Beleid bij zuigelingen van moeders die drager zijn van HBsAg

: Evaluatie van een aanbeveling

Samenvatting

Introduction
Perinatal hepatitis B virus (HBV) transmission is a worldwide health problem that can be responsible for chronic liver inflammation with an increased risk of cirrhosis and hepatocellular carcinoma (HCC). The likelihood of chronic HBV infection depends on the age of primary infection. 80–90% of infants infected during the first year of life develop chronic infection. HBV vaccine is 95% effective in preventing infection and its chronic consequences. The World Health Organization (WHO) pleads for a universal vaccination against HBV as soon as
possible after birth, preferably within 24 hours. (1) Belgium, similar to most West-European countries, uses a strategy of selective vaccination of children born to Hepatitis B surface Antigen (HBsAg) seropositive mothers (2).
The Belgian Higher Health Council (HGR) recommends a first dose of the vaccine together with 300 IU hepatitis B immunoglobulins (HBIG) to newborns of HBsAg seropositive mothers within 12 hours after birth. Then, as for non-exposed infants, the routine vaccination schedule will be offered at 8, 12, 16 weeks and 15 months. Serological control is recommended one month after the last vaccination to document vaccine-induced immune response or breakthrough infection. (3) So far, this recommendation was evaluated once in a hospital
in Antwerp (4).
Aim
The goal of this study was to determine the compliance with the 2004 recommendation (HGR) in another hospital in Antwerp and the influencing factors of compliance with the recommendation.
Methodology
A retrospective cohort study was performed using data from women who gave birth in 2010 in the studied hospital. We evaluate the screening policy for HBV and other infectious diseases. Univariate and multivariate logistic regression analyses were used to examine the influencing factors of non-availability of a HBsAg screening result. In the second part of our study, we evaluated the immunization policy at birth and the further vaccination program in case of a HBsAg seropositive screening result. The HBsAg seropositive women who
agreed to participate were visited at home to fill in a questionnaire.
Results
• Out of 2,852 mothers records, 795 (27.9%) showed a HBsAg screening result in the hospital records1. Three factors significantly influence the probability of having a HBsAg screening result available in the hospital records: gynecological follow-up (Odds Ratio (OR) 4.288 and 95% confidence interval (C.I.) 3.261 – 5.640), proxy for foreign origin (OR 1.884 en 95% C.I. 1.571 – 2.259) and a not spontaneous pregnancy (OR 3.049 en 95% C.I. 2.299 – 4.043)).
• We identified 9 HBsAg seropositive mothers of whom one mother gave birth to a twin. 5 were identified through the hospital laboratory, 3 through contact with laboratories different from the hospital laboratory and 1 woman was in follow-up for chronic HBV. In 7 of the 10 baby patient files there was a clear documentation that the mother was HBsAg seropositive and that the child had received HBV vaccination and HBIG at birth. In 3/10 baby patient files, the twin and another baby, there was no documentation that the mother was HBsAg
seropositive or that the children received HBV vaccination or HBIG. We were able to contact 5 of the 9 identified HBsAg seropositive mothers. 1 mother was not aware of her HBsAg seropositive status. With the given data we calculate that out of 78%-89% mothers, the children received proper active and passive immunization immediately after birth.
• All children of questioned mothers received the routine vaccination schedule.
• None of the children received serological control.
1 We contacted 3 external laboratories that gave us additional results of positive screening for HBsAg. These data didn’t contribute to the part of research regarding screening.
Conclusion
HBsAg screening was not performed or not documented in the hospital records for a substantial part of the studied population, which means there is room for improvement in the compliance with the first step of the recommendation. Problems of non-systematic screening and of transmural data transferring were identified. The correct policy at birth, HBV vaccination and HBIG administration was performed in 78%-89% of HBsAg seropositive mothers. Taking into consideration the best estimation of the screening prevalence (5) it means
that only 60-68% HBsAg positive mothers are both identified by screening and the correct policy at birth is followed. It raises the question whether we shouldn’t implement a universal birth dose of the HBV vaccine as
recommended by the WHO (1).

Datum prijs	2014
Originele taal	English
Prijsuitreikende instantie	University of Antwerp
Begeleider	Pierre Van Damme (Promotor) & Heidi Theeten (Promotor)