Preventing hepatitis B: focus on women and their families

Infections contracted during infancy or childhood are responsible for 42 percent of case of chronic hepatitis B disease, and in 25 percent or more these infections result in death from hepatoma or cirrhosis during adulthood. Hepatitis B vaccine and immune globulin provide the means of preventing the disease and its sequelae, but their proper use requires clinical strategies for deciding which patients are at risk and which responses are appropriate for family practice.

A MEDLINE search of the literature pertaining to hepatitis B and its prevention, a review from the Centers for Disease Control (CDC), and critique by both practitioners and members of the CDC Hepatitis Branch led to the development of the clinical guidelines reported in this review.

Women at high risk for hepatitis B should be screened, including during pregnancy, by testing for hepatitis B core antibody. Those at low risk should be screened by testing for hepatitis B surface antigen. Susceptible high-risk women should be vaccinated; pregnancy is not a contraindication. Administration of hepatitis B immune globulin and vaccine to newborns is 95 percent effective in preventing transmission from a hepatitis B-infected mother. Follow-up vaccination is critical. Prophylaxis of contacts can include hepatitis B immune globulin and vaccination with or without previous testing, depending on age group and risk. Testing for hepatitis B surface antibody to assess development of immunity after vaccination is indicated only for those with ongoing exposure.