title: Selective immunisation strategy to protect newborns at risk for transmission of hepatitis B: retrospective audit of vaccine uptake.
abstract: BACKGROUND
  90% of newborns infected perinatally will develop chronic hepatitis B infection with the risk of liver cirrhosis or hepatocellular carcinoma. In Switzerland, screening of all pregnant women for hepatitis B virus (HBV) has been recommended since 1983. Neonates at risk for perinatally acquired HBV are passively and actively immunised immediately after birth as well as at 1 and 6 months of age. The objective of this study was to evaluate the proportion of newborns immunised in accordance with the proposed vaccination schedule.
  
  
  METHODS
  Patient records of 3997 mothers who gave birth to a liveborn infant during a two-year period at Zürich University Hospital were screened by computer. 128 women were identified as HBsAg positive or anti-HBc alone positive. Of 133 infants born to these mothers, complete data were available for 94 (71%).
  
  
  RESULTS
  Immunisation was started in 88 infants (94%), but only in 78 (83%) within the first 24 hours of life. 85 (90%) received the 2nd immunisation but only 72 (77%) within the given time limit. 80 (85%) of the infants received the 3rd immunisation but only 69 (73%) within the correct time limit. In summary, only 51 (54%) of the infants at risk for HBV infection were immunised correctly (immunoglobulin within 24 hours and active prophylaxis at 0, 1 and 6 months).
  
  
  CONCLUSIONS
  The success of the immunisation strategy following maternal screening and selective immunisation of newborns at risk for HBV infection is limited for various reasons (lack of screening results at birth, problems with correct documentation and communication). To overcome these drawbacks, selective vaccination strategy should be improved and general vaccination strategy, including infants, should be reconsidered.
authors.affiliation: Clinic for Neonatology, Department of Obstetrics and Gynecology, University Hospital Zürich, Switzerland.
authors.forename: Janine
authors.initials: J
authors.lastname: Rhiner
authors.forename: Roger
authors.initials: R
authors.lastname: Pfister
authors.forename: Yasmine
authors.initials: Y
authors.lastname: Nassehi Tschopp
authors.forename: Hans Ulrich
authors.initials: HU
authors.lastname: Bucher
mesh_terms: D005260:Female; D006509:Hepatitis B / Q000517:prevention & control* / Q000635:transmission; D017325:Hepatitis B Vaccines / Q000008:administration & dosage; D006785:Hospitals, University; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration*; D007115:Immunization Schedule; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D008485:Medical Audit; D018579:Patient Selection; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D012189:Retrospective Studies; D012307:Risk Factors; D013557:Switzerland
chemical_list: D017325:Hepatitis B Vaccines