Immunization Program Protects Babies From Hepatitis B

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By Janet Byron, Senior Communications Specialist, Kaiser Permanente Northern California Division of Research

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The transmission of hepatitis B from mother to child has been virtually eliminated in Kaiser Permanente’s Northern California region, thanks to a program which ensures that babies receive all recommended shots on time.

“Without intervention, a mother with the more active form of hepatitis B virus has an up to 90 percent risk of passing the infection on to her child at birth,” says Dena Lakritz, RN, MPH, a Kaiser Permanente nurse who has devoted 28 years of her 34-year career to the Regional Perinatal Screening Hepatitis B Program, based at Oakland Medical Center.

 “Today in the region, all pregnant women are screened for hepatitis B before they deliver,” Lakritz adds, “and we recommend that those with the disease immunize their newborns in accordance with national guidelines.”

Hepatitis B is a chronic viral disease that can cause severe liver damage and death if left untreated. According to the Centers for Disease Control and Prevention (CDC), there are between 800,000 and 1.4 million hepatitis B carriers in the United States, and approximately 24,000 infected women give birth each year. 

The disease is of particular concern to Asians. A recent Kaiser Permanente study found that between 1997 and 2010, 80% of pregnant Kaiser Permanente members in Northern California who carried hepatitis B were Asian or Pacific Islanders.

Under CDC guidelines, babies of mothers with hepatitis B should be immunized within 12 hours of birth with hepatitis B immunoglobulin and the hepatitis B vaccine, then receive two more vaccines during their first 6 months.

“We began with a log book and a mainframe to identify hepatitis B carrier mothers,” Lakritz notes. “Over the years, new technologies and now electronic health records have greatly improved our ability to identify, track, and communicate with providers and members needing care.”

Study shows that program works
Now a study published recently in Annals of Internal Medicine shows that the program has been working, and spectacularly well.

“We found that it’s possible to carry out this type of screening program, track moms and babies, and have the vaccines administered on time,” said Ai Kubo, PhD, the study’s lead author and a staff scientist with the Kaiser Permanente Northern California Division of Research in Oakland. “Furthermore, this program is very effective in preventing transmission of hepatitis B.”

Between 1997 and 2010, 4,446 infants were born to 3,253 mothers carrying hepatitis B in Kaiser Permanente Northern California, and all were enrolled in the hepatitis B tracking program.

The results demonstrated that implementation of an organized program can substantially improve screening, detection, and treatment. By 2010, 90 to 95 percent of mothers carrying the active form of hepatitis B received prenatal testing for e-antigen status and viral load, more than 95 percent of infants were vaccinated within the recommended time frames, and more than 90 percent of children had received follow-up testing. The overall infant infection rate between 1997 and 2010 was 0.75 per 100 births, which compares very favorably to published rates of five per 100 births. 

Transmission of virus is rare
The study also found that among mothers carrying the more active form of hepatitis B virus, transmission occurred in only three cases—and only when levels of the virus in the mother’s blood were extremely high. This finding will help doctors to better identify women who could benefit from antiviral therapy prior to giving birth.

“These new data suggest that most mothers carrying hepatitis B—who have their babies immunized—do not need to receive additional medications during their pregnancy,” says co-author said Lyle Shlager, MD, a gastroenterologist at the Kaiser Permanente San Francisco Medical Center and clinical lead for the regional hepatitis B prevention program.

In addition to Lakritz, Kubo, and Shlager, co-authors of the study were Amy R. Marks, MPH, Colette Beaumont, RN, MSN, Kim Gabellini, RN, MS, and Douglas A. Corley, MD, PhD, all of Kaiser Permanente Northern California.

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