title: Ethical issues in preventing mother-to-child transmission of hepatitis B by immunisation.
abstract: Without intervention, a pregnant woman who is a chronic hepatitis B carrier is at risk of transmitting hepatitis B and of her infant becoming a chronic carrier and having a significantly increased lifetime risk of developing liver cancer or cirrhosis. Hepatitis B vaccine and immunoglobulin reduce the risk of the baby becoming a carrier, but with only a short window period after birth to deliver this potentially life-saving intervention. We reviewed the evidence on the magnitude of the risk. If the carrier mother is e antigen positive (highly infective), the calculated risk to the infant without intervention is 75.2%, reduced to 6.0% by giving vaccine and immunoglobulin at birth. If the mother is surface antigen positive but e antigen negative, the risk to the infant without intervention is 10.3%, reduced to 1.0% by giving vaccine and immunoglobulin. If vaccine is accepted but immunoglobulin refused, as for example by some Jehovah's Witnesses, the risk to babies of e antigen positive mothers is reduced to 21.0% and to babies of e antigen negative mothers to 2.6%. These figures can be used to inform parents and as a possible basis for child protection proceedings if parents decline vaccine and/or immunoglobulin. We argue from the perspective of the best interests of the child that the severity of the condition justifies initiating child protection proceedings whenever a baby is born to a hepatitis B carrier mother and, despite concerted attempts to persuade them, the parents refuse vaccine and/or immunoglobulin.
authors: Clinical Ethics Advisory Group, Children's Hospital at Westmead, Westmead, NSW, 2145, Australia. davidi@chw.edu.au
authors: David
authors: D
authors: Isaacs
authors: Henry A
authors: HA
authors: Kilham
authors: Shirley
authors: S
authors: Alexander
authors: Nick
authors: N
authors: Wood
authors: Adam
authors: A
authors: Buckmaster
authors: Jenny
authors: J
authors: Royle
mesh_terms: D000328:Adult; D002353:Carrier State / Q000276:immunology / Q000635:transmission; D005260:Female; D006509:Hepatitis B / Q000276:immunology / Q000517:prevention & control / Q000635:transmission; D006510:Hepatitis B Antibodies / Q000276:immunology; D017325:Hepatitis B Vaccines / Q000627:therapeutic use*; D006513:Hepatitis B e Antigens / Q000276:immunology; D006801:Humans; D007114:Immunization / Q000331:legislation & jurisprudence; D007136:Immunoglobulins / Q000627:therapeutic use; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008103:Liver Cirrhosis / Q000821:virology; D008113:Liver Neoplasms / Q000821:virology; D009035:Mothers; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000276:immunology / Q000517:prevention & control; D012306:Risk; D016312:Treatment Refusal / Q000941:ethics / Q000331:legislation & jurisprudence*
chemical_list: D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines; D006513:Hepatitis B e Antigens; D007136:Immunoglobulins