Hepatitis B virus (HBV) infection\u00a0acquired\u00a0at birth or during early infancy can lead to lifelong health complications, including chronic liver disease.\u00a0Despite longstanding recommendations for prenatal screening,\u00a0an estimated 12% to 16% of pregnant individuals in the US\u00a0are not screened for hepatitis B. This gap leaves a\u00a0portion\u00a0of newborns at risk for undetected exposure.<\/p>\n
Vaccination at birth serves as a\u00a0safeguard, particularly for infants born to mothers whose hepatitis B status is unknown.\u00a0<\/p>\n
Researchers\u00a0at Boston Medical Center (BMC) and Boston University (BU) School of Public Health\u00a0used simulation modeling to examine how\u00a0different levels\u00a0of newborn vaccination coverage and maternal screening influence HBV infection rates in infants across the US. The\u00a0findings, published in\u00a0JAMA Pediatrics,\u00a0compared outcomes under varying real-world conditions to better understand how\u00a0screening and vaccination\u00a0work together to prevent transmission.\u00a0<\/p>\n
The study found that lower vaccination coverage among infants born to unscreened mothers was associated with a substantial increase in HBV infections.\u00a0When vaccination coverage in this group was estimated at 10%, based on historical coverage during a brief pause in the birth dose vaccination recommendation in 1999, the model projected more than 1,000\u00a0additional\u00a0infections.<\/p>\n
When coverage increased to 80%, consistent with current levels under universal birth dose vaccination, the projected increase dropped to just over 100\u00a0additional\u00a0infections,\u00a0representing\u00a0a tenfold reduction.\u00a0<\/p>\n
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Our modeling shows how sensitive hepatitis B prevention is to changes in vaccination coverage at birth. Even under optimistic assumptions, lower coverage among higher-risk groups leads to increased infections, reinforcing the importance of maintaining high uptake to protect infants.”<\/p>\n
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Margaret Lind, PhD, Assistant Professor, Epidemiology, School of Public Health, Boston University<\/p>\n
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Researchers also found that\u00a0very high\u00a0levels of maternal screening would be\u00a0required\u00a0to offset the increase in infections associated with lower vaccination coverage. The model estimated that screening rates would need to reach\u00a0approximately 98%\u00a0to\u00a0maintain\u00a0similar levels of protection, a level that has not been achieved\u00a0nationally\u00a0in practice.\u00a0<\/p>\n
“Even small drops in birth dose vaccination can increase\u00a0HBV\u00a0infection risk, especially for infants of unscreened mothers,” says Rachel Epstein, MD, MSCE,\u00a0pediatric and adult infectious disease clinician-scientist at BMC\u00a0and assistant professor of medicine at BU Chobanian & Avedisian School of Medicine. “This study highlights the importance of consistent prevention strategies to protect newborns and reduce hepatitis B nationwide.”\u00a0<\/p>\n
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