Prevention and control of perinatal hepatitis B virus transmission in ...

Eriksen EM, Perlman JA, Miller A, Marcy SM, Lee H, Vadheim C, Zangwill KM, Chen RT,DeStefano F, Lewis E, Black S, Shinefield H, Ward JI. Lack of association between hepatitis Bbirth immunization and neonatal death: a population-based study from the vaccine safety datalinkproject. Pediatr Infect Dis J 2004; 23:656-662.UCLA Center for Vaccine Research, Harbor-UCLA Medical Center, Torrance, CA 90502, USA.There have been no population-based studies of the potential association between neonatal deathand newborn immunization with hepatitis B vaccine (HBV). As part of the Vaccine SafetyDatalink Project, we defined a birth cohort at Southern and Northern California Kaiser PermanenteHealth Plans of more than 350,000 live births from 1993 to 1998 and ascertained all deathsoccurring under 29 days of age. We compared the proportions of deaths among birth HBVvaccinatedand unvaccinated newborns and reviewed the causes and circumstances of their deaths.We performed detailed clinical reviews of all HBV-vaccinated neonates who died and a sample ofunvaccinated neonates who died and who were matched to vaccinated deaths for days of life, sex,birth year and site of care. To avoid confounding, we categorized the causes of death as either‘expected’ or ‘unexpected’ and performed a stratified analysis to compare mortality withimmunization status. There were 1363 neonatal deaths during the study period. Whereas 67% ofthe entire birth cohort received HBV at birth, only 72 (5%) of the neonates who died were HBVvaccinatedat birth (P < 0.01). We found no significant difference in the proportion of HBVvaccinated(31%) and unvaccinated (35%) neonates dying of unexpected causes (P = 0.6). Furtherwe could not identify a plausible causal or temporal relationship between HBV administration anddeath for the 22 vaccinated neonates who died unexpectedly. A relationship between HBV andneonatal death was not identified.Euler GL, Copeland J, Williams WW. Impact of four urban perinatal hepatitis B preventionprograms on screening and vaccination of infants and household members. Am J Epidemiol 2003;157:747-753.Epidemiology and Surveillance Division, National Immunization Program, Centers for DiseaseControl and Prevention, Atlanta, GA 30333, USA. gle0@cdc.govDuring 1992-2000, the authors studied compliance with perinatal hepatitis B preventionrecommendations, including vaccination of household contacts, at four metropolitan sites inConnecticut, Georgia, Texas, and Michigan. Demographic and hepatitis B-related knowledge,attitudes, practices, and barrier data were collected on pregnant women testing positive forhepatitis B surface antigen and on their infants, children, and household and sexual contacts.Generalized estimating equations with repeated measures in a multivariable model were used toobtain adjusted relative risks of household noncompliance. In 1,458 households studied, 1,490infants and 3,502 other contacts were identified. Among infants, vaccination start/finish rates were92%/72%, and 73% were serotested postvaccination. Prevaccination serotesting rates amongcontacts were 22% preenrollment and 47% postenrollment. Among 2,519 contacts whoseimmunity status was susceptible or unknown, the vaccination start/finish rate was 45%/41%. Sitespecificadjusted relative risks of household noncompliance compared with Texas were 2.14(Michigan), 1.96 (Georgia), and 1.30 (Connecticut). Mother's birth in the United States increasedthe relative risk of household noncompliance (1.32). Home visits, implemented only in Texas,most likely account for higher compliance rates in that state. Findings may indicate that manyperinatal programs could achieve higher overall rates of infant and contact identification; pre- andpostvaccination serologic testing in contacts and infants, respectively; and contact hepatitis Bvaccination.15