Maternal knowledge of the risk of vertical transmission and offspring acquisition of hepatitis B

Eliminating mother-to-child transmission of hepatitis B virus: practice and progress in Baoan, a national pilot district of China

BACKGROUND

While mother-to-child transmission (MTCT) of hepatitis B virus (HBV) remains a significant challenge in China, research investigating the effectiveness of the September 2017 pilot program to eliminate MTCT of HIV, syphilis, and HBV is limited. Baoan district, which has a higher-than-average rate of hepatitis B infection among pregnant women and strong support from the government, was one of six national pilot districts selected for the program. Therefore, this study aims to assess the progress and implementation of the elimination of MTCT of HBV in Baoan district over a period of 5 years.

METHODS

Data was collected from the national information system for the prevention of MTCT, registration forms, and follow-up forms of pregnant women and their live births from 2018 to 2022. Joinpoint models were used to analyze changing trends over time, calculating annual percentage change (APC) and the corresponding 95% confidence interval (95%CI). Multivariate logistic regression models were used to analyze risk factors for HBV MTCT.

RESULTS

From 2018 to 2022, the coverage of HBV screening during pregnancy increased from 98.29 to 99.55% (APC = 0.30, P = 0.012). The coverage of HBV early screening within 13 gestational weeks increased from 40.76 to 86.42% (APC = 18.88, P = 0.033). The prevalence of maternal HBV infection declined by an APC of - 3.50 (95% CI -6.28 ~ - 0.63). The coverage of antiviral therapy among high-risk pregnant women increased from 63.59 to 90.04% (APC = 11.90, P = 0.031). Coverage for timely administration of hepatitis B immunoglobulin, hepatitis B birth dose vaccine, and three-dose hepatitis B vaccination remained consistently above 97.50%. The coverage of post-vaccination serological testing (PVST) in high-risk infants was 56.15% (1352/2408), and the MTCT rate of HBV was 0.18%. Mothers with high-school education or below (OR = 3.76, 95% CI 1.04 ~ 13.60, P = 0.04) and hepatitis B e antigen (HBeAg) positivity (OR = 18.89, 95% CI 1.98 ~ 18.50, P = 0.01) had increased MTCT risk.

CONCLUSIONS

The implementation of comprehensive prevention strategies in Baoan district, including screening, treatment, and immunoprophylaxis, has proven effective in maintaining the MTCT of HBV at an extremely low level. However, it remains crucial to raise public awareness, specifically on the importance of improving the coverage of PVST for infants exposed to HBV.

Maternal-to-Child Transmission of Hepatitis B Virus and Hepatitis Delta Virus

Maternal-to-child transmission of hepatitis B virus (HBV) and hepatitis delta virus (HDV) can lead to the risk of progressive liver disease in infants, but fortunately effective interventions exist to decrease transmission. Counseling on the risk of maternal-to-child transmission, care pathways to decrease transmission, and the implications of HBV and HDV on pregnancy outcomes are the key components of caring for pregnant people living with HBV and HDV.

A mixed-methods evaluation of hepatitis B knowledge, attitudes, and practices among migrant women in Thailand

BACKGROUND

Globally 90 % of transmission of Hepatitis B virus (HBV) is from mother-to child and occurs predominantly in resource limited countries where the prevalence of HBV is high. Transmission could be interrupted by timely vaccinations but coverage remains problematic in these areas. Low knowledge or awareness of HBV may play a part in low vaccination coverage. This study examines the provision of antenatal care counselling with a focus on HBV in two different regions of northern Thailand, Sarapee Hospital (SH), Chiang Mai, and Shoklo Malaria Research Unit (SMRU), Tak Province.

METHODS

A mixed-methods sequential explanatory study design was used to evaluate antenatal services for migrants. Cross-sectional knowledge, attitude and practice (KAP) surveys were conducted immediately after counselling at first ANC contact, at 3-6 months after first ANC contact and at delivery. Surveys provided quantitative data, and qualitative methods included observations, focus group discussions (FGD) and in-depth interviews (IDI); analysed thematically to explore concepts of knowledge and understanding, attitude and practice of pregnant women and providers.

RESULTS

Between September-2019 and May-2020, 757 women participated to KAP surveys, and 31 observations of counselling, 16 FGD and 9 IDI were conducted. KAP surveys showed in spite of low knowledge about HBV transmission, infection, or vaccination (correct response: SH 5.7 %, 9/157; SMRU 34.0 %, 204/600), most women (≥ 93 %, either site) understood they were screened for HBV and were willing to vaccinate infants for HBV. In explaining KAP survey results, qualitative analysis suggests counselling should: use the appropriate language; be tailored to the local health literacy level, provide only pertinent information, be repeated over the antenatal period; and attempt to ensure patient privacy (where possible). Programme effectiveness benefits from positive attitudes to screening and vaccinations and a high level of trust in the providers nevertheless participants provided good suggestions for improvements of the service.

CONCLUSIONS

Limited knowledge of HBV among migrant women can be improved by counselling that emphasizes actionable knowledge such as vaccination schedule. Key improvements to the counselling process include training counsellors to conduct interactive counselling sessions in the woman's language, using appropriate visual aids and timely repetition over the course of the antenatal period.

Adequate Knowledge and Low Vaccination Rates of Hepatitis B Virus Infection Among Students, Medical, and Paramedical Persons in a Tertiary Care Teaching Hospital

Introduction 

Hepatitis B virus (HBV) is probably the only vaccine-preventable virus transmitted from one person to the other by blood transfusion, sex, and contact with blood and blood products. HBV is highly transmissible, where the infection has been noted to transmit among the household contacts. HBV is also transmitted from the mother to the child through the transplacental barrier. Clinical infection with HBV may be chronic and could remain for a lifetime. Most exposures with HBV are automatically resolved, but a few infected people may become carriers and may transmit infections. Although HBV can be treated, complete elimination of the virus and the morbidity and mortality associated with chronic infection should be considered as a cause of serious concern. Because healthcare workers are predisposed to HBV infection, adequate knowledge about the virus and the vaccine to prevent the infection is necessary. This study is carried out to assess the knowledge of HBV infection and the status of vaccination among medical, paramedical students, laboratory technicians, and doctors.

Methods

The study included 256 participants attending a tertiary care teaching hospital in Telangana, South India. The participants belonged to three groups, the MBBS students (first, second-, and third-year students), the doctors (the postgraduates, medical teachers, and the clinicians), and the paramedical personnel. All the participants in the study were included after oral consent, and the study was approved by the Institutional Ethics Committee. A questionnaire containing 13 points was used for the study. Seven questions were asked to know the respondent’s knowledge of HBV infection, and the other six were used to know the participant's knowledge and status of HBV vaccination. The study participants filled in the responses with their current understanding of the HBV infection and the vaccine. All the responses were analyzed using Microsoft Office Excel and drawing means and percentages.

Results

Among the 94 medical students, 79 (84%) knew about HBV infection. There was a significant improvement in the knowledge of HBV infection among MBBS students, with first-year MBBS (68%) to the final-year MBBS (100%). The knowledge of HBV among the doctors (postgraduates, medical teachers, and clinicians) was 100%. Among the paramedical participants that included the laboratory technicians and the nursing students, all (100%) knew about HBV infection. Very few MBBS students (12%), 28% of paramedical persons, and 45% of doctors were tested for HBV infection. The knowledge of HBV vaccination was best among the doctors (100%) followed by the paramedical personnel (89%) and the MBBS students (72%). The teaching faculty including the postgraduate students (83%) were vaccinated followed by the paramedical persons (66%), and only 24% of MBBS students were vaccinated.

Conclusions

The study participants had a reasonably good knowledge of HBV infection, and low vaccination rates were observed among various participants. There is an urgent need to understand the significance of HBV infection, especially among healthcare workers. Being easily transmissible and because of the availability of an effective vaccine, healthcare workers should be adequately vaccinated to prevent the spread of infection.