Hepatitis B program helps cut infant infections
LONGER FOLLOW-UP NEEDED
Still, they were only able to follow about half of babies out to one year. And the number of infants who’d had all of their hepatitis B vaccines by that point actually decreased during the study period - from 86 percent to 78 percent - with at least some of that due to more families refusing vaccines.
“The program is certainly working - they’re vaccinating more infants successfully,” said Dr. Maya Gambarin-Gelwan, who has studied hepatitis B at Weill Cornell Medical College in New York but wasn’t involved in the new research.
“But half of the infants who are born to those mothers are slipping through the system essentially,” she told Reuters Health. “It’s also bothersome that there’s this growing percentage of infants who are not completing vaccination or that we don’t have a follow-up on.”
Do women who have been vaccinated previously against HBV infection still need to be screened during pregnancy?
Yes. Women who have received hepatitis B vaccine should still be screened for HBsAg early with each pregnancy. Just because a woman has been vaccinated does not mean she is HBsAg negative. Since postvaccination testing is not performed for most vaccinated persons, she could have been vaccinated even though she was already HBsAg positive.
Is it safe to give hepatitis B vaccine to a pregnant woman?
Yes. Limited data indicate no apparent risk for adverse events to developing fetuses. Current vaccines contain noninfectious HBsAg and should cause no risk to the fetus. If the mother is being vaccinated because she is at risk for HBV infection (e.g., a healthcare worker [HCW], a person with an STD, an IDU, multiple sex partners), vaccination should be initiated as soon as her risk factor is identified during the pregnancy. In contrast, HBV infection affecting a pregnant woman might result in severe disease for the mother and chronic infection for the newborn.
Smith agreed that not being able to follow infants over time is a problem.
“Women need to receive hepatitis B screening and positive results need to be reported to (the program), to make sure that the infants receive vaccination and care and testing,” she said.
Gambarin-Gelwan added that it’s important to get the message out that hepatitis B programs really do work when babies get all of their recommended vaccines, especially to communities with high virus rates, such as among Asian-Americans.
Is it safe for an HBsAg-positive mother to breastfeed her infant?
Yes! An HBsAg-positive mother who wishes to breastfeed should be encouraged to do so, including immediately following delivery. However, the infant should receive HBIG and hepatitis B vaccine within 12 hours of birth. Although HBsAg can be detected in breast milk, studies done before hepatitis B vaccine was available showed that breastfed infants born to HBsAg-positive mothers did not demonstrate an increased rate of perinatal or early childhood HBV infection. More recent studies have shown that, among infants receiving postexposure prophylaxis to prevent perinatal HBV infection, there is no increased risk of infection among breastfed infants.
What is the possibility of maternal HBV transmission when breastfeeding an infant if the mother is HBsAg positive and has cracked or bleeding nipples?
As stated before, although HBsAg can be detected in breast milk, there is no evidence that HBV is transmitted by breastfeeding. Babies born to HBsAg-positive mothers should be immunized with hepatitis B vaccine and HBIG, which will substantially reduce the risk of perinatal transmission and protect the infant from modes of postnatal HBV transmission, including the theoretical exposure to HBV from cracked or bleeding nipples during breastfeeding. To prevent cracked and bleeding nipples, all mothers that breastfeed should be instructed on proper nipple care.
Dr. Tram Tran from Cedars-Sinai Medical Center in Los Angeles told Reuters Health that while doctors are really good at screening women early in pregnancy when they’re already in the health care system, there’s still a big gap for other women, such immigrants and illicit drug users.
And even if those women do get screened, she said, they may not have the resources to bring their babies back for the multiple hepatitis B shots necessary for protection.
“It’s a completely preventable disease, that’s the thing that’s frustrating,” said Tran, a hepatitis researcher who wasn’t part of the study team.
“We have a vaccine that works really well. It’s just getting to these high-risk pockets and these high-risk groups where there’s still a lot of opportunity.”
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SOURCE: Pediatrics, online March 26, 2012.
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The National Perinatal Hepatitis B Prevention Program, 1994–2008
Emily A. Smith, MPH,
Lisa Jacques-Carroll, MSW,
Tanja Y. Walker, MPH,
Barry Sirotkin, MS, and
Trudy V. Murphy, MD