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Schmidt N, Rios J, Alpert L, Mageras A, Lieb W, Kushner T. Hepatitis B Triple Panel Testing Implementation in the Obstetric Care Setting: Unique Predictors of Hepatitis B Virus Vaccine Immunity, Exposure, and Positivity. Open Forum Infect Dis 2024; 11:ofae632. [PMID: 39540121 PMCID: PMC11558448 DOI: 10.1093/ofid/ofae632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Accepted: 10/22/2024] [Indexed: 11/16/2024] Open
Affiliation(s)
- Natalia Schmidt
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jeanette Rios
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lauren Alpert
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anna Mageras
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Whitney Lieb
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Affiliation(s)
- Yunshan Chen
- Guangzhou Key Laboratory of Maternal-Fetal Medicine, Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Rong Fan
- Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lele Wang
- Guangzhou Key Laboratory of Maternal-Fetal Medicine, Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Abraham Nick Morse
- Department of Community Medicine, Tufts University School of Medicine, Boston, USA
| | - Huishu Liu
- Guangzhou Key Laboratory of Maternal-Fetal Medicine, Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Pinon M, Giugliano L, Rocchi F, Cananzi M, Auriti C, Wade B, Calvo PL, Giaquinto C, Indolfi G. Inadequate Hospital Practices to Prevent Mother-to-Child Transmission of Hepatitis B Virus Infection: A European Survey. J Pediatr Gastroenterol Nutr 2023; 76:716-722. [PMID: 36930981 DOI: 10.1097/mpg.0000000000003765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
OBJECTIVES Prevention of vertical transmission of hepatitis B virus (HBV) infection is crucial to eliminate viral hepatitis as a major public health threat by 2030. We aimed to assess the current hospital policies and practices implemented before, at, and after birth, and to evaluate potential barriers to the full application of international guidelines. METHODS A web-based survey was supported by PENTA Foundation and distributed across Europe from October to December 2021. RESULTS Overall, 76 centers with delivery departments completed the survey. Hepatitis B surface antigen (HBsAg) maternal screening is performed in the first trimester of pregnancy in 53% of the centers and in the third in 46%. HBsAg positive pregnant women are tested for serologic HBV markers and HBV-DNA in 78% and 63% of the departments; 38% of the HBeAg positive women with high HBV-DNA levels are treated during the last trimester of pregnancy. At birth, 91% of the departments administer HBV vaccine to infants born to HBsAg positive mothers within 12 hours of birth; 74% test women with unknown HBsAg status and 78% of them wait for the maternal testing results before administering HBV vaccine to their newborns. After birth, 47% of the departments provide postvaccination serological testing for infants born to HBsAg positive mothers. The timing of the HBV vaccine schedule varies greatly. CONCLUSIONS There is significant heterogeneity in the hospital policies and correlated procedures. The implementation of a multidisciplinary clinical pathway is a must if a stronger connection between the prenatal, perinatal, and postnatal phases is to be established.
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Affiliation(s)
- Michele Pinon
- From the Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Laura Giugliano
- From the Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Francesca Rocchi
- the Center of Excellence for the Development and Implementation of Medicines, Vaccines, and Medical Devices for Pediatric Use, INCiPiT Italian Network For Pediatric Clinical Trials, Bambino Gesù Children's Hospital IRCCS, Roma, Italy
| | - Mara Cananzi
- the Unit of Gastroenterology, Digestive Endoscopy, Hepatology and Care of Children with Liver Transplantation, University Hospital of Padova, Padova, Italy
| | - Cinzia Auriti
- the Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant, Bambino Gesù Children's Hospital IRCCS, Roma, Italy
| | - Barbara Wade
- the Faculty of Medicine, University of Turin, Turin, Italy
| | - Pier Luigi Calvo
- From the Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Carlo Giaquinto
- the Department of Women and Child Health, University of Padova, Padova, Italy
- PENTA Foundation, Padova, Italy
| | - Giuseppe Indolfi
- the Pediatric and Liver Unit, Meyer Children's University Hospital of Florence, Firenze, Italy
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Pressman K, Ros S. Management of Hepatitis B and C during Pregnancy: Neonatal Implications. Neoreviews 2023; 24:24-30. [PMID: 36587010 DOI: 10.1542/neo.24-1-e24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Over the last several decades, we have seen increased rates of infants born to persons with chronic hepatitis B virus (HBV) and hepatitis C virus (HCV). Due to this, many obstetric and pediatric organizations have updated their guidelines about screening and management of HBV and HCV during pregnancy, as well as the management of the exposed infant. Current guidelines suggest that all pregnant individuals should be screened for both HBV and HCV during each pregnancy. Appropriate medical care of pregnant persons and the newborn can significantly reduce the risk of vertical transmission.
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Affiliation(s)
- Katherine Pressman
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL
| | - Stephanie Ros
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL
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Blagden S, Newell K, Ghazarians N, Sulaiman S, Tunn L, Odumala M, Isba R, Edge R. Interventions delivered in secondary or tertiary medical care settings to improve routine vaccination uptake in children and young people: a scoping review. BMJ Open 2022; 12:e061749. [PMID: 35918116 PMCID: PMC9351315 DOI: 10.1136/bmjopen-2022-061749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 07/13/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To identify and analyse the interventions delivered opportunistically in secondary or tertiary medical settings, focused on improving routine vaccination uptake in children and young people. DESIGN Scoping review. SEARCH STRATEGY We searched CINAHL, Web of Science, Medline, Embase and Cochrane Database of Systematic Reviews for studies in English published between 1989 and 2021 detailing interventions delivered in secondary or tertiary care that aimed to improve childhood vaccination coverage. Title, abstract and full-text screening were performed by two independent reviewers. RESULTS After deduplication, the search returned 3456 titles. Following screening and discussion between reviewers, 53 studies were included in the review. Most papers were single-centre studies from high-income countries and varied considerably in terms of their study design, population, target vaccination, clinical setting and intervention delivered. To present and analyse the study findings, and to depict the complexity of vaccination interventions in hospital settings, findings were presented and described as a sequential pathway to opportunistic vaccination in secondary and tertiary care comprising the following stages: (1) identify patients eligible for vaccination; (2) take consent and offer immunisations; (3) order/prescribe vaccine; (4) dispense vaccine; (5) administer vaccine; (6) communicate with primary care; and (7) ongoing benefits of vaccination. CONCLUSIONS Most published studies report improved vaccination coverage associated with opportunistic vaccination interventions in secondary and tertiary care. Children attending hospital appear to have lower baseline vaccination coverage and are likely to benefit from vaccination interventions in these settings. Checking immunisation status is challenging, however, and electronic immunisation registers are required to enable this to be done quickly and accurately in hospital settings. Further research is required in this area, particularly multicentre studies and cost-effectiveness analysis of interventions.
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Affiliation(s)
- Sarah Blagden
- Lancaster University Faculty of Health and Medicine, Lancaster, UK
- Health Education England North West Liverpool, Liverpool, UK
| | - Kathryn Newell
- Lancaster University Faculty of Health and Medicine, Lancaster, UK
- Health Education England North West Liverpool, Liverpool, UK
| | - Nareh Ghazarians
- Lancaster University Faculty of Health and Medicine, Lancaster, UK
| | - Sabrena Sulaiman
- Lancaster University Faculty of Health and Medicine, Lancaster, UK
| | - Lucy Tunn
- Lancaster University Faculty of Health and Medicine, Lancaster, UK
| | - Michael Odumala
- Lancaster University Faculty of Health and Medicine, Lancaster, UK
| | - Rachel Isba
- Lancaster University Faculty of Health and Medicine, Lancaster, UK
| | - Rhiannon Edge
- Lancaster University Faculty of Health and Medicine, Lancaster, UK
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Abstract
Hepatitis B virus infection remains a global public health problem with changing epidemiology due to several factors including vaccination policies and migration.
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Affiliation(s)
- Issam Tout
- Université de Paris, Centre de Recherche sur l'inflammation, Inserm U1149, CNRS ERL8252, 16 rue Henri Huchard, F-75018 Paris, France; Department of Hepatology, AP-HP, Hôpital Beaujon, 100 boulevard du Général Leclerc, F-92110 Clichy, France
| | - Dimitri Loureiro
- Université de Paris, Centre de Recherche sur l'inflammation, Inserm U1149, CNRS ERL8252, 16 rue Henri Huchard, F-75018 Paris, France; Department of Hepatology, AP-HP, Hôpital Beaujon, 100 boulevard du Général Leclerc, F-92110 Clichy, France
| | - Tarik Asselah
- Université de Paris, Centre de Recherche sur l'inflammation, Inserm U1149, CNRS ERL8252, 16 rue Henri Huchard, F-75018 Paris, France; Department of Hepatology, AP-HP, Hôpital Beaujon, 100 boulevard du Général Leclerc, F-92110 Clichy, France.
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Timely Birth Dose Vaccine to Prevent Vertical Transmission of Hepatitis B: A Single Center Experience on the Road to the WHO Elimination Goals in Italy. Vaccines (Basel) 2021; 9:vaccines9070801. [PMID: 34358216 PMCID: PMC8310039 DOI: 10.3390/vaccines9070801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 12/05/2022] Open
Abstract
Italy was one of the first industrialized countries to implement a program of routine vaccination against hepatitis B virus (HBV) infection. However, currently, no HBV vaccine is administered at birth if the screened mother is HBsAg negative, whilst babies born to HBsAg positive mothers are given vaccine and hepatitis B immunoglobulin, within 12–24 post-delivery hours. A single center retrospective analysis of policies and practices to prevent mother-to-child transmission of HBV was carried out, to evaluate their adherence to HBV care guidelines. Paired maternal-infant medical records for consecutive live births, between January 2015 and December 2019, were reviewed at the AOU Città della Salute e Scienza di Torino, where a total of 235/35,506 babies (0.7%) were born to HBsAg positive mothers. Markers of active viral replication, i.e., HBV DNA level and/or HBeAg, were reported in only 66/235 (28%) of the mothers’ medical records. All newborns had immunoprophylaxis at birth: 61% at <12 h, 31% between 12 and 24 h, 7% between 24 and 36 h and 1% at >36 h. In 2019, two cases of vertical HBV transmission occurred, despite timely immunoprophylaxis, as their mothers’ viral load was detected too late for antiviral prophylaxis. Missed early identification of pregnant women with high viremia levels or late vaccinations may contribute to perinatal HBV infection. Immunoprophylaxis should be given to babies born to HBsAg positive mothers at the latest within 12 h. In Italy, policies aimed at achieving the WHO 2030 goal of eliminating viral hepatitis should be further implemented.
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