Preventing perinatal hepatitis B transmission: An evaluation in Pinellas County, Florida

Background: Without timely administration of immunizations, perinatal transmission of the hepatitis B virus (HBV) carries an elevated risk of resulting in chronic infection. An evaluation was conducted for the Pinellas County Health Department to assess compliance to the Advisory Committee on Immunization Practices (ACIP) recommendations and to determine factors associated with delaying vaccinations.

Methods: From 2000-2009, 220 newborns of hepatitis B surface antigen (HBsAg) positive women were analyzed from state databases. Sociodemographic predictors of delayed vaccination administration were determined with log-binomial regression models while prevalence rates and survival plots were used to describe vaccination coverage.

Results: All infants received the birth dose and second dose of the vaccine. For the second and third vaccine doses, 67.7% and 77.3% infants were vaccinated on time, respectively. Infants whose mother did not receive prenatal care are at a higher risk of delaying the second dose (RR= 2.48, 95%CI= 1.47-4.20) while those lacking another sexually transmitted disease were at a lower risk of delaying the third dose (RR=0.51, 95%CI= 0.32-0.82). Compared to U.S.-born mothers, foreign-born mothers more often adhered to prenatal care appointments (P <0.001) and postvaccination testing of their infants (P= 0.0362). Among household contacts, 6.8% were found to be HBsAg-positive with prevalence rates highest among siblings (20%, P= 0.0002).

Conclusion: Perinatal HBV transmission resulted in only two infants becoming infected. However, efforts to ensure timely immunizations by enhanced case management with emphasis on prenatal care are warranted to optimize protection and mitigate risks that might result from late vaccinations.