Hepatitis B maternal screening, infant vaccination, and infant prophylaxispractices in North Carolina

Objectives: To determine if the Advisory Committee on Immunization Practice s hepatitis B screening, vaccination, and prophylaxis recommendations were being followed in North Carolina, and to establish a baseline hepatitis B s eroprevalence rate. Design: A survey of mother and infant birthing facility medical records. Setting: Four birthing facilities selected from each of the 7 districts in North Carolina (a total of 28 facilities). Participants: A probability proportional to size survey design was used to select 4763 mother-infant record pairs. All records came from the 1996 birt h cohort. Main Outcome Measures: Maternal hepatitis B screening status, infant vaccin ation status, infants prophylaxis status, hepatitis B seroprevalence rate, demographic and clinical predictors for maternal infection, failure to rece ive prenatal care or for whom status was unknown, failure to screen, and fa ilure to vaccinate. Results: Ninety-two percent of pregnant women were screened for hepatitis B surface antigen. Eighty-six percent of infants received dose 1 of the hepa titis B vaccine. Four of the 9 infants with mothers who were hepatitis B su rface antigen-positive did not receive both vaccine and hepatitis B immune globulin. The hepatitis B seroprevalence rate was 0.2%. Mothers who were no t screened for infection were 3.4 times more likely to have infants who wer e not vaccinated. White mothers were twice as likely not to have their chil d vaccinated as mothers of other races. Conclusions: Not all infants with hepatitis B-infected mothers were receivi ng vaccine and hepatitis B immune globulin as recommended. Seroprevalence o f hepatitis B infection may be lower in North Carolina than in other states . Hepatitis B laboratory test results should be included in every mother's medical record.