Progress Report on the Perinatal Hepatitis B Prevention Program, 1999-2008

Background: Infants born to hepatitis B surface antigen (HBsAg)-positive mothers have a 90% risk of chronic infection and a 25% risk of premature liver failure or cancer.   Post-exposure prophylaxis (PEP) (hepatitis B immune globulin [HBIG] and hepatitis B vaccine [HepB] at birth), with completion of the HepB series, decreases an infant’s risk of infection by 85%-95%.  In 1990, the Centers for Disease Control and Prevention (CDC) established the Perinatal Hepatitis B Prevention Program (PHBPP) and funded programs in 64 jurisdictions (including 50 states and six cities) to identify and case manage infants at risk of perinatal hepatitis B infection.

Objectives: To determine outcomes of the PHBPP from 1999-2008.

Methods: CDC annually estimates the number of births to HBsAg-positive mothers by jurisdiction.  PHBPP submits annual reports of the number of identified HBsAg-positive mothers, infants who received PEP, completion of the HepB series, and post-vaccination testing for exposed infants. Data from these reports were analyzed for all participating jurisdictions over time.

Results: From 1999-2008, the annual number of expected births to HBsAg-positive mothers steadily increased (20,056 to 24,623, p<0.001); however only half of these cases are being identified.  On average, 98.4% of identified infants entered case management annually, and 95.0% of these infants received PEP.  The percentage of infants who completed the HepB series by age 12 months decreased from 80.0% in 1999 to 78.0% in 2008 (p=0.01).  Infants lost-to-follow-up decreased from 2004-2008 (26.4% to 12.8%), but the difference was not significant.  Post-vaccination testing steadily increased from 41.0% to 56.0% over the ten-year period (p<0.001).  Annual incidence of perinatally-acquired chronic hepatitis B infection decreased from 1999-2008 (1.9%-0.8%, p=0.001).  

Conclusions: Substantial progress has been made in the prevention of perinatal hepatitis B infection.  Additional efforts are needed to improve identification of the increasing number of HBsAg-positive pregnant women and complete case management of their infants.