Applicability and efficacy of a model for prevention of perinatal transmission of hepatitis B virus infection:Single center study in Egypt

AIM:To identify possible maternal risk factors for hepatitis B virus(HBV)acquisition and assess the efficacy of immunoprophylaxis given to infants born to hepatitis B virus surface antigen(HBs Ag)positive mothers.METHODS:Screening of 2000 pregnant females wascarried out using rapid test and confirmed by enzyme immunoassay.A questionnaire consisting of 20 questions about the possible risk factors for acquisition of HBV infection was filled for every pregnant HBs Ag positive female in addition to at least 2 pregnant HBs Ag negative females for each positive case.Infants of HBs Ag positive women were offered passive and active immunoprophylaxis within the 1st 48 h after birth,in addition to 2nd and 3rd doses of HBV vaccine after1 and 6 mo respectively.Infants were tested for HBs Ag and hepatitis B surface antibodies(HBs Ab)at six months of age.RESULTS:HBs Ag was confirmed positive in 1.2%of tested pregnant women.Risk factors significantly associated with HBV positivity were;history of injections(OR=5.65),history of seeking medical advice in a clinic(OR=7.02),history of hospitalization(OR=6.82),history of surgery(OR=4)and family history of hepatitis(OR=3.89)(P<0.05).Dropout rate was 28%for HBs Ag women whose rapid test was not confirmed and could not be reached to provide immunoprophylaxis for thier newborns.Immunoprophylaxis failure was detected in only one newborn(3.7%)who tested positive for HBs Ag at 6 mo of age;and vaccine failure(seronegative to HBs Ab after 4 doses of the vaccine)was detected in another one(3.7%).The success rate of the immunoprophylaxis regimen was 92.6%.CONCLUSION:This pilot study shows that a successful national program for prevention of perinatal transmission of HBV needs to be preceded by an awareness campaign to avoid a high dropout rate.