Program to prevent perinatal hepatitis B virus transmission in a health-maintenance organization--Northern California, 1990-1995.
Each year, an estimated 20,000 infants are born to hepatitis B surface antigen (HBsAg)-positive women in the United States. These infants are at high risk for perinatal hepatitis B virus (HBV) infection, chronic HBV infection, and associated complications of chronic liver disease, including cirrhosis and hepatocellular carcinoma. All vaccine advisory groups recommend that all pregnant women be routinely tested for HBsAg during an early prenatal visit during each pregnancy to determine whether their newborns will require immunoprophylaxis for the prevention of perinatal HBV infection. Administration of appropriate immunoprophylaxis is approximately 90% effective in preventing HBV infection among children born to HBsAg-positive mothers. In 1995, the Kaiser Permanente Medical Care Program of Northern California (KP)--a health-maintenance organization (HMO) providing care to 2.5 million members and delivering 30,000 infants annually--implemented HBsAg screening of all pregnant women. After initiating the program, KP estimated that at least 25% of the infants born to HBsAg-positive women were not receiving appropriate post-exposure prophylaxis. In response, KP implemented a tracking and follow-up program in 1988. This report describes an assessment of the impact of this program, which indicates that a centralized case-management and tracking system can substantially improve levels of post-exposure prophylaxis.
D005260:Female; D006279:Health Maintenance Organizations; D006509:Hepatitis B / Q000151:congenital / Q000175:diagnosis / Q000276:immunology / Q000517:prevention & control* / Q000635:transmission; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D017325:Hepatitis B Vaccines / Q000008:administration & dosage; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000517:prevention & control*; D011295:Prenatal Care; D012698:Serologic Tests
D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines; D016756:Immunoglobulins, Intravenous