Could New Perinatal Hepatitis B Prevention Laws Save Infants from Premature Death?

*Updated on 12/05/2016 at 11:06 AM EST

Because mother-to-child transmission (MTCT) of hepatitis B virus (HBV) is considered preventable, the standard of care in the United States is to screen pregnant women for HBV. Identification of HBV-positive pregnant women is all the more important because then healthcare providers can administer postexposure prophylaxis (PEP) to HBV-exposed infants as soon as possible. Post-exposure prophylaxis can prevent MTCT and ultimately save a child’s life; however, the window of opportunity to administer it is very small.

In 90% of infants, HBV progresses into chronic HBV, and 25% of these infants end up dying due to liver failure or liver cancer. By administering PEP to HBV-exposed infants within 12 hours after birth, 95% of cases of MTCT can be prevented. With the idea that laws pertaining to screening and reporting may increase identification of HBV in pregnant women, thereby allowing for more exposed infants to receive PEP, in 2014, researchers from the Centers for Disease Control and Prevention’s Public Health Law Program took a closer look at laws within the United States and the District of Columbia, current through December 31, 2013, related to HBV infection in general and HBV-positive pregnant women in particular.

The questions that the researchers sought to answer were:

• Does the jurisdiction require screening of pregnant women specifically for HBV infection or hepatitis B surface antigen (HBsAg)?

• Does the jurisdiction require reporting of HBV infection or HBsAg in pregnant women?

• Does the jurisdiction require general reporting of HBV infection?

• Does the jurisdiction require reporting the pregnancy status of women who have HBV infection or who test positive for HBsAg?

In order to explore all of the different laws and statutes pertaining to the screening and reporting of HBV infection, the researchers used WestLawNext, a legal research service. They found that although all states require HBV cases to be reported, only 26 require HBV screening for pregnant women. Additionally, whereas 23 states require public health reporting of pregnant women who test positive for HBV, only 12 require reporting pregnancy status in HBV-positive women. Not knowing that status makes it harder for the healthcare community seeking to reduce MTCT of HBV, such as through the Perinatal Hepatitis B Prevention Program, whose goal is to identify and assist all HBV-positive pregnant women within their particular jurisdiction. According to the authors, there were a number of limitations to their assessment: the researchers did not closely analyze the adherence of each state to these laws and statutes, nor did they note that a number of the laws may have changed since their assessment.

The authors concluded, “As new laws are considered to reduce MTCT of HBV infection, several provisions to increase the effectiveness of screening and reporting could be considered. Requiring all pregnant women to be screened for HBsAg at either the initial prenatal visit or at admission for delivery if there is no record of test results, and reporting pregnancy status in HBsAg-positive women, could increase the number of women identified for prenatal intervention. Further, requiring reporting of positive test results within 1 day could increase the number of women identified in time for intervention.”

With new laws that focus on increasing the identification of HBV-positive pregnant women, public health officials can intervene within the limited window of opportunity they have and ultimately save a number of infants from HBV-related deaths.