combined passive and active immunization. Hepatitis B vaccination, given concomitantly with the diphtheria-tetanus-pertussis-poliomyelitis (DTPpolio) vaccination, was compared to hepatitis B vaccination initiated immediately after birth as far as compliance, immunogenicity and protective efficacy are concerned. Initial results of the study, completed in December 1992, were described by Maze! (7 -8). On the basis of the preliminary results, a national program for the prevention of perinatal hepatitis B infection was launched earlier, in October 1989

Immunoprophylaxis to limit a hepatitis B epidemic among women undergoing in vitro fertilization

Abstract Women (175) who participated in an in vitro fertilization (IVF) programme were possibly exposed to hepatitis B virus. Later it became evident that 79 women had a hepatitis B infection, 49 were exposed but not infected and 47 were not exposed. Hepatitis B immunoglobulin (HBIg) and recombina

Anti-HBs levels in infants of hepatitis B carrier mothers after delayed active immunization with recombinant vaccine concomitant with DTP-polio vaccine: Is there need for a second dose of HBIg?

The need for an additional dose of hepatitis B immune globulin (HBIg) was studied by comparing infants receiving 1 ml HBIg at birth followed by hepatitis B immunization, concomitant with DTP-polio vaccine, at 3, 4, 5 and 11 months (schedule E), with infants receiving the same schedule with additional HBIg at 3 months (schedule F). The immune response to recombinant hepatitis B vaccine (20 μg) was evaluated in 195 infants born to HBsAg-positive mothers allocated to groups E and F and compared with historic controls who received plasma vaccine (10 μg) according to schedule F. Blood samples were drawn at 0, 3, 4, 6, 11, 12 and 24 months of age. No difference in efficacy between the two schedules was observed; 8 and 6% of infants born to HBeAg-positive HBsAg carrier mothers in groups E and F, respectively, became HBsAg carriers. Passively acquired antibodies at birth remained present for about 5 months in most infants. The seroprotection rates (anti-HBs ⩾ 10 IU l−1) were over 90% at all time points and similar for groups E and F. The titres of anti-HBs attained during the first 6 months were statistically lower (p ⩽ 0.02) for group E than for group F but similar thereafter. Anti-HBs titres in infants receiving the recombinant vaccine were significantly lower than in infants receiving the plasma vaccine (p ⪡ 0.001). Supplemental doses of HBIg in infants receiving a high dose of HBIg (> 200 IU) at birth and the first dose o

Prevalence and risk factors for hepatitis B virus infections among visitors to an STD clinic.

OBJECTIVE: To determine the prevalence and risk factors for hepatitis B virus (HBV) infections among individuals attending an STD clinic in a low endemic region. STUDY DESIGN: A total of 1228 women and 1648 men attending the STD clinic at the University Hospital Rotterdam, Netherlands, were examined for HBV infection by determination of hepatitis B surface antigen (HBsAg) and antibodies to hepatitis B core antigen (anti-HBc). Demographic characteristics, information on sexual behaviour, and intravenous drug use were recorded. RESULTS: The seroprevalence of HBsAg was 1.4% in women and 2.1% in men (0% in homosexual men). The seroprevalence of anti-HBc was 13% in women and 20% in men (36% in homosexual men). Native country, intravenous drug use, a history of STD, and the number of partners in the past half year (inversely) were independent risk factors for HBsAg positivity in women and heterosexual men. For anti-HBc independent associations were observed for native country, age, intravenous drug use, commercial sex, number of lifetime partners, homosexual contacts, orogenital contact (inverse), and a history of STD. CONCLUSION: The HBV prevalence in the STD clinic attendants was high, exceeding the national estimate, and indicates that the STD clinic population may be considered a high risk group. Our data confirmed an increased risk for HBV infections among established risk groups. Therefore, these risk groups should be routinely screened to identify HBV cases for counselling and contact tracing