Low Hepatitis B (HBV) Knowledge among Perinatal Health Care Providers Serving County with Nation's Highest Rate of Births to Mothers Chronically Infected with HBV

Background:
Despite ACIP recommendations for routine infant HBV immunoprophylaxis since 1991, approximately 800 infants each year still become chronically infected.

Objectives:
To assess first-line perinatal health care providers' (obstetricians/gynecologists, ObGyn; peripartum nurses, PRN) HBV knowledge and ACIP recommended management of HBsAg+ pregnant patients.

Methods:
Between July and October, 2008, questionnaires were mailed or administered in person to 331 practicing ObGyn and 31 PRN in Santa Clara County, CA

Results:
One hundred ObGyn and 31 PRN participated in the study. Ninety-eight percent of ObGyns reported routinely testing pregnant women for HBsAg, and most reported advising HBsAg+ women that their newborns should receive both the HBV vaccine (94%) and hepatitis B immunoglobulin (92%) within 12 hours of birth. However, knowledge about HBV was low. Only 33% of ObGyn and 17% of PRN recognized that up to 90% of newborns infected perinatally could develop chronic HBV infection without immunoprophylaxis. Only 22% and 37%, respectively, were aware of the mortality risks associated with chronic HBV infection. In addition, only 44% ObGyn routinely inform pregnant women that their infants need to complete the HBV vaccine series, and even fewer (14%) recommended post-vaccination serologic testing for infants born to HBsAg+ mothers. In a county where over 90% of HBsAg+ pregnant women were Asian, just 26% and 10%, respectively, recognized the high prevalence of chronic HBV infection in Asians. Only 45% of ObGyn and PRN provided educational information about HBV to HBsAg+ patients.

Conclusions:
This study demonstrates that major gaps in HBV knowledge exist in first-line perinatal health care providers who are key in implementing national strategies to eliminate perinatal HBV transmission. Most providers do not provide HBV education to their HBsAg+ patients. Improving HBV knowledge of OBGyn and PRN may be an important strategy that will help to eliminate the risk of perinatal HBV transmission.