Failure of Centers for Disease Control criteria to identify hepatitis B infection in a large municipal obstetrical population

Prevalence of hepatitis B, C, and D virus infection in Haiti: A systematic review and meta-analysis

Background

Viral hepatitis causes an important global health burden. In 2016, the World Health Assembly adopted an objective to globally eliminate this as a public health threat by 2030. However, significant gaps exist between countries in their progress. Haiti is the last country that has introduced infant hepatitis B vaccines into the routine immunization program in the Region of the Americas, and its schedule still does not incorporate birth dose vaccines. As the first step to raise awareness of viral hepatitis in this country, we conducted a systematic review and meta-analysis to estimate the prevalence of hepatitis B (HBV), C (HCV), and D (HDV) viruses in Haiti.

Methods

We searched PubMed, EMBASE, Web of Science and Scopus for studies reporting the prevalence of HBV, HCV and HDV among Haitian, with no language restriction, published until November 30th, 2021. Prevalence was pooled via a random-effects meta-analysis using a generalized linear mixed model with the logit link.

Results

Of 453 articles retrieved, 25 studies were included: 16 reported the prevalence of hepatitis B surface antigen (HBsAg), three for anti-HCV antibody, and six for both HBsAg and anti-HCV. No study was found for HDV prevalence. The pooled prevalence of HBsAg was 0.7% [95% confidence interval (CI): 0.3-1.4, I ² = 77.7%] among children, 3.5% (95% CI: 2.8-4.4, I ² = 93.2%) in the general adult population and 7.4% (95% CI: 4.0-13.3, I ² = 83.9%) in high-risk adult population. The pooled prevalence of anti-HCV antibody was 0.9% (95% CI: 0.6-1.4, I ² = 93.5%) among the general population and 1.4% (95% CI: 0.4-4.2, I ² = 0.0%) in high-risk adult population. No study reported the prevalence of anti-HCV antibody exclusively in children.

Interpretation

The prevalence of blood-borne hepatitis, particularly that of HBV, is substantial in Haiti. The introduction of birth dose hepatitis B vaccines and improving access to testing and treatment services should be urgently considered to meet the elimination goal.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022298081, identifier: PROSPERO (CRD42022298081).

Prevalence, sociodemographic features and risk factors of Hepatitis B virus infection among pregnant women in Southwestern Nigeria

INTRODUCTION

Hepatitis B virus is responsible for 50%-80% of Hepatocellular carcinoma cases worldwide. In Nigeria, vertical transmission remains a major route of Hepatitis B virus infection. Primary (vaccines and post-exposure prophylaxis) and secondary prevention of HBV transmission by appropriate sexual and sanitary practices are not yet optimal in the country yet measures for early detection (serological, molecular) and treatment of infected pregnant women is not a practice. This study aimed at identifying the prevalence and risk factors for Hepatitis B virus infection among pregnant women in Ibadan, Southwestern Nigeria.

METHODS

A cross-sectional study was done at the Ante-natal clinic of the University College Hospital Ibadan. One hundred and eighty pregnant women were recruited from March to August 2013, and tested for Hepatitis B surface antigen (BIORAD FRANCE) using third generation ELISA, as well as HIV-1 and 2 using Uni-Gold Recombigen and ALERE determine (a rapid immunoassay designed to detect antibodies to HIV 1 and/or 2). Positive HBsAg samples were tested for Hepatitis B envelope antigen, antibody and Hepatitis B core antibody (DIAPRO Italy) while serum HBV DNA was detected using PCR. Data were obtained using questionnaires to establish and analysis was performed using SPSS version 20.

RESULTS

The seroprevalence of HBsAg was 8.3% out of which 26.7% were positive for HBeAg, 53.3% had HBeAb, 20% had neither HBeAg nor HBeAb, 100% had total HBcAb and 86.7% had HBV DNA in their serum. The mean age was 32.1 years, the highest HBV infection rate occurred in 25-29 year age group. Multiple sexual partners (OR- 3.987, P- value=0.026) and early age at sexual debut (OR 11.996, P- value=0.022) were independent risk factors for HBV infection.

CONCLUSION

Hepatitis B virus infection is of high endemicity in Nigeria thus early detection, treatment of infected pregnant women, immunoprophylaxis for exposed newborns and surveillance for those with chronic infection is essential. Health education programs on prevention and control measures must be instituted.

Prevention of neonatal hepatitis B virus transmission

Hepatitis B virus (HBV) vertical transmission remains a worldwide issue but is fairly uncommon in the western world due to routine screening and vaccination. Universal screening of pregnant women during the second trimester facilitates interruption of mother-to-child transmission (MTCT) by identifying HBV-infected mothers for whom intervention may reduce MTCT risk. HBV DNA level is the single most important predictor of MTCT. Other risk factors include HBeAg, HBe Ab, anti-HB core IgG, and HIV status. Current recommendations for infants born to HBsAg-positive mothers include administration of HBIG within 12 hours of birth and first dose of HBV vaccine within 24 hours of birth. Antiviral therapy is recommended in the third trimester of pregnancy in a subset of patients based on HBeAg and HBV DNA status for prophylaxis of MTCT, although discontinuation of antivirals after delivery is associated with significant increased risk of flares. This article outlines the data for prevention of vertical transmission of HBV.

The case for universal prenatal genetic counseling

Recent scientific advances in human genetics and prenatal diagnostic technologies challenge the counseling infrastructure of most obstetric services. In just the past several years, the American College of Obstetricians and Gynecologists has published guidelines on fragile X, spinal muscular atrophy, and cystic fibrosis screening, and new technologies including microarray analysis, cell-free fetal DNA, and carrier gene panels have become available. Obstetrics is at a crossroads, which requires consideration of new ways of providing genetic counseling. Currently a two-tiered process is used. Specific tests such as first- or second-trimester screening for aneuploidy are offered to virtually all women by a clinician who provides counseling and who may offer additional tests to patients in particular ethnic groups and those with unique obstetric or family histories. Frequently only this latter group and those who "screen positive" on the universally offered tests are sent to a genetic counselor. This approach worked well when screening focused on a relatively small number of diagnoses, but that is no longer the case. We argue that obstetricians, who were able to maintain mastery over the content of counseling when aneuploidies and karyotype analysis were the essential diagnoses and diagnostic tools available, are rarely able to offer the same level of expertise regarding the chromosomal, genomic, and genetic diseases now diagnosable and the newest available diagnostic methodologies. Therefore, all women, not just those surpassing some poorly defined level of risk, deserve genetic counseling. Approaches for achieving this goal are discussed.

Characteristics of hepatitis B infection in a sample of omani patients

OBJECTIVES

This study aimed to describe the demographic and virological characteristics of chronic hepatitis B virus (HBV) infection in a sample of Omani patients, and indirectly assess the efficacy of hepatitis B vaccination programmes and catch-up strategies.

METHODS

A retrospective study was undertaken of all patients with chronic HBV infections evaluated and followed-up at the Hepatology Clinic of the Armed Forces Hospital (AFH), Muscat, Oman, between January 2009 and April 2011.

RESULTS

A total of 154 patients met the inclusion criteria. The mean age of infected patients was 33 years with 72.7% being over 27 years. Females constituted 47.7% of the patients. Half of the cohort was referred either from the AFH's Obstetric Clinic (29.2%) or its Blood Bank (22.1%). A family history of chronic HBV infection was present in 70% of patients. A total of 95% had positive hepatitis B surface antigens, while only 5% had isolated total hepatitis B core antibodies. Most patients (96%) were hepatitis B e-antigen-negative. The majority (77.9%) had low HBV dioribonucleic acid levels of <2,000 IU/ml. Radiological features of liver cirrhosis were observed in 5%. Patients requiring treatment were in the minority (9%).

CONCLUSION

Almost 50% of the infected patients were female, the majority being of childbearing age. Medical authorities in Oman should consider enforcing a screening policy for all pregnant women using complete hepatitis B serological testing.

HBV perinatal transmission

Hepatitis B is a serious public health problem all around the world. It is a blood-borne and sexually transmitted DNA virus in adults, but mother to child transmission of hepatitis B virus also occurs in infants born to hepatitis B surface antigen positive mothers.

Pregnancy and chronic hepatitis B virus infection

The combination of chronic hepatitis B virus (HBV) infection and pregnancy presents unique management questions. Aspects of care that need to be considered include effects of hepatitis B on pregnancy, effects of pregnancy itself on the course of hepatitis B infection, treatment of hepatitis B during pregnancy and prevention of mother-to-infant transmission. Chronic HBV infection is usually mild in pregnant women, but may flare shortly after delivery. Effect of HBV infection on pregnancy outcomes are generally favorable, but may depend on severity of liver disease. Mother-to-infant transmission can be minimized by current immunoprophylaxis strategies, however, high levels of viremia in mothers may be a factor in the small but reproducible failure rate of current immunoprophylaxis strategies. Use of antivirals during pregnancy needs to be individualized. Careful planning and management of pregnancy must be done among patients with chronic HBV infection.

Hepatitis B and pregnancy: an underestimated issue

Hepatitis B infection during pregnancy presents a unique set of management issues. Aspects of care that must be considered include maternal and fetal effects of hepatitis B, effects of pregnancy itself on the course of hepatitis B infection and its complications, treatment of hepatitis B during pregnancy and prevention of perinatal infection. There are insufficient studies to date regarding these concerns; most are from the Far East, and many have important limitations, but some have yielded valuable data. Pregnant women with acute hepatitis B virus (HBV) infection typically have a course not very different from that in the general adult population, but the risk of transmission of HBV to neonates increases the later in gestation the acute infection occurs. Chronic HBV infection is usually mild in pregnant women, but may flare shortly after delivery. The risk of perinatal transmission is highest in women with high levels of viraemia; this may be a factor in the small but reproducible failure rate of current immunoprophylaxis strategies. Obstetrical policies must be assessed with respect to detection of maternal infection and liver disease, as well as with respect to perinatal transmission risk. In addition to the usual issues of drug efficacy and safety in the affected individuals, effects on the developing fetus must be considered. This paper reviews the current experience in each of these areas, and highlights the need for further investigation into this critical but often underestimated topic.

Hepatitis B virus sero-prevalence among pregnant females in Saudi Arabia

BACKGROUND/AIM

Since selective screening for Hepatitis B virus (HBV) in pregnant women has failed to identify a high proportion of HBV-infected mothers, pre-natal HBsAg testing of all pregnant women is now recommended. We aimed to determine the prevalence of HBV infection among pregnant women at the ante-natal clinic of a tertiary care center in Saudi Arabia and to identify the target group for postpartum immunization.

MATERIALS AND METHODS

A total of 755 pregnant females who attended the antenatal clinic from June 2005 to June 2006 for the first time - before 38 weeks of gestation - constituted the target of the present study. Blood samples 30-39 were drawn from all subjects and sera were tested for HBV serologic markers including Hepatitis B surface antigen, anti-HBs, and anti-HBc using ELISA technique (third generation).

RESULTS

The overall prevalence of sero-positive HBsAg among pregnant women was 1.6%. As age increased, the prevalence of sero-positive HBsAg significantly increased (chi(2) = 116.43, P < 0.001), 30-39 were women aged >or=40 were five times more likely to be positive for HBsAg as compared to those <30 years (OR = 4.78). On the other hand, women aged 40 and over were five times more likely to be susceptible to infection with hepatitis as compared to young women aged <20 (OR = 5.15). Women susceptible to HBV infection constituted about 80% of all pregnant females.

CONCLUSION

These findings reflect that the full impact of the Hepatitis B vaccination program that was conducted in 1989 for all Saudi children has not yet reached all pregnant women, with the majority (79.9%) being nonimmune and thus liable to HBV infection. Postpartum HB immunization should be recommended in such cases.

Adherence to the screening program for HBV infection in pregnant women delivering in Greece

Background

Hepatitis B infection (HBV) is a major Public Health Problem.

Perinatal transmission can be prevented with the identification of HBsAg(+) women and administration of immunoprophylaxis to their newborns. A national prevention programme for HBV with universal screening of pregnant women and vaccination of infants is in effect since 1998 in Greece.

Methods

To evaluate adherence to the national guidelines, all women delivering in Greece between 17–30/03/03 were included in the study. Trained health professionals completed a questionnaire on demographic data, prenatal or perinatal screening for HBsAg and the implementation of appropriate immunoprophylaxis.

Results

During the study period 3,760 women delivered. Prenatal screening for HBsAg was documented in 91.3%. Greek women were more likely to have had prenatal testing. HBsAg prevalence was 2.89% (95%CI 2.3–3.4%). Higher prevalence of HBV-infection was noted in immigrant women, especially those born in Albania (9.8%). Other risk factors associated with maternal HBsAg (+) included young maternal age and absence of prenatal testing. No prenatal or perinatal HBsAg testing was performed in 3.2% women. Delivering in public hospital and illiteracy were identifiable risk factors for never being tested. All newborns of identified HBsAg (+) mothers received appropriate immunoprophylaxis.

Conclusion

The prevalence of HBsAg in Greek pregnant women is low and comparable to other European countries. However, immigrant women composing almost 20% of our childbearing population, have significant higher prevalence rates. There are still women who never get tested. Universal vaccination against HBV at birth and reinforcement of perinatal testing of all women not prenatally tested should be discussed with Public Health Authorities.

Considerations for hepatitis B as part of a combination vaccine

BACKGROUND

In 1991 the Advisory Committee on Immunization Practices (ACIP) developed a comprehensive strategy to eliminate the transmission of hepatitis B virus in the United States, which includes immunization of all infants. Today, as the number of recommended childhood vaccinations increases, combination vaccines are needed to simplify the immunization schedule and improve coverage levels.

METHODS

A review of the literature was performed to determine the considerations that should be taken when hepatitis B virus vaccine (HepB) is included as part of a combination vaccine.

RESULTS

A combination vaccine that incorporates HepB and other routine infant vaccine antigens has been developed for administration at 2, 4 and 6 months of age. Clinical studies have demonstrated that administration of HepB, either as a monovalent or combination vaccine at 2, 4 and 6 months of age, induces a seroprotective immune response similar to that achieved with monovalent HepB administered at 0, 1 and 6 months of age. In addition the combination vaccine results in similar or fewer adverse reactions compared with separate administration of its components. Infants given a dose of monovalent HepB at birth will receive a total of four doses of HepB when the combination is used. The extra dose of HepB has not led to increased adverse reactions.

CONCLUSIONS

A HepB-containing combination vaccine administered at 2, 4 and 6 months of age is as safe and immunogenic as separate administration of its components and will help simplify the childhood immunization schedule.

Assessing prenatal hepatitis B screening in Illinois with an inexpensive study design adaptable to other jurisdictions

OBJECTIVES

This study estimated, using an economical survey design adaptable to other jurisdictions, the proportion of birth admissions in Illinois hospitals in which mothers were not screened for hepatitis B surface antigen prior to delivery. It also identified factors associated with lack of screening.

METHODS

Based on a cluster sampling design, 1372 birth records were sampled, and data were abstracted by local personnel at 56 hospitals. Selected data elements were reabstracted on a subsample to evaluate recording errors.

RESULTS

Reabstracted data demonstrated 95% agreement among reviewers. Hepatitis B surface antigen screening was documented for 90.7% of mothers; 11% of responding hospitals accounted for 45% of nonscreened mothers. Risk factors for not being screened included no prenatal care, Medicaid or no insurance, and delivery at a hospital lacking a written hepatitis B surface antigen policy.

CONCLUSIONS

In Illinois, prenatal hepatitis B surface antigen screening rates were high and similar to those in other states. Births without screening or transferred information clustered in a few hospitals. The methods used here can economically identify underscreened populations by sampling a large number of hospitals within designated areas.

Proposal for routine antenatal screening at 14 weeks for hepatitis B surface antigen. Dutch Study Group on Prevention of Neonatal Hepatitis

OBJECTIVE

To develop a low cost, high compliance screening programme for identification of carriers of hepatitis B surface antigen in the obstetric population of the Netherlands.

DESIGN

A seven year open, descriptive study of screening for hepatitis B surface antigen as part of routine prenatal laboratory testing at 14 weeks of gestation. Compliance with programme evaluated by checking delivery records (hospitals) or registration of births in the 30 participating municipalities (rural area).

SETTING

Three large city hospitals (two tertiary referral centres) and one rural area with a large number of home deliveries.

SUBJECTS

99,706 pregnant women applying for prenatal care for the first time.

MAIN OUTCOME MEASURES

Proportion of pregnant women routinely screened; prevalence of hepatitis B surface antigen in large cities and rural area.

RESULTS

Uptake of screening reached 97% in the hospitals after inclusion of 10% screened at delivery; the estimated uptake in the rural area was > 95%. Prevalence of hepatitis B surface antigen was 1.6% in the large cities and 0.3% in the rural area. For screening at delivery the prevalence was 2.5 times higher (4%, P < 0.01) than for screening at week 14 of gestation.

CONCLUSION

Incorporation of universal testing for hepatitis B surface antigen into routine prenatal laboratory testing is practical; high compliance is achieved when screening is supplemented with rapid screening at delivery for those who escaped routine prenatal care.

Prevalence of hepatitis B surface antigen among pregnant women in a low-risk population

OBJECTIVES

To estimate the prevalence of chronic hepatitis B carriers among our low-risk obstetric population and to determine the need for routine screening.

METHODS

A group of 1224 pregnant women, admitted to Gazi University Medical Center, were screened for HBsAg using an enzyme-immunoassay technique, and the obstetrical care records were reviewed.

RESULTS

Fifty-three patients were seropositive with a prevalence of 4.33% for HBV chronic carrier status in our obstetric population.

CONCLUSIONS

Routine HBsAg screening is advisable in our antenatal population.

Prevention of perinatal hepatitis B virus transmission in an obstetric/infant population

STUDY DESIGN

This retrospective study reviewed the screening practice and seroprevalence of hepatitis B surface antigen (HBsAg) among all mothers with live births at a teaching hospital in Montreal between November 1, 1990 and April 30, 1991.

RESULTS

Most women (94%) were screened prenatally and 5.2% postnatally. Screening status could not be determined for 0.8% of women. One-quarter of all postnatal screening results were available only at 48 h or more postdelivery. No infants born to women with postnatal screening or to women with unknown screening status were immunized expectantly. The maternal seroprevalence was 1.08% (95% confidence interval from 0.6, 1.4). All 22 infants born to HBsAg-positive mothers had received hepatitis B immune globulin within 12 h of birth and the first dose of hepatitis B vaccine within 24 h. Follow-up of infants revealed that only 50% had received the second and third doses according to the recommended protocol, with 83% completing the immunization series.

CONCLUSION

These results indicate that a program of prenatal HBsAg screening and neonatal prophylaxis against hepatitis B can be successfully instituted in a high volume obstetric hospital, and that better monitoring of infants is required to ensure completion of vaccination.

Hepatitis C virus in pregnancy: seroprevalence and risk factors for infection

OBJECTIVES

Our purpose was to define the prevalence of antibodies to hepatitis C virus among inner-city prenatal patients. We also sought to examine both the reliability of traditional hepatitis risk factors to predict evidence of infection among these women and the incidence of coinfection in this population with other blood-borne and sexually transmissible agents.

STUDY DESIGN

An anonymous serosurvey was performed to define and compare anti-hepatitis C virus prevalences among women registering for prenatal care at both an inner-city, university hospital-based clinic and an academic private practice based at the same institution.

RESULTS

Anti-hepatitis C virus antibodies were detected in 4.3% of 599 pregnant women screened. In comparison, 0.8% had positive antibody tests for human T-lymphotropic virus and 0.5% were positive for antibodies to human immunodeficiency virus. Evidence of chronic hepatitis B infection was seen in 0.8%. The relative risk of other coexisting infections was significantly higher among women with anti-hepatitis C virus antibodies than among those who were antibody negative. Substance abuse was the most commonly identified risk factor for anti-hepatitis C virus-positive status, although risk factor-targeted screening would have failed to detect half of the anti-hepatitis C virus-positive women in this study.

CONCLUSIONS

Hepatitis C virus infection among inner-city pregnant women, with its potential for maternal-fetal transmission, represents a public health issue of sufficient magnitude to warrant more extensive study. More information is needed, given this documented reservoir of maternal seropositivity, regarding the vertical transmissibility of the virus and the effects of coinfections on neonatal disease.

Evaluation of prophylaxis against hepatitis B in a large municipal hospital

BACKGROUND

Perinatal transmission of hepatitis B can be interrupted by the administration of hepatitis B vaccine and hepatitis B globulin to the infants of carrier mothers. Universal screening of pregnant women makes this strategy possible.

METHODS

To evaluate the implementation of universal hepatitis B surface antigen screening of women giving birth at Kings County Hospital Center during 1988, we reviewed laboratory records to find all women with a positive test result who might give birth. We also randomly reviewed records of women who gave birth to live infants to determine the percentage of screening in the population. Infants' charts were reviewed for documentation of maternal hepatitis B surface antigen status and administration of hepatitis B immune globulin and vaccine.

RESULTS

Sixty infants who lived long enough to receive antihepatitis B prophylaxis were distinguished out of a total of 5146 births. Screening was done for from 66.8% to 80.4% (95% confidence interval) of the mothers of these infants. Although 44 of 60 infants received hepatitis B immune globulin and 39 of 60 infants received vaccine, only 27 of 60 received vaccine within 12 hours in combination with immune globulin (Centers for Disease Control-recommended therapy).

CONCLUSIONS

Documentation of hepatitis B surface antigen in the infant's delivery room record was present in 23 of 60 infants. Those infants all received hepatitis B immune globulin and vaccine; 21 received hepatitis B immune globulin within 12 hours. Hepatitis B immune globulin was given within 12 hours to 8 of 37 infants who lacked documentation of hepatitis B surface antigen status on the delivery room record. These differences were highly significant (p less than 0.001) even when only the 40 patients who had documented prenatal screening at Kings County Hospital Center (21/23 vs 4/17). Prenatal care did not have any effect on outcome.

Targeted HIV screening at a Los Angeles prenatal/family planning health center

In 1988, the Los Angeles County Health Department conducted a blinded human immunodeficiency virus (HIV) seroprevalence study at a public prenatal (PN) and family planning (FP) center serving mostly Hispanic women in order to determine seroprevalence and to evaluate the center's targeted HIV screening program. Four women (0.13 percent) tested positive (3/1801 PN and 1/1167 FP). Three reported no risk factors; one reported a history of syphilis since 1978. Voluntary HIV testing was selectively offered to women who reported risk factors for HIV infection. Only 14 percent (96/685) of clients offered testing chose to do it: 28 percent (14/50) of clients classified as being at highest risk of infection, and 27 percent (16/59) of women who judged themselves to have some chance of being exposed to HIV. None of the four women who tested positive by blinded testing chose testing. While few women at this center were infected with HIV, higher risk women were not persuaded to be tested through a targeted screening program. Blinded HIV seroprevalence studies provide a tool for both tracking infection in a population and evaluating screening programs.

Routine prenatal screening for HIV infection

Guidelines in most developed countries for testing pregnant women for HIV infection recommend that screening should be directed to groups with acknowledged risk factors for infection. Our prospective study of HIV seroprevalence among 2724 pregnant women in an inner-city area of Baltimore, USA, showed that if these guidelines had been applied only 57% of HIV-seropositive women would have been detected. By offering counselling and HIV testing to all pregnant women, the detection rate was raised to 87%. We conclude that screening directed at women who admit risk factors is not effective in identifying HIV-infected women and that routine HIV screening should be offered to all pregnant women.

Reproductive epidemiologic research in developing countries

This paper discusses the scientific rationale for carrying out reproductive epidemiologic research in developing countries, and the generalizability of results of research done in developed countries to developing countries. Practical problems encountered in doing research in developing countries include limited resources, overcommitted researchers, cost, and study monitoring. Cultural differences that affect the design and conduct of research activities in developing countries are also discussed.

Cost effectiveness of antenatal hepatitis B screening and vaccination of infants

Over a 2-year study period 5,858 public antenatal patients were screened with the Welcome hepatitis B surface antigen HA screening kit; 52 (0.89%) were positive (carriers) and 45 (87%) of these were identifiable as high risk patients and would have been diagnosed by selective screening; the remaining 7 (13%) would have been missed. Using a subsample of 1,000 women, it was found that high risk factors were present in 237 (23.7%). Restriction of screening to the high risk group cost an estimated $97 per carrier identified; universal screening cost $354 to identify each carrier. Screening only the high risk group would have missed the 7 carriers in the low risk group, which was estimated to number 4,470 patients (76.3% of the total). Estimated cost of screening the low risk group was $14,036, or $2,005 per carrier identified. The advent of highly effective vaccines enables the almost complete prevention of vertical transmission of hepatitis B. In mid-1988, vaccine costs in terms of hepatitis B prevention per baby were estimated to be $2,432 for vaccination of babies born to mothers in the high risk group, irrespective of maternal serology; and $9,729 for universal vaccination. Carrier rates vary between populations. For our clinic patients, universal screening and vaccination of all babies of high risk group mothers are considered appropriate. Selective screening may be more appropriate in a low risk private practice.

Intrapartum hepatitis B screening in a low-risk population

Intrapartum hepatitis B surface antigen testing was performed on all laboring patients admitted to Forsyth Memorial Hospital in Winston-Salem, North Carolina from December, 1988 through November, 1989. Of the 5580 patients tested, eight patients had test results positive for hepatitis B surface antigen (overall prevalence rate of 0.14%). HBsAg was present in 0.3% of public patients and 0.08% of private patients. Of the seven patients who were not known to be positive for hepatitis B surface antigen before pregnancy, three had identifiable risk factors for hepatitis B virus. The time interval from birth to administration of hepatitis B immune globulin in the newborn averaged 13.3 hours. Patient cost per new case detected was $13,203. Intrapartum hepatitis B surface antigen screening with an assay performed once daily allows for timely administration of hepatitis B immune globulin to the newborn in accordance with recommendations of the American College of Obstetricians and Gynecologists, although some newborns receive hepatitis B immune globulin after the 12-hour birth-to-administration interval recommended by the Centers for Disease Control.

Controlling hepatitis B virus transmission in North America. The North American Regional Study Group

In the US in 1988, 54,011 cases of viral hepatitis were reported to the Centers for Disease Control (CDC), 42% of which were categorized as hepatitis B. Because of incomplete reporting and subclinical disease, the CDC estimates that approximately 300,000 acute cases of hepatitis B are occurring in the US each year for an annual estimated incidence of 125 cases per 100,000 population. Since 1985, a gradual decrease in the reported incidence of hepatitis B has been observed which may be attributed partly to the availability of new hepatitis B vaccines. Comprehensive control of hepatitis B infection in North America has, however, been impeded by the diversity and mobility of high-risk groups who often are unaware of their potential to infect other individuals. Surveillance studies have indicated that the modes of transmission of hepatitis B may be changing in the US. A larger proportion of cases are seen in parenteral drug abusers and in active heterosexuals. It is believed that hepatitis B vaccine has been administered to only 7% of the population who are at risk of acquiring hepatitis B virus (HBV). To achieve maximum control, universal immunization of infants will therefore be necessary. A first programme, already inaugurated in the US, involves screening of all pregnant women and providing appropriate prophylaxis to neonates of hepatitis B surface antigen-positive mothers and to susceptible household contacts of these individuals. Along with mandatory guidelines, collaboration between the hepatitis community, vaccine manufacturers, the CDC and appropriate medical, legislative and health care organizations should be fostered to achieve successful control of HBV in North America.

Prevalence of hepatitis B markers among pregnant Hispanic women in migrant/seasonal work in Oregon

We screened 303 Hispanic pregnant women who were migrant or seasonal agricultural workers in Oregon for the presence of Hepatitis B serological markers. One carrier was identified (0.3 per cent, 95% confidence interval [CI] .02%, 2.1%). Evidence of previous HB infection was present in 5.3 per cent (16/303) of the women (95% CI 3.2%, 8.6%), rates similar to those for the general US population.

Hepatitis B serology--help in interpretation

This review discusses the serologic markers of hepatitis B virus (HBV) infection. Interpretation of various serologic profiles is provided, and the importance of maternal screening for interruption of perinatal transmission of HBV infection is stressed.