Interim Results From Women and Infants Enrolled in the Enhanced Perinatal Hepatitis B Case Management Project, United States January 2008 - May 2009

Background:   Case management (hepatitis B vaccine [HepB] series and hepatitis B immune globulin [HBIG] beginning at birth, and post-vaccination serology) can prevent ~95% hepatitis B virus (HBV) infections among infants born to hepatitis B surface antigen-positive (HBsAg+) women. The Enhanced Perinatal Hepatitis B Case Management Project is a pilot program to assess the effectiveness of case management and characterize the population at risk by obtaining data at the individual level (de-identified).  The program is conducted in 5 jurisdictions where 20% of US births to HBsAg+ women occur (2006 estimates). 

Objectives:   To describe the HBsAg+ women and risks for perinatal HBV infection in select US jurisdictions.

Methods:   Core clinical and expanded program data elements were collected and reported to CDC between January 2008 and May 2009.  Data collection at the city, county, and/or state level began in 2008; analysis was using SAS.

Results:  During the reporting period, 4359 HBsAg+ pregnant women were enrolled;   median age was 29 years (range, 11-54 years); 52% were Asian/Pacific Islanders. Hepatitis B e antigen (HBeAg) status was reported for 511(12%); 156 (4%) of those enrolled were reported HBeAg-positive. To date, 3092 infants have been born; 120/1507 (8%) infants with information weighed <2000 grams.  Among infants with data, 1625/1664 (98%) received HepB and HBIG ≤24 hours of birth (98% within 12 hours); 2984/3092 (97%) received both HBIG and HepB (85% within 1^st calendar day of life). Among 328 infants with post-vaccination serology reported, 304 (93%) were immune, 20 (6%) remained susceptible, and 4 (1%) had chronic HBV infection.  The maternal HBeAg status was positive for 2 HBsAg+ infants and unknown for 2 HBsAg+ infants.

Conclusions:   Significant challenges remain to improve the quality of data needed to optimize prevention of perinatal HBV infection. Analysis of pooled data from different jurisdictions may help guide and improve case management.