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 infection with hepatitis B in the Netherlands. Design-Routine antenatal screening and intervention programme. Setting-Community antenatal programme, the Netherlands. Subjects-Infants of mothers who were carriers of hepatitis B detected by routine screening. Interventions-Infants of infected mothers received hepatitis B immunoglobulin at birth and four doses of hepatitis B vaccine in conjunction with routine immunisation at 3, 4, 5, and 11 months of age. Main outcome measures-Results of screening and immunisation from 1989-92. Results-The coverage of screening increased from 46% in 1989 to 84% in 1992. Hepatitis B surface antigen was detected in 2145 women (0.44%). The coverage of postnatal immunoprophylaxis in 1645 neonates born to mothers who were carriers of hepatitis 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, third, and fourth dose of vaccine, respectively. There was considerable variation in the timing of vaccination; 17% (258) of the infants received their first dose more than two weeks late. Of the 59% (583) of infants who received the fourth dose more than two weeks beyond target age, 14% (141) also received their first dose too late. Conclusions-A prevention programme for perinatal hepatitis B in an area of low prevalence, when incorporated into existing health care, is feasible and achieves satisfactory coverage rates. Intensive follow up is needed to improve adherence to the immunisation schedule.