[Vertical HBV transmission in Jerusalem in the vaccine era]

We evaluated the vertical transmission of hepatitis B virus (HBV) in the vaccine era after 1992.

A cross-sectional descriptive study was conducted in the year 2005-2006 at Clalit Health Services, Jerusalem. Children at age > or = 1 year born after 1992, with HBsAg positive mothers, were evaluated.

A total of 22,683 HBsAg tests were performed for 20,415 patients (11,186 Jewish and 9,229 Arabs). The prevalence of positive HBsAg was 2.64% (95% CI, 2.43-2.87] among the general Jerusalem population. It was 3.9% among the Arab population (95% CI, 3.34-4.34), compared to 1.59% [95% CI, 1.37-1.84) among the Jewish population. Data from fertile women aged 18-44 years, showed a prevalence of HBV carrier state of 1.7% (total); 2.84% (95%CI, 2.43-3.3) in Arab women as compared to 0.66% [95% CI, 0.48-0.9) among Jewish women. Of 164 Arab positive HBsAg women, we identified 157 mothers for 409 children at age > or = 1 year born after 1992. Data for 188 children of 70 mothers was collected. The prevalence of vertical infection among the child cohort (positive anti-HBc) as well as the prevalence of chronic infection [positive HBsAg) were 8.4% (95% CI, 4.71-13.1) and 4.4% (95% CI, 1.8-7.6], respectively; 37.1% of these children had negative anti-HBs titters, compared to 41.4% with antiHBs 11-100 mlU/ml and only 21.5% with titters above antiHBs 100 mLU/mL; 48% (23/48) children received passive-active vaccine combination; 35% (17/48) children received only active vaccination; 12.5% (6/48) were born to mothers prior to HBV infection diagnosis and received only the active vaccine; 4.5% (2/48) received no vaccination at all.

HBV vertical transmission is highly prevalent in our tested Arab cohort, in spite of the universal vaccination program, suggesting its failure. Improvement of physician awareness and double vaccination of infants of carrier mothers will likely reduce the vertical transmission.