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Continuing risk for hepatitis B virus transmission among Southeast Asian infants in Louisiana
F J Mahoney1, M Lawrence, C Scott
1Hepatitis Branch, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Insights
Hepatitis B virus (HBV) infection is transmitted throughout childhood in Southeast Asian children in Louisiana, with chronic infection rates nearing those of their country of origin. Enhanced vaccination efforts are crucial for all Asian and Pacific Islander infants and children to prevent widespread HBV transmission.
Area of Science:
- Public Health
- Infectious Diseases
- Vaccinology
Background:
- Hepatitis B virus (HBV) infection poses a significant health risk, particularly in Asian and Pacific Islander communities.
- Understanding transmission patterns in US-born Southeast Asian children is vital for effective prevention strategies.
Purpose of the Study:
- To implement and evaluate a hepatitis B vaccination program for Southeast Asian infants in Louisiana.
- To assess HBV seroprevalence and vaccination coverage in this population.
Main Methods:
- A baseline seroprevalence survey of HBV infection was conducted in 1991.
- Hepatitis B vaccination and postvaccination serologic testing were performed on children 10 years and younger.
- A vaccination coverage survey was conducted 18 months after vaccine integration into infant schedules.
Main Results:
- In 1991, 4.1% of US-born Southeast Asian children in Louisiana had chronic HBV infection, with transmission occurring throughout childhood.
- Chronic HBV infection prevalence increased with age, particularly in children living with carriers.
- Vaccination coverage in July 1993 was 43% for infants 9-18 months; private provider immunizations were more effective.
Conclusions:
- HBV transmission is prevalent in US-born Southeast Asian children, mirroring rates in their countries of origin.
- Low hepatitis B vaccine uptake was observed in this population prior to enhanced efforts.
- Enhanced prevention efforts, including timely vaccination for all infants and older children, are essential for Asian and Pacific Islander communities.
Objective:
Implementation and evaluation of a hepatitis B vaccination program for Southeast Asian infants in Louisiana.
Methods:
A baseline seroprevalence survey of hepatitis B virus (HBV) infection in US-born Southeast Asian children was conducted in 1991 before the implementation of a vaccination program. Hepatitis B vaccination and postvaccination serologic testing of survey participants 10 years of age and younger was performed. Eighteen months after the hepatitis B vaccine was integrated into infant immunization schedules in July 1993, a vaccination coverage survey was performed.
Results:
Baseline serologic testing was conducted on 96% of persons from 225 randomly selected households in a Southeast Asian community in Louisiana. Of 676 US-born children, 28 (4.1%) had chronic HBV infection; 61% of children with chronic HBV infection were born to hepatitis B surface antigen (HBsAg)-negative women. Among children born to HBsAg-negative women, the prevalence of chronic HBV infection increased with age, reaching 7.3% for children 13 to 16 years of age. Children born to HBsAg-negative women and living with carriers were 5.4 times more likely to have evidence of HBV infection than were children who did not live with carriers. Before the survey, only one child had received three doses of hepatitis B vaccine. In July 1993, 43% of Southeast Asian infants 9 to 18 months of age born in Louisiana had received three doses of hepatitis B vaccine. Infants who received immunizations from private providers were more likely to be fully vaccinated than were infants who received services from public sector clinics (prevalence ratio, 2.1; 95% confidence interval, 1.4, 3.1).
Conclusions:
HBV transmission occurs throughout childhood in US-born Southeast Asian children, and the prevalence of chronic HBV infection approaches that of the country of origin. Few US-born Southeast Asian children have received hepatitis B vaccine. Because of the high rates of early childhood HBV transmission and the high risk of chronic infection in Asian and Pacific Islander communities, prevention efforts should be enhanced to ensure that all Asian and Pacific Islander infants receive hepatitis B vaccine in the first 12 months of life and that older children are vaccinated.