Prevention of Perinatal Transmission of Hepatitis B Virus: Assessment Among Wisconsin Maternity Hospitals.

PURPOSE To evaluate the completeness of identification of pregnant women testing positive for hepatitis B surface antigen (HBsAg) and birth dose hepatitis B vaccine administration, and the extent of appropriate prophylaxis of infants born to women with and without maternal HBsAg status documented in the infant medical record. METHODS We conducted medical record reviews of 3058 maternal and infant pairs at 58 Wisconsin maternity hospitals that cumulatively delivered 90% of Wisconsin's 2010 birth cohort. RESULTS A documented HBsAg test result for the current pregnancy was included in 2928 (95.7%) of maternal records, and in 2676 (87.5%) infant records. Four infants (15%) were born to HBsAg-positive women; all 4 infants received appropriate prophylaxis: hepatitis B immunoglobulin (HBIG) and a dose of hepatitis B vaccine within 12 hours of birth. However, among 382 infants without a documented maternal HBsAg test result in the infant medical record, only 135 (35%) received appropriate prophylaxis: a dose of hepatitis B vaccine within 12 hours of birth or a dose of hepatitis B vaccine and HBIG within 12 hours of birth for infants weighing < 2000 g. Among all infants, 81.6% received hepatitis B vaccine prior to hospital discharge. CONCLUSIONS Hospitals must ensure that infants without a documented maternal HBsAg test result receive appropriate prophylaxis to prevent hepatitis B vaccine infection. All infants, regardless of maternal HBsAg test result, should receive a dose of hepatitis B vaccine before hospital discharge to serve as a "safety net" to prevent infection among infants born to HBsAg-positive women who are not identified prenatally. A written hospital policy for universal hepatitis B vaccine birth dose administration should be developed to reinforce admission orders.