News

Hepatitis B is a significant public health challenge in Australia and many parts of the world and mother-to-child transmission (MTCT) around the time of birth is the leading cause of transmission worldwide. About 90 per cent of infants who are exposed to the hepatitis B virus (HBV) at birth and do not receive appropriate post-exposure treatment will go on to develop chronic hepatitis B (CHB), a condition that claims 800,000 lives annually across the world. The prevention of MTCT is crucial in the efforts to eliminate hepatitis B and is a key priority action in the Victorian Hepatitis B Plan 2022-2030.

In a first-of-its-kind study assessing how recording hepatitis B status affects the administration of the hepatitis B vaccine at birth, Doherty Institute researchers found that one in 20 infants born in Victoria with the highest risk of MTCT of hepatitis B are not receiving the recommended birth dose, increasing their risk of developing CHB.

The research, published in Vaccine and led by the Doherty Institute in collaboration with researchers from the Victorian Department of Health evaluated how many babies born between 2009 and 2017 from women with a record of CHB received the recommended birth dose vaccination and hepatitis B immunoglobulin (HBIG) in Victoria.

The Royal Melbourne Hospital’s Nicole Romero, an Epidemiologist at the WHO Collaborating Centre for Viral Hepatitis at the Doherty Institute, said that of the 465,000 women recorded to have given births between 2009 and 2017, nearly 4,200 women had CHB, and they were linked to more than 6,000 infant records.

“Of note, we discovered that there were inconsistent recording of mothers’ CHB status between various datasets, including the Public Health Event Surveillance System (PHESS) which records information on all notifiable diseases in Victoria, the Victorian Admitted Episodes Dataset (VAED) which collects data about hospital stays and hospital discharge summaries, and the Victorian Perinatal Data Collection (VPDC) which gathers data on the health of Victorian mothers and babies,” said Ms Romero.

“Only 28 per cent of women living with CHB were identified in all three datasets.

“Recording issues like these highlight the potential for missed diagnoses and may influence whether or not providers are aware of the mother's hepatitis B status. This may ultimately affect the opportunity to prevent the MTCT transmission of hepatitis B in Victoria.”

The analysis also identified risk factors associated with low uptake of birth dose in Victoria, included births in private hospitals, very low birth weight, NICU admission and non-obstetrics led cases.

The Royal Melbourne Hospital’s Professor Benjamin Cowie, Director of the WHO Collaborating Centre for Viral Hepatitis at the Doherty Institute, said that without coordinated care and improved data collection that reports access to interventions to prevent mother-to-child transmission for women with CHB, the actual incidence of MTCT will remain unclear.

“The goal is to enhance the care provided to Victorian women living with hepatitis B and their babies by systematically collecting and analysing healthcare data. This effort will support our broader goal to eliminate hepatitis B as a significant health issue in Victoria by 2030,” said Professor Cowie.

Peer review:  Deng A, et al. Uptake of perinatal immunoprophylaxis for infants born to women with a record of hepatitis B in Victoria (2009–2017). Vaccine (2023). DOI: 10.1016/j.vaccine.2023.01.045