Progress and Challenges in US Perinatal HBV Prevention Program

By Reuters Staff

February 03, 2021

NEW YORK (Reuters Health) - The United States has made progress in identifying infants born to hepatitis B surface antigen (HBsAg)-positive women and getting them vaccinated.

Yet, there is also substantial room for improvement, including closing the gap between the number of infants identified and vaccinated, according to new data from the Centers for Disease Control and Prevention (CDC).

The CDC Perinatal Hepatitis B Prevention Program (PHBPP) identified more than 103,000 infants born to HBsAg-positive women from 2009 to 2017, with a range of 10,956 to 12,103 infants annually.

The proportion of infants identified annually increased overall from 48.1% to 52.6% (P=0.098), Alaya Koneru and colleagues at the CDC report in Pediatrics.

The proportion of "case-managed" infants receiving postexposure prophylaxis (PEP) increased from 94.7% to 97.0% (P=0.0952). And the proportion receiving at least three vaccine doses increased by 83.1% to 84.7% (P=0.5377).

Finally, the proportion of babies receiving postvaccination serologic testing (PVST) increased from 58.8% to 66.8% (P=0.0002). However, this means that 33.2% of infants did not receive PVST, "leaving them at potential risk of disease burden. Additional efforts are needed to increase series completion and PVST rates among case-managed infants," Koneru and colleagues write.

They note that gaps in identifying HBsAg-positive women (and subsequently, their infants) could be due to limited access to prenatal care, as well as challenges in reporting HBsAg-positive pregnant women to the program, including by laboratories, clinicians and health departments.

In a linked editorial, Dr. Esther Chung and Dr. Daniel Enquobahrie of the University of Washington and Seattle Children's Hospital say, "The role of the United States in global efforts to eliminate HBV infection cannot be overstated when HBV together with hepatitis C virus infection accounts for 96% of the 1.34 million viral hepatitis deaths annually. Most HBV infections occur perinatally and in early childhood and thus are preventable by early and widespread HBV vaccination."

The PHBPP, they note, has been "instrumental" in identifying and tracking infants exposed to HBV, but "dramatic improvements" are needed if the CDC is to meet its target of identifying 80% of births to HBsAg-positive mothers.

"Closing the loop by ensuring completion of the HBV vaccine series and PVST for exposed infants is essential. Approximately 1 in 6 infants case managed by PHBPP did not complete the HBV vaccine series, and 1 in 3 did not receive PVST. As a community, we have a responsibility to ensure that these children at risk for chronic HBV infection and hepatocellular carcinoma are protected and disease free," the editorialists say.

"Extra efforts to protect children from vaccine-preventable HBV infection are required during the current coronavirus disease 2019 pandemic. A recent study revealed declines in vaccination coverage for all vaccines except for the birth dose of HBV vaccine, attributable to pandemic-associated measures and declines in access to health care services," they add.

SOURCE: https://bit.ly/39Dz97S and https://bit.ly/3riOLUf Pediatrics, online February 2, 2021.

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