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

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to 14 years at the beginning of HBV immunization was 18.59 to 20.52/100,000, and declined to0.39 to 2.38/100,000 in 2000 (chi 2 = 58.26, P < 0.01). The HBsAg carrying rate of the childrendecreased from 2.82% to 0.60%, about 80.00% after vaccination (chi 2 = 10.75, P < 0.01). HepatitisB vaccination of newborn babies is an effective measure for prevention and control of hepatitis Bvirus infection.Grosheide PM, den Ouden AL, Verrips GH, Conyn-van Spaendonck MA, Loeber JG,Verloove-Vanhorick SP. Evaluation of the hepatitis B prevention program in newborn infants. I.National data, 1990. Ned Tijdschr Geneeskd 1993; 137:2589-2594. [Article in Dutch]Centrum voor Infectieziekten Epidemiologie, Rijksinstituut voor Volksgezondheid enMilieuhygiene, Bilthoven.The aim was to evaluate the effectiveness of the national programme for prevention of perinatalhepatitis B infections. Setting: the regional public health laboratories and provincial immunizationadministrations in the Netherlands. Design: retrospective evaluation. Starting October 1989 routinescreening of pregnant women for HBsAg was performed and passive-active immunisation ofinfants of HBsAg-positive mothers was added to the national immunisation programme. Infantsreceive hepatitis B immunoglobulin at birth and hepatitis B vaccine at 3,4,5, and 11 months of age,concomitant with the DTP-polio vaccine. The effectiveness of screening and intervention in 1990was evaluated. Screening covered about 85% of the pregnant population and the prevalence(0.44%) was less than expected. About 60% of the infants born to HBsAg-positive mothers wereregistered for vaccination. Of these infants the average coverage was 83% for immunoglobulin,and 90%, 86%, 80% and 55% for the four successive hepatitis B vaccinations. There wasconsiderable delay in vaccine administration; frequently doses were administered later thanrecommended. Compliance with screening and vaccination appeared incomplete.Recommendations for the simplification of the current programme are made.Grosheide PM, Klokman-Houweling JM, Conyn-van Spaendonck MA. Programme forpreventing perinatal hepatitis B infection through screening of pregnant women and immunisationof infants of infected mothers in The Netherlands, 1989-92. National Hepatitis B SteeringCommittee. BMJ 1995; 311:1200-1202.Department of Infectious Diseases Epidemiology, National Institute of Public Health andEnvironmental Protection, Bilthoven, Netherlands.The objective was to launch a programme for the prevention of perinatal infection with hepatitis Bin the Netherlands. Design: Routine antenatal screening and intervention programme. Setting:community antenatal programme, the Netherlands. Subjects: infants of mothers who were carriersof hepatitis B detected by routine screening. Interventions: infants of infected mothers receivedhepatitis B immunoglobulin at birth and four doses of hepatitis B vaccine in conjunction withroutine immunisation at 3, 4, 5, and 11 months of age. Main outcome measures: results ofscreening and immunisation from 1989-92. The coverage of screening increased from 46% in1989 to 84% in 1992. Hepatitis B surface antigen was detected in 2145 women (0.44%). Thecoverage of postnatal immunoprophylaxis in 1645 neonates born to mothers who were carriers ofhepatitis B was 85% (1391); in 3% (42) there was a delay in administration of immunoglobulin ofover 24 hours. In 1991, 96% (537), 95% (532), 94% (525), and 87% (489) of the infants receivedthe first, second, third, and fourth dose of vaccine, respectively. There was considerable variationin the timing of vaccination; 17% (258) of the infants received their first dose more than twoweeks late. Of the 59% (583) of infants who received the fourth dose more than two weeks beyondtarget age, 14% (141) also received their first dose too late. It was concluded that a preventionprogramme for perinatal hepatitis B in an area of low prevalence, when incorporated into existing18
health care, is feasible and achieves satisfactory coverage rates. Intensive follow up is needed toimprove adherence to the immunisation schedule.Hipgrave DB, Maynard JE, Biggs B-A. Improving birth dose coverage of hepatitis B vaccine.Bull WHO 2006; 84:65-70.UNICEF Indonesia, Wisma Metropolitan 11, Jalan Sudirman 31, Jakarta 12920, Indonesia.dhipgrave@unicef.orgAdministration of a birth dose of hepatitis B vaccine (HepB vaccine) to neonates is recommendedto prevent mother-to-infant transmission and chronic infection with the hepatitis B virus (HBV).Although manufacturers recommend HepB vaccine distribution and storage at 2-8 degrees C,recognition of the heat stability of hepatitis B surface antigen stimulated research into its use afterstorage at, or exposure to, ambient or high temperatures. Storage of HepB vaccine at ambienttemperatures would enable birth dosing for neonates delivered at home in remote areas or at healthposts lacking refrigeration. This article reviews the current evidence on the thermostability ofHepB vaccine when stored outside the cold chain (OCC). The reports reviewed show that thevaccines studied were safe and effective whether stored cold or OCC. Field and laboratory dataalso verifies the retained potency of the vaccine after exposure to heat. The attachment of a highlystable variety of a vaccine vial monitor (measuring cumulative exposure to heat) on many HepBvaccines strongly supports policies allowing their storage OCC, when this will benefit birth dosecoverage. We recommend that this strategy be introduced to improve birth dose coverage,especially in rural and remote areas. Concurrent monitoring and evaluation should be undertakento affirm the safe implementation of this strategy, and assess its cost, feasibility and effect onreducing HBV infection rates. Meanwhile, release of manufacturer data verifying the potency ofcurrently available HepB vaccines after exposure to heat will increase confidence in the use ofvaccine vial monitors as a managerial tool during storage of HepB vaccine OCC.Hipgrave DB, Nguyen TV, Vu MH, Hoang TL, Do TD, Tran NT, Jolley D, Maynard JE,Biggs BA. Hepatitis B infection in rural Vietnam and the implications for a national program ofinfant immunization. Am J Trop Med Hyg 2003; 69:288-294.International Health Unit, The Burnet Institute, Alfred Medical Research & Education Precinct,Melbourne, Australia.To ascertain hepatitis B virus (HBV) infection rates for Vietnam, we surveyed HBV markers intwo districts of Thanh Hoa province. We randomly selected 536 infants (9- < or = 18 months old),228 children (4 to < or = 6 years old), 219 adolescents (14 to < or = 16 years old), and 596 adults(25 to < or = 40 years old). On questioning, none of those surveyed had received vaccine againstHBV. Hepatitis B virus surface antigen (HBsAg) and total HBV core antibody (anti-HBc) weremeasured in all specimens, and HBV e antigen (HBeAg) in those positive for HBsAg, and HBVsurface antibody (anti-HBs) were measured in all others. Current infection (HBsAg+) rates wereinfants = 12.5%, children = 18.4%, adolescents = 20.5%, and adults = 18.8%. Current or previousinfection (HBsAg+, anti-HBc+, or anti-HBs+) increased with age (infants = 19.6%, children =36.4%, adolescents = 55.3%, adults = 79.2%). Rates of HBeAg among those HBsAg+ were infants= 85.1%, children = 88.1%, adolescents = 71.1%, and adults = 30.4%. The epidemiology of HBVin Vietnam resembles that of many southeast Asian nations before introduction of vaccine.Immunization of newborns will have enormous impact on HBV-related morbidity and mortalitythere.19
Page 1 and 2: Pre-meeting documentPrevention and
Page 3 and 4: Part I Prevention and control of pe
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Page 7 and 8: clusters (obstetrics wards/hospital
Page 9 and 10: Boxall E. Screening of pregnant wom
Page 11 and 12: Chang MH, Hsu HY, Huang LM, Lee PI,
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Page 15 and 16: Eriksen EM, Perlman JA, Miller A, M
Page 17: liver enzyme abnormalities than wer
Page 21 and 22: HBsAg and anti-HBs in 4.5%. In the
Page 23 and 24: immunoprophylaxis. Reflecting effec
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Page 27 and 28: Delaying vaccination of premature i
Page 29 and 30: diagnosis. In the past, the inciden
Page 31 and 32: shows that the prevalence of HBV in
Page 33 and 34: Niu MT, Targonski PV, Stoll BJ, Alb
Page 35 and 36: Ranger-Rogez S, Alain S, Denis F. H
Page 37 and 38: vaccinees) and low reactogenicity o
Page 39 and 40: single ELISA test is about Rs40. At
Page 41 and 42: newborns with surface antigenemia,
Page 43 and 44: Wang Z, Zhang J, Yang H, Li X, Wen
Page 45 and 46: of hepatitis B vaccine. This study
Page 47 and 48: transmission has been estimated at
Page 49 and 50: at birth and 2 weeks after birth, f
Page 51 and 52: Chubinishvili OV, Mikhailov MI, Sak
Page 53 and 54: Jensen L, Heilmann C, Smith E, Want
Page 55 and 56: Onishchenko GG. Incidence of infect
Page 57: Zanetti A, Tanzi E, Semprini AE. He

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