RT Journal Article
SR Electronic
T1 Prenatal hepatitis B screening, and hepatitis B burden among children, in Ontario: a descriptive study
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E1299
OP E1305
DO 10.1503/cmaj.200290
VO 192
IS 43
A1 Mia J. Biondi
A1 Alex Marchand-Austin
A1 Kirby Cronin
A1 Natasha Nanwa
A1 Vithusha Ravirajan
A1 Erin Mandel
A1 Lee W. Goneau
A1 Tony Mazzulli
A1 Hemant Shah
A1 Camelia Capraru
A1 Harry L.A. Janssen
A1 Beate Sander
A1 Jordan J. Feld
YR 2020
UL http://www.cmaj.ca/content/192/43/E1299.abstract
AB BACKGROUND: Ontario is 1 of 5 provinces that immunize adolescents for hepatitis B virus (HBV), despite the World Health Organization recommendation for universal birth dose vaccination. One rationale for not vaccinating at birth is that universal prenatal screening and related interventions prevent vertical transmission. The aims of our study were to evaluate the uptake and epidemiology of prenatal HBV screening, and to determine the number of children in Ontario with a diagnosis of HBV before adolescent vaccination.METHODS: We extracted data from ICES, Public Health Ontario and Better Outcomes & Registry Network (BORN) Ontario databases. We assessed prenatal screening uptake and prevalence of prenatal hepatitis B surface antigen (HBsAg) from 2012 to 2016, as well as subsequent hepatitis B e-antigen (HBeAg) and HBV DNA testing and percent positivity. We used age and region to subcategorize the results. In a separate unlinked analysis, we evaluated the number of children positive for HBV aged 0–11 years who were born in Ontario from 2003 to 2013.RESULTS: From 2012 to 2016, 93% of pregnant women were screened for HBV, with an HBsAg prevalence of 0.6%. Prevalence of HBsAg increased with age, peaking at older than 45 years at 3%. North Toronto had the highest overall prevalence of 1.5%, whereas northern Ontario had the lowest. Of women who were HBsAg positive, HBeAg and HBV DNA tests were subsequently ordered in 13% and 38%, respectively. Of children born in Ontario between 2003 and 2013, 139 of 23 759 tested positive for HBV.INTERPRETATION: Prenatal HBV screening is not universal and subsequent evaluation is poor, limiting optimal intervention and possibly contributing to some Ontario-born children being given a diagnosis of HBV before age 12 years. These findings underscore the limitations of the province’s adolescent vaccination strategy.