[Hepatitis B vaccination of neonates born in 1989 and 1990.]

Abstract niet beschikbaarTo combat vertical transmission of hepatitis B virus infection in a low prevalence area, passive and active immunization against hepatitis B was incorporated into the national Dutch immunization program in October 1989. Neonates of mothers found HBsAG-positive by screening receive hepatitis B immunoglobulin at birth and active immunization with hepatitis B vaccine at 3,4, 5 and 11 months of age. Vaccination data were requested for quarterly birth cohorts. The cohorts described are those born between October 1989 and December 1990. Data on 490 neonates at risk for hepatitis B have been analysed to examine the administration of passive active immunization during the first year of life. The average coverage was 83% for immunoglobulin, 90% for the lst HB vaccination, 86% for the 2nd, 80% for the 3rd and 55% for 4th HB vaccination. In 19% of neonates (n=93) there was a delay in immunoglobulin administration beyond 48 hours or it was not known whether it was administered or not. There was considerable variation in vaccine administration. Although compliance with the vaccination generally appeared satisfactory for this program in the first 15 months, 20-40% of infants were not properly immunized. Frequently doses were received later than planned. From these data it appeared feasible to establish hepatitis B immunization services at Health Bureaus dealing with DTP-polio. Continuous attention is needed for public education to improve adherence to the immunization schedule.GH

Hepatitis B screening in pregnancy. Results over 1989 en 1990

In October 1989 routine screening for Hepatitis B surface antigen HBsAg) in all pregnant women was introduced in the Netherlands. In order to prevent hepatitis b infection in their offspring all infants of HBsAg-positive mothers receive passive active immunization. During the first 15 months of the programme about 70% of the estimated total number of pregnant women was screened for HBsAg in the regional laboratories appointed by the National Institute of Public Health and Environmental Protection. It is currently unknown whether the remaining 30% of the pregnant women were screened and if so, where. The overall prevalence of HBsAg-positivity was 0.45% in 1990, with a range of virtually 0% in rural areas to 0,9% in the city of Amsterdam. The overall percentage of HBsAg-positive women appeared to be much lower than the originally expected percentage of 0.8%. The question therefore is whether the women not reacted by the programme belong to the high risk groups for hepatitis B. Although a number of regional laboratories dit not provide details concerning their analytical performance, in general the laboratory methods used seemed to be adequate.RIV

[Hepatitis B screening in pregnancy ; results over 1992.]

In October 1989 routine screening for hepatitis B surface antigen (HBsAg) in all pregnant women was introduced in the Netherlands. In order to prevent hepatitis B infection in their offspring all infants of HBsAG-positive mothers receive passive and active immunization. During 1992 about 82% of the estimated total number of pregnant women was screened for HBsAG in the regional laboratories appointed by the National Institute of Public Health and Environmental Protection. Based on data of 1990 it is estimated that about another 10% of the pregnant women were screened elsewhere. The overall prevalence of HBsAG-positivity was 0.41% in 1992, with a range of 0.2% in rural areas to 0.8% in the city of Amsterdam. The overall percentage of HBsAG-positive women is similar to the prevalence found in 1990 and 1991. At present it is unknowh whether the women not reached by the programme belong to the high risk groups for hepatitis B. Passive and active immunization of infants was not guaranteed in these cases. The quality of a screeningprogramme must be monitored continuously. It is therefore imperative that all relevant data are made available. This pertains not only to organizational aspects, but also to administrative and analytical performance of the laboratories. In spite of written agreements a number of regional laboratories did not provide details concerning their analytical performance. In general, the analytical quality is adequate to good and has improved since the start of the programme. Nevertheless, some laboratories should be aware of certain improvement that easily can be achieved.GH

[Process evaluation of prenatal screening for hepatis B, syphilis and rhesus-antagonism and the prevention of ensuing neonatal disease in the Netherlands.]

Abstract niet beschikbaarA process evaluation of the national programme of screening and prevention of perinatal hepatitis B infection, congenital syphilis and bloodgroup/rhesus-antagonism was performed with special reference to organizational pitfalls. Structured questionnaires were used to collect information from all parties and professional groups involved in the execution of the programme (obstetricians, midwives laboratories, provincial immunization administrations, well baby clinics). The coverage of the hepatitis B programme is not complete. Timely passive/active immunization is not warranted in case of screening in other than the assigned regional public health laboratories. Recommendations are given to adjust the current procedures to obtain immunoglobulin and vaccine.Ziekenfondsraa

Hepatitis B virus infections in the Netherlands: an inventory

Abstract niet beschikbaarTo determine the incidence of hepatitis B and possible trends since the introduction of the hepatitis B vaccine in the Netherlands, serologic and epidemiologic data pertaining to risk factors of disease acquisition were obtained. Recent studies from the United States showed that the current strategy for prevention of hepatitis B, which targets high-risk groups immunization, has failed to have a significant impact on the incidence of disease. This finding made reconsideration of the similar strategy for prevention of hepatitis B in the Netherlands necessary. Since the major means by which the status of infectious diseases are monitored in the Netherlands are limited the need for a more active surveillance system in order to accurately reflect the success of prevention, is stressed.DGVGZ/A

Prevention of Congenital Syphilis ; economic evaluation of data supplied by the regional Public Health laboratoria

Doel: Vaststellen van de programmakosten, monetaire baten en gewonnen levensjaren, verbonden aan het screeningsprogramma van zwangeren op syfilis, gebruik makend van gegevens over serologische testresultaten in de Streeklaboratoria. Data & Methode: We gebruiken twee typen gegevens: (i) Aantallen en resultaten van serologische testen op syfilis (TPHA, VDRL, RPR, FTA) bij zwangeren in de 2e helft van 1991 en in 1992 in de Nederlandse Streeklaboratoria ; (ii) Relevante informatie over de kosten van testen, gezondheidszorg en onderwijs en de levensverwachting. Het economische evaluatie-model dat wij hanteren is een uitgebreide versie van het Noorse epidemiologische model dat specifiek is ontwikkeld voor syfilis tijdens de zwangerschap en preventie van congenitale syfilis. Het evaluatie-model koppelt het epidemiologische model met economische informatie. Naast de directe kosten van het screeningsprogramma zoals testen, behandeling en na-controle worden in het model monetaire baten bepaald van voorkomen gezondheidszorg voor geinfecteerde en te vroeg geboren kinderen en van voorkomen zorg en speciaal onderwijs voor lichamelijk en geestelijk gehandicapten. Tot slot worden in het model de door het screeningsprogramma gewonnen levensjaren berekend wegens het voorkomen van perinatale sterfte en verkorte levensverwachting van gehandicapten (berekening van gewonnen levensjaren op basis van resterende levensverwachting). De gegevensverzameling is bruikbaar voor de analyse van de effectiviteit van het screeningsprogramma en continuering ervan is daarom van belang. (ii) Op basis van de hier gebruikte gegevens en het Noorse epidemiologische model is de screening ter preventie van congenitale syfilis een kosten-effectief programma en is het aan te bevelen de screening voort te zetten. (iii) Voor een definitieve berekening van de kosten en baten van het screeningsprogramma is het nodig het gebruikte evaluatie-model verder te ontwikkelen en te valideren.The objective of this investigation was assessment of the program costs, monetary benefits and life years gained, connected to the screeningsprogram for syphilis during pregnancy, using laboratory data on serological test results. Two types of data were used: (i) Numbers and results of serological syphilis tests (TPHA, VDRL, RPR, FTA) for pregnant women in the second half of 1991 and in 1992, supplied by the regional Public Health laboratoria ; (ii) Relevant information on the costs of tests, health care utilisation and education and the life expectancy. The applied economic evaluation-model is an extension of the Norwegian epidemiological model that has specifically been developed for syphilis during pregancy and prevention of congenital syphilis. The evaluation-model links the epidemiological model with economic information. Next to the direct costs of the screeningsprogram such as testing, treatment and follow-up the model assesses the monetary benefits of preventing health care for infected and prematurely born children and of preventing care and special education of mentally retarded and physically disabled persons. Further, the model incorporates the years of life gained by the screeningsprogram due to preventing perinatal mortality and shortened life expectancy of handicaped persons (life years gained are calculated using the remaining life expectancy at time of death). The data-gathering is useful for analysing the effectivity of the screeningsprogram, analogous data-gathering in the future is therefore important. (ii) On the basis of our data and the Norwegian epidemiological model, the screening for preventing congenital syphilis is estimated to be a cost-effective program and should therefore be continued. (iii) For a final calculation of the cost-effectiveness of the screeningsprogram it is necessary to further develop the evaluation-model and to validate it.HI

The risk of perinatal hepatitis B virus transmission: hepatitis B e antigen (HBeAg) prevalence estimates for all world regions

<p><b>Abstract</b></p> <p>Background</p> <p>HBeAg presence in childbearing-age women is a major determinant of perinatal hepatitis B virus (HBV) transmission. The risk of developing chronic HBV infection and liver disease is highest at young age. Our aim was to assess perinatal HBV transmission risk by means of estimating age- and region-specific HBeAg prevalence.</p> <p>Methods</p> <p>Based on observed HBeAg seroprevalence data obtained from a systematic literature review, we modeled HBeAg prevalence using an empirical Bayesian hierarchical model. Age- and region-specific estimates were generated for 1990 and 2005.</p> <p>Results</p> <p>Globally, highest HBeAg prevalence of over 50 % was found in 0–9 years old girls. At reproductive age, HBeAg prevalence was 20-50 %. Prevalence was highest in young females in East Asia in 1990 (78 %), the infection was less common in Sub-Saharan and North Africa. Regional differences in prevalence were smaller in 2005. There was an overall decrease in HBeAg between 1990 and 2005, which was strongest among girls in Oceania (23.3 % decline), South and South-East Asia (14 % decline). However, in these regions, prevalence remained high at 67 % among young females in 2005. Smaller decreases were observed in women at reproductive age, at which 24-32 % of all HBsAg-positive women were HBeAg-positive in 2005, with lowest prevalence in Southern Sub-Saharan Africa and highest prevalence in Oceania and South-East Asia.</p> <p>Conclusions</p> <p>HBeAg estimates are crucial for understanding the epidemiology of HBV and for prioritizing implementation of WHO`s prevention recommendations for all infants to receive the first dose of hepatitis B vaccine within 24 hours of birth. Results will have importance as access to treatment for chronic HBV infection is expanded.</p