title: An investigation of perinatal hepatitis B virus infections among a high risk population: the delivery hospital as a safety net.
abstract: BACKGROUND
  There was an increase in perinatal hepatitis B virus (HBV) infections in one Arkansas county that disproportionately affected Marshallese infants.
  
  
  METHODS
  An estimated 6000 to 10,000 Marshallese, from the Pacific island nation of the Marshall Islands where HBV is highly endemic, live in one Arkansas county. We conducted a retrospective review of hospital and health department records from 2003 to 2005 in that county. We compared maternal screening for hepatitis B surface antigen (HBsAg) between Marshallese and non-Marshallese. We also reviewed birth and immunization records for infants born to HBsAg-positive mothers to evaluate postexposure prophylaxis (PEP).
  
  
  RESULTS
  Ten percent (n = 41) of Marshallese births and 0.1% (n = 15) of non-Marshallese births were to HBsAg-positive women. Among those born to HBsAg-positive women, Marshallese and non-Marshallese infants were equally likely to receive PEP with hepatitis B vaccine (98% vs. 100%; P[r] = 0.98) and hepatitis B immune globulin (HBIG) <or=12 hours after birth (88% vs. 87%; P = 0.91). Approximately 57% (n = 32) of all infants born to HBsAg-positive women were tested for perinatal HBV infection. The proportion of Marshallese (17%) and non-Marshallese (13%) infants who tested positive for HBsAg at ages 9 to 25 months was similar (P = 0.78). Receiving HBIG >12 hours after birth was the only factor significantly associated with infection.
  
  
  CONCLUSIONS
  Although HBV infection was more prevalent among Marshallese compared with non-Marshallese women, there were no differences in infant receipt of PEP and perinatal HBV infection. Delivery hospitals in this county had standing orders to administer hepatitis B vaccine to all newborns, which likely provided a safety net to prevent perinatal HBV transmission in this high-risk population.
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA 0333, USA. gefischer@cdc.gov
authors.forename: Gayle
authors.initials: G
authors.lastname: Fischer
authors.forename: Susan
authors.initials: S
authors.lastname: Wang
authors.forename: Sherry
authors.initials: S
authors.lastname: Ahring
authors.forename: Karen
authors.initials: K
authors.lastname: Fowler
authors.forename: Sandra
authors.initials: S
authors.lastname: Hainline
authors.forename: Merlyna
authors.initials: M
authors.lastname: Chinglong
authors.forename: Lisa
authors.initials: L
authors.lastname: Jacques-Carroll
authors.forename: Beth
authors.initials: B
authors.lastname: Bell
authors.forename: Ian
authors.initials: I
authors.lastname: Williams
mesh_terms: D000328:Adult; D001131:Arkansas / Q000453:epidemiology; D002675:Child, Preschool; D005006:Ethnicity; D005260:Female; D006509:Hepatitis B / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D006515:Hepatitis B virus / Q000302:isolation & purification*; D006761:Hospitals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000821:virology; D012307:Risk Factors; D055815:Young Adult
chemical_list: D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines