Hepatitis B: Transmission From Mother to Newborn Is Preventable

Tagged:  

Hepatitis B is a serious disease 100 times more infectious than AIDS and the leading cause of liver cancer. Hepatitis B can also cause cirrhosis of the liver and, rarely, life-threatening acute fulminant hepatitis (Hepatitis B Foundation, 1997).

Approximately 22,000 infants are born each year to women in the United States with the chronic viral infection hepatitis B (Morbidity and Mortality Weekly Report, 1994). The risk for transmission from the mother to the fetus/neonate ranges from 10-90%, depending upon whether the acute infection in the mother occurs early or late in pregnancy (Nichols & Zwelling, 1997).

The current recommendations by the Centers for Disease Control (CDC) (CDC, 1998) are that all pregnant women be screened for the hepatitis B surface antigen (HBsAg). This is extremely important since vertical transmission of hepatitis B can be prevented 85-95% of the time if hepatitis B vaccine and hepatitis B immunoglobulin are given to infants whose mothers are hepatitis B carriers (Beasley, et al., 1984). To be most effective, these vaccines must be given to infants within 12 hours of birth.

In some states, screening for hepatitis B during the prenatal period is mandated by law. However, there are indications that the mandate alone is insufficient. For example, although 93% of the obstetricians surveyed in California ordered the appropriate test, only 18% of the pediatricians reported receiving in writing the results of the maternal hepatitis B antigen test (Rosenthal, Wood, Greenspoon & Pereyra, 1995). Therefore, it is imperative to educate women about hepatitis B and encourage them to ask about the results of their own hepatitis B surface antigen test. If the result is positive, the mother is in a position to see that treatment for her newborn is not overlooked.

The CDC (1998) also recommends that all newborn infants be immunized against the hepatitis B virus. The vaccine can be given safely to infants, children, and adults in three doses over a period of 6 months. Usually, the newborn will be given the first dose right after birth. The subsequent doses are given when the infant is 1 and 6 months of age. It is important to note that the hepatitis B vaccination is safe and effective for preterm infants weighing at least 2000 grams (Huang, et al., 1997).

References

Beasley R., Huang, L., Lee, G., Lan C., Roan, C., Huang, F. & Chen, C. (1983). Prevention of perinatally transmitted hepatitis B virus infections with hepatitis B immune globulin and hepatitis B vaccine. Lancet, 12(2), 1099-1102.

Centers for Disease Control and Prevention. (1998). 1998 guidelines for treatment of sexually transmitted diseases. Morbidity and Mortality Weekly Report, 23(47), 1-111.

Hepatitis B Foundation. (1997). Available at http://www2.hepb.org/hepb/

Morbidity and Mortality Weekly Report. (1994). Maternal hepatitis B screening practices -- California, Connecticut, Kansas, and United States, 1992-1993.43(17), 311.

Nichols, E & Zwelling, E. (1997). Maternal-newborn nursing: Theory and practice. Philadelphia: W.B. Saunders.

Rosenthal, P., Wood, D., Greenspoon, J. & Pereyra, M. (1995). Hepatitis B virus serology in pregnant women: Transmittal of results from obstetricians to pediatricians in California. Pediatric Infectious Disease Journal, 14(11), 927-931.

~~~~~~~~

By Mary Beth Flanders-Stepans

Share this with your friends