436 Preventing vertical hepatitis B transmission: a five-year overview of a UK Family Hepatitis Clinic

• Published in: Archives of disease in childhood Vol. 108; no. Suppl 2; pp. A178 - A179
• Main Authors: Elizabeth O’Mahony, Foster, Caroline, Brown, Ashley, Raghunanan, Sophie, Whittaker, Elizabeth
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.07.2023
• Subjects: Birth; Hepatitis; Hepatitis B; Immunization; Infants; Migrants; Neonates; Pediatrics; Public health; Risk groups; Serology; Tenofovir; Vaccination; Vaccines; Young Children; United Kingdom > UK
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2023-rcpch.282

ObjectivesThe WHO estimate 3.5% of the population live with hepatitis B (HBV); migrants to Europe being disproportionately affected.1 UK infant HBV vaccination begins from 8 weeks, with birth dose limited to infants born to women living with HBV (WLHBV). High risk infants (prematurity, high maternal viral load) also receive HBV immunoglobulin (HBIG). The Family Clinic follows up infants and WLHBV working towards WHO goals of combating viral hepatitis by 2030.MethodsA single centre electronic note review of outcomes for infants born to WLHBV (2016–2020).Results271 infants, 140 (52%) female, 71% born to first generation migrants (0.3% UK-born mothers, 28% unrecorded) born to WLHBV were referred. 216 (80%) attended follow-up with a vertical transmission rate of 0%. 22 (8%) WLHBV received third trimester tenofovir disoproxil fumerate (TDF); median viral load (VL) at initiation 125,416,376 DNA c/ml- one having birth VL. 31 (11%) infants received HBIG; 10 (32%) were lost to follow-up, compared to 46 (19%) low risk infants.246 (90%) had birth dose vaccination documented and 210 (77%) received at least 4 doses. 227 (83%) infants had serology by 24 months; 209 (92%) HBsAb >100 and 167 (73%) >1000. 7.3% (20) required repeat serology due to persistent maternal core antibodies at median 16 months.ConclusionPrevention of vertical transmission of HBV was universal in those attending although higher risk infants were more likely to be lost to follow up (32% versus 19%). HBV serological protection was comparable with national data from 2021 (77% > 4 doses, 77% HBsAb >100).2 Service improvements in birth VL for mothers on TDF, enhanced engagement for high risk infants and serology moving to 22 months are subsequently being instituted.ReferencesWHO, Global Hepatitis Report 2017.Public Health England. Guidance on the hepatitis B antenatal screening and selective neonatal immunisation pathway. January 2021.