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A new set of recommendations on hepatitis B (HBV) advocates universal screening tests and vaccines to limit the potentially life-threatening disease that can infect newborns or mothers.
Previously, the US Task Force on Prevention Services (USPSTF) had made recommendations for screening for HBV infection in pregnant women. New evidence however shows that the 2009 recommendations should be updated to include serological tests for hepatitis B surface antigen (HBsAg), which accurately identify the potential infection.
The investigators, led by Douglas K. Owens, MD, also said that interventions and case management were effective in preventing perinatal transmission and that the 2009 recommendation for HBV screening effectively reduced potential infections.
"Screening for HBV infection during pregnancy identifies women whose infants are at risk of perinatal transmission," the authors wrote. "The USPSTF has found compelling evidence that universal prenatal screening for HBV infection significantly reduces perinatal HBV transmission and the subsequent development of chronic HBV infection."
The USPSTF also recommends vaccinating all infants against HBV while providing at birth post-exposure prophylaxis with hepatitis B immunoglobulin (HBIG) to infants whose mothers are infected with HBV.
They have not found evidence that HBV screenings are harmful to pregnant women, concluding that the net benefit of HBV testing is substantial with high certainty.
Overall recommendations include screening during each pregnancy at the first antenatal visit, regardless of vaccination history or negative HBsAg test results, while women with unknown HBsAg status or risk are new or persistent need to be tested upon admission to the hospital. or other delivery parameter.
Treatment includes screening of all pregnant women and vaccination of infants born to HBV negative mothers within 24 hours of birth, completing the series of vaccines within 18 months.
In HBV-positive mothers, case management would include HBV DNA viral load testing and referral to specialized care for counseling and medical management of HBV infection.
Current guidelines recommend vaccination against HBV and prophylaxis against HBIG within 12 hours of birth, while the vaccine series is completed within 8 months and serological tests of infection and immunity are performed. between 9 and 12 months.
In a research letter accompanying the recommendations, researchers at the Kaiser Permanente Center for Health Research in Oregon, led by Jillian Henderson, PhD, MPH, conducted a literature search in common databases including 5688 titles. and abstracts and 499 full-text articles from 1986. to find evidence of the effectiveness of HBV testing and case management programs.
In one study, the team found that 155,081 infants born with HBV were badigned to care through the US Centers for Disease Control's (CDC) Hepatitis B Prevention Program, which was implemented from 1994 to 2008.
The investigators uncovered the case management results for 4446 infants born to HIV-positive women in the United States from 1997 to 2010 in a second study.
In both studies, researchers observed low rates (0.5% to 1.9%) of perinatal transmissions, with reductions over time.
Over the past three decades, it has been common practice to screen HBV in pregnant women to identify women at risk of transmitting infection to their child and to provide effective prophylactic interventions in a timely manner. , usually through case management programs using evidence-based protocols.
Neonatal vaccines and hepatitis B immunoglobulins can effectively prevent perinatal transmission.
A nationally representative sample revealed 85.8 cases of maternal HBV infection per 100,000 deliveries in the United States between 1998 and 2011. Despite universal vaccination guidelines, the number of maternal HBV infections has increased by 5.5% per year since 1998. Currently, 26 states require prenatal screening.
HBV causes chronic infections in 80 to 90% of infants infected with the virus, leading to long-term or life-threatening health complications including cirrhosis, liver failure and hepatocellular carcinoma.
One of the reasons for the surge in universal testing is that known risk factors are only present in 35-65% of pregnant women with HBV.
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