title: Evaluation of the compliance with recommended procedures in newborns exposed to HBsAg-positive mothers: a multicenter collaborative study.
abstract: BACKGROUND
  Maternal-infant transmission of hepatitis B virus (HBV) during birth carries a high risk for chronic HBV infection in infants with frequent subsequent development of chronic disease. This can be efficiently prevented by early immunization of exposed newborns. The purpose of this study was to determine the compliance with official recommendations for prevention of perinatal HBV transmission in hepatitis B surface antigen (HBsAg) exposed infants.
  
  
  METHODS
  Records of pregnant women at 4 sites in Switzerland, admitted for delivery in 2005 and 2006, were screened for maternal HBsAg testing. In HBsAg-exposed infants, recommended procedures (postnatal active and passive immunization, completion of immunization series, and serological success control) were checked.
  
  
  RESULTS
  Of 27,131 women tested for HBsAg, 194 (0.73%) were positive with 196 exposed neonates. Of these neonates, 143 (73%) were enrolled and 141 (99%) received simultaneous active and passive HBV immunization within 24 hours of birth. After discharge, the HBV immunization series was completed in 83%. Only 38% of children were tested for anti-HBs afterwards and protective antibody values (>100 U/L) were documented in 27% of the study cohort. No chronically infected child was identified. Analysis of hospital discharge letters revealed significant quality problems.
  
  
  CONCLUSIONS
  Intensified efforts are needed to improve the currently suboptimal medical care in HBsAg-exposed infants. We propose standardized discharge letters, as well as reminders to primary care physicians with precise instructions on the need to complete the immunization series in HBsAg-exposed infants and to evaluate success by determination of anti-HBs antibodies after the last dose.
authors.affiliation: Division of Pediatric Infectious Diseases, University Children's Hospital-Basel, Switzerland. Ulrich.Heininger@ukbb.ch
authors.forename: Ulrich
authors.initials: U
authors.lastname: Heininger
authors.forename: Bernard
authors.initials: B
authors.lastname: Vaudaux
authors.forename: Myriam
authors.initials: M
authors.lastname: Nidecker
authors.forename: Riccardo E
authors.initials: RE
authors.lastname: Pfister
authors.forename: Klara M
authors.initials: KM
authors.lastname: Posfay-Barbe
authors.forename: Marius
authors.initials: M
authors.lastname: Bachofner
authors.forename: Irene
authors.initials: I
authors.lastname: Hoigné
authors.forename: Hanspeter E
authors.initials: HE
authors.lastname: Gnehm
mesh_terms: D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006302:Health Services Research; D006509:Hepatitis B / Q000517:prevention & control* / Q000635:transmission*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D017325:Hepatitis B Vaccines / Q000008:administration & dosage; D006801:Humans; D007116:Immunization, Passive / Q000706:statistics & numerical data; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D009035:Mothers; D011247:Pregnancy; D013557:Switzerland; D014611:Vaccination / Q000706:statistics & numerical data
chemical_list: D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines