PROGRAM FOR PREVENTING PERINATAL HEPATITIS-B INFECTION THROUGH SCREENING OF PREGNANT-WOMEN AND IMMUNIZATION OF INFANTS OF INFECTED MOTHERS IN THE NETHERLANDS, 1989-92

Objectives-To launch a programme for the prevention of perinatal infec tion with hepatitis B in the Netherlands. Design-Routine antenatal scr eening and intervention programme. Setting-Community antenatal program me, the Netherlands. Subjects-Infants of mothers who were carriers of hepatitis B detected by routine screening. Interventions-Infants of in fected mothers received hepatitis B immunoglobulin at birth and four d oses of hepatitis B vaccine in conjunction with routine immunisation a t 3, 4, 5, and 11 months of age. Main outcome measures-Results of scre ening and immunisation from 1989-92. Results-The coverage of screening increased from 46% in 1989 to 84% in 1992. Hepatitis B surface antige n was detected in 2145 women (0.44%). The coverage of postnatal immuno prophylaxis in 1645 neonates born to mothers who were carriers of hepa titis B was 85% (1398); in 3% (42) there was a delay in administration of immunoglobulin of over 24 hours. In 1991, 96% (537), 95% (532), 94 % (525), and 87% (489) of the infants received the first, second, thir d, and fourth dose of vaccine, respectively. There was considerable va riation in the timing of vaccination; 17% (258) of the infants receive d their first dose more than two weeks late. Of the 59% (583) of infan ts who received the fourth dose more than two weeks beyond target age, 14% (141) also received their first dose too late. Conclusions-A prev ention programme for perinatal hepatitis B in an area of low prevalenc e, when incorporated into existing health care, is feasible and achiev es satisfactory coverage rates. Intensive follow up is needed to impro ve adherence to the immunisation schedule.