Assessment of hepatitis B screening, vaccination and documentation in California birth hospitals

Background

To prevent perinatal transmission of hepatitis B virus (HBV), the Advisory Committee on Immunization Practices (ACIP) recommends that: 1) all pregnant women be screened for hepatitis B surface antigen (HBsAg); 2) a HBsAg lab report copy be provided to the delivery hospital; 3) infants of HBsAg-positive mothers receive hepatitis B immunoglobulin (HBIG) and the first HBV vaccine dose within 12 hours of birth; and 5) all infants receive HBV vaccine before discharge.

Methods

The medical records of 3381 randomly-selected mother and infants from the 2006 California birth cohort in 33 birth hospitals were reviewed to evaluate adherence to the ACIP recommendations.

Results

Of 1688 maternal records reviewed, 1627 (96.4%) women had documentation of HBsAg status. HBsAg status documentation consisted of copies of prenatal records in 1301 (80.0%) records; only 480 (29.5%) records contained a copy of the HBsAg laboratory report. Of 1693 infant records reviewed, 1502 (88.7%) had documented maternal HBsAg status. Only 109 of 128 (85.28%) infants born to HBsAg-positive women had date/time documented administration of HBIG and HBV vaccine within 12 hours of birth. Of 21 hospitals with a universal birth dose policy, 920 (79.2%) infants received the birth dose versus 149 (28.1%) infants born in a hospital without a universal birth dose policy.

Conclusion

Although pregnant women are screened for HBsAg during pregnancy, maternal HBsAg status is moderately documented in the infant records and copies of HBsAg laboratory results are rarely provided; increasing the possibility that infants of HBV-infected mothers are not given appropriate post-exposure prophylaxis.