Programme for preventing perinatal hepatitis B infection through screening of pregnant women and immunisation of infants of infected mothers in the Netherlands, 1989-92

BMJ 1995;311:1200-1202 (4 November)

Papers

Programme for preventing perinatal hepatitis B infection through screening of pregnant women and immunisation of infants of infected mothers in the Netherlands, 1989-92

P M Grosheide, epidemiologist,^a J M Klokman-Houweling, statistical analyst,^a M A E Conyn-van Spaendonck, epidemiologist,^a and the National Hepatitis B Steering Committee

^a Department of Infectious Diseases Epidemiology, National Institute of Public Health and Environmental Protection, Bilthoven, Netherlands

Members of the National Hepatitis B Steering Committee are listed at the end of the article.Correspondence to: Dr Klokman-Houweling, RIVM, CIE/PB 75, PO Box 1, 3720 BA Bilthoven, Netherlands.

Abstract

Objectives: To launch a programme for the prevention of perinatalinfection with hepatitis B in the Netherlands.
Design: Routine antenatal screening and intervention programme.
Setting: Community antenatal programme, the Netherlands.
Subjects: Infants of mothers who were carriers of hepatitisB detected by routine screening.
Interventions: Infants of infected mothers received hepatitisB immunoglobulin at birth and four doses of hepatitis B vaccinein conjunction with routine immunisation at 3, 4, 5, and 11months of age.
Main outcome measures: Results of screening and immunisationfrom 1989-92.
Results: The coverage of screening increased from 46% in 1989to 84% in 1992. Hepatitis B surface antigen was detected in2145 women (0.44%). The coverage of postnatal immunoprophylaxisin 1645 neonates born to mothers who were carriers of hepatitisB was 85% (1391); in 3% (42) there was a delay in administrationof immunoglobulin of over 24 hours. In 1991, 96% (537), 95%(532), 94% (525), and 87% (489) of the infants received thefirst, second, third, and fourth dose of vaccine, respectively.There was considerable variation in the timing of vaccination;17% (258) of the infants received their first dose more thantwo weeks late. Of the 59% (583) of infants who received thefourth dose more than two weeks beyond target age, 14% (141)also received their first dose too late.
Conclusions: A prevention programme for perinatal hepatitisB in an area of low prevalence, when incorporated into existinghealth care, is feasible and achieves satisfactory coveragerates. Intensive follow up is needed to improve adherence tothe immunisation schedule.

Key messages

Key messages
From 1989 a nationwide programme in the Netherlands offered passive-active immunisation against hepatitis B for the infants of mothers detected positive for hepatitis B surface antigen during routine screening. After immunoglobin at birth four doses of vaccine were offered in conjunction with routine immunisations
The coverage of screening increased from 46% of mothers in 1989 to 84% in 1992. Postnatal immunoprophylaxis was achieved in 85% of 1645 infants born to carrier mothers
By 1991, 96%, 95%, 94%, and 87% of infants received, respectively, the first, second, third, and fourth doses of vaccine, but there was considerable variation in timing
A prevention programme for perinatal hepatitis B in an area of low prevalence, incorporated into existing health care, is feasible and achieves satisfactory coverage

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