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Universal prenatal screening for hepatitis B, Alberta, 1985-1988
Insights
Universal hepatitis B screening for pregnant individuals is highly effective, protecting most infants from infection. This public health approach is more efficient and cost-effective than selective testing programs.
Area of Science:
- Public Health
- Infectious Disease Prevention
- Hepatitis B Research
Background:
- Hepatitis B infection poses a significant risk to newborns.
- Early identification and intervention are crucial to prevent chronic infection and carrier states.
Purpose of the Study:
- To evaluate the effectiveness and cost-efficiency of a universal prenatal screening program for hepatitis B in Alberta.
- To compare universal screening with selective testing strategies for identifying at-risk infants.
Main Methods:
- Analysis of a cooperative public health program involving multiple healthcare entities since 1985.
- Assessment of screening data to determine the number of infected mothers and protected infants.
- Cost-effectiveness analysis comparing universal screening with a hypothetical selective testing program.
Main Results:
- Routine universal screening identifies nearly 200 infected mothers annually.
- Approximately 90% of infants born to infected mothers receive timely protection (HBIG and HB vaccine).
- Selective testing would miss at least 50% of at-risk infants and incur costs at least four times higher.
Conclusions:
- Universal prenatal screening for hepatitis B (HBsAg) is a highly cost-effective and efficient public health strategy.
- This program successfully protects a vast majority of infants from hepatitis B infection and carrier status.
- It is recommended that all jurisdictions implement similar programs, aligning with ACIP recommendations, unless hepatitis B carrier prevalence is exceptionally low.
Abstract:
A cooperative effort to identify all newborn infants at risk of acquiring hepatitis B infection involving the Canadian Red Cross BTS, Health Units, hospitals, and private doctors has been in place in Alberta since 1985. Routine universal screening of all prenatal patients identifies just under 200 infected mothers per year and about 90% of their infants receive HBIG and HB vaccine in a timely manner and are protected against infection and becoming hepatitis B carriers. At least half of these infants would not be identified if a selective testing program was in place and the cost for this much less efficient policy would be at least 4 times higher. The cost per infant protected through the universal screening program is estimated to be less than $1275. Routine screening of prenatal patients for HBsAg in a public health-coordinated program is highly cost effective and efficient. It is recommended that all jurisdictions consider such a program as recommended by the ACIP unless the hepatitis B carrier state is known to be extremely rare.