Mothers passing on HBV to children due to patchy hospital policies across Europe

A recent European survey has found major discrepancies and gaps in hospital policies and procedures to prevent the direct transmission of hepatitis B virus (HBV) from mother to child, particularly before and after birth.

“This survey provides a strong indication that significant variance and gaps exist in hospital policies and procedures to prevent direct mother-to-child transmission of HBV across Europe,” said lead author Michele Pinon from the University of Turin, Italy.

The survey was supported by Penta Foundation and distributed by INCIPIT (Italian Network for Paediatric Clinical Trials) across Italy and all European countries through the Network of European National Hubs, the linked clinical sites, from 1–30 October 2020.

Seventy-six delivery hospitals (45 from Italy and 31 from nine other European countries, namely Spain, Portugal, Turkey, Macedonia, UK, France, Belgium, Switzerland, and Austria) completed the survey, and the results were presented at the 6th World Congress of Paediatric Gastroenterology, Hepatology and Nutrition (WCPGHAN 2021).

Three in four responders (75 percent) were from neonatal intensive care units with more than 1,000 deliveries per year. On average, the number of hepatitis B surface antigen (HBsAg)-positive women was between 10 and 50 per year in 47 percent and >50 per year in 5.3 percent of the centres, most of which (88 percent) had a written protocol to prevent mother-to-child transmission of HBV. [WCPGHAN 2021, abstract H-O-035]

Before birth, 53 percent of responders performed HBsAg screening in the first trimester of pregnancy and 46 percent in the third trimester. HBsAg-positive pregnant women underwent testing for serologic HBV markers and HBV DNA in 78 percent and 63 percent of the centres, respectively. During the last trimester, only 38 percent of HB e-antigen–positive women with high HBV-DNA levels were treated. Seventy-six percent of the centres tested HBsAg-positive women for HCV.

Infants born from HBsAg-positive mothers received HBV vaccine in 91 percent of the centres within 12 hours of birth. Women with unknown HBsAg status were tested at hospital admission in 74 percent of the centres; in 78 percent, the result of maternal testing was waited for prior to HBV vaccine administration to newborns.

Of note, postvaccination serological testing of infants born from HBsAg-positive mothers was provided in only 47 percent of the centres. In addition, there was inconsistency across all centres as regards the timing of HBV vaccine schedule.

“The new survey … discovered that postvaccination testing of infants from HBV positive mothers is provided in less than half of centres, even though 10–20 percent of vaccinated infants still acquire HBV when their mothers had high levels of the virus,” the researchers said in a statement. “This means that infected children, despite being immunized, may not be diagnosed.”

This finding is noteworthy in cases where the identification of HBV status happens in the third trimester, which may be too late to initiate antiviral therapy in women with high HBV-DNA levels, they added.

“There is a clear need to implement a multidisciplinary clinical pathway involving obstetricians, neonatologists, and hepatologists, with a stronger connection between the phases before, during and after birth,” Pinon said.