title: Prevention of perinatal hepatitis B transmission in Haimen City, China: Results of a community public health initiative.
abstract: In regions where hepatitis B virus (HBV) is endemic, perinatal transmission is common. Infected newborns have a 90% chance of developing chronic HBV infection, and 1 in 4 will die prematurely from HBV-related liver disease. In 2010, the Hepatitis B Foundation and the Haimen City CDC launched the Gateway to Care campaign in Haimen City, China to improve awareness, prevention, and control of HBV infection citywide. The campaign included efforts to prevent perinatal HBV transmission by screening all pregnant women for hepatitis B surface antigen (HBsAg), following those who tested positive, and administering immunoprophylaxis to their newborns at birth. Of 5407 pregnant women screened, 185 were confirmed HBsAg-positive and followed until delivery. At age one, 175 babies were available for follow up testing. Of those, 137 tested negative for HBsAg and positive for antibodies to HBsAg, indicating protection. An additional 34 HBsAg-negative babies also tested negative for antibodies to HBsAg or had indeterminate test results, were considered to have had inadequate immune responses to the vaccine, and were given a booster dose. A higher prevalence of nonresponse to HBV vaccine was observed among babies born to hepatitis B e antigen (HBeAg)-positive mothers and mothers with high HBV DNA titers. The remaining 4 babies tested positive for HBsAg and negative for antibodies, indicative of active HBV infection. The mothers of all 4 had viral loads ≥8×10(6) copies/ml in the third trimester. Although inadequate response or nonresponse to HBV vaccine was more common among babies born to HBeAg-positive and/or high viral load mothers, these risk factors did not completely predict nonresponsiveness. All babies born to HBV-infected mothers should be tested upon completion of the vaccine series to ascertain adequate protection. Some babies of HBeAg-positive mothers with high viral load may still become HBV infected despite timely immunoprophylaxis with HBV vaccine and HBIG.
authors.affiliation: Drexel University, Philadelphia, PA, USA; Hepatitis B Foundation, 3805 Old Easton Road, Doylestown, PA 18902, USA. Electronic address: aae29@drexel.edu.
authors.forename: Alison A
authors.initials: AA
authors.lastname: Evans
authors.affiliation: Hepatitis B Foundation, 3805 Old Easton Road, Doylestown, PA 18902, USA. Electronic address: chari.cohen@hepb.org.
authors.forename: Chari
authors.initials: C
authors.lastname: Cohen
authors.affiliation: Haimen City Center for Disease Control and Prevention (HCCDC), 520 Ren Min Xi Road, Haimen City 226100, Jiangsu, PR China.
authors.forename: Peixin
authors.initials: P
authors.lastname: Huang
authors.affiliation: Haimen City Center for Disease Control and Prevention (HCCDC), 520 Ren Min Xi Road, Haimen City 226100, Jiangsu, PR China.
authors.forename: Liping
authors.initials: L
authors.lastname: Qian
authors.affiliation: Hepatitis B Foundation, 3805 Old Easton Road, Doylestown, PA 18902, USA; Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA. Electronic address: Thomas.London@fccc.edu.
authors.forename: W Thomas
authors.initials: WT
authors.lastname: London
authors.affiliation: Hepatitis B Foundation, 3805 Old Easton Road, Doylestown, PA 18902, USA. Electronic address: joan.block@hepb.org.
authors.forename: Joan M
authors.initials: JM
authors.lastname: Block
authors.affiliation: Hepatitis B Foundation, 3805 Old Easton Road, Doylestown, PA 18902, USA. Electronic address: gang.chen@hepb.org.
authors.forename: Gang
authors.initials: G
authors.lastname: Chen
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D004279:DNA, Viral / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000276:immunology; D006510:Hepatitis B Antibodies / Q000276:immunology; D006514:Hepatitis B Surface Antigens / Q000276:immunology; D017325:Hepatitis B Vaccines / Q000008:administration & dosage* / Q000276:immunology; D006513:Hepatitis B e Antigens / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000517:prevention & control*; D006801:Humans; D007116:Immunization, Passive; D007117:Immunization, Secondary; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000276:immunology; D011634:Public Health; D012111:Residence Characteristics; D012307:Risk Factors; D019562:Viral Load / Q000276:immunology; D055815:Young Adult
chemical_list: D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines; D006513:Hepatitis B e Antigens
keywords: Chronic hepatitis B infection; HBV DNA titer; Haimen City, China; Hepatitis B immunoprophylaxis; Hepatitis B vaccination; Perinatal hepatitis