Success of a program of routine prenatal screening for hepatitis B surface antigen: the first 2 years.
Prenatal screening for hepatitis B surface antigen (HBsAg) restricted to women with defined risk factors for chronic hepatitis B virus (HBV) infection fails to identify many carriers. A centralized program of routine HBsAg screening for all pregnant women in Alberta was introduced in 1985. We collected and analysed data for the first 2 years of the program in Edmonton to determine the frequency of risk factors for HBsAg positivity, the proportion of multiparous HBsAg-positive women not identified in previous pregnancies, the efficiency and cost-effectiveness of providing immunoprophylaxis to infants at risk of HBV infection and the degree of success in inducing adequate protection. A total of 149 women (158 pregnancies) were found to be HBsAg positive. Risk factors were readily ascertainable for 85% of the women; the remaining 15% would not have been identified through risk-selective screening. The most common risk factors were Oriental ethnic origin, history of hepatitis, jaundice or multiple transfusions of blood or blood products, and occupational exposure to blood. Although 86% of the multiparous HBsAg-positive women had risk factors, only 7% had been identified in previous pregnancies. The Alberta program appears to be cost-effective. We conclude that only routine prenatal screening will identify all infants at risk of perinatal HBV infection and that a comprehensive public health program involving central laboratories, private physicians and public health staff can be highly effective and efficient in protecting infants against hepatitis B.
Okun
N B
NB
Department of Obstetrics and Gynecology, University of Alberta, Edmonton.
Larke
R P
RP
Waters
J R
JR
Joffres
M R
MR
D000416:Alberta; D002353:Carrier State; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000175:diagnosis* / Q000517:prevention & control; D006510:Hepatitis B Antibodies / Q000032:analysis*; D006514:Hepatitis B Surface Antigens / Q000032:analysis*; D017325:Hepatitis B Vaccines; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage; D007231:Infant, Newborn; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000517:prevention & control; D011296:Prenatal Diagnosis; D012189:Retrospective Studies; D012307:Risk Factors; D014761:Viral Hepatitis Vaccines / Q000008:administration & dosage
D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines; D007136:Immunoglobulins; D014761:Viral Hepatitis Vaccines; C045213:hepatitis B hyperimmune globulin