and Respiratory Disease (Jacques-Carroll et al., 2007). The programs are administered by state and local public-health departments and vary in reach and intensity. As mentioned in Chapter 2, many programs simply provide surveillance, and others provide comprehensive case management that even includes client home visits by local coordinators. That variability accounts for the wide variation (17–59%) in rates of vaccination of household contacts of HBsAg-positive pregnant women (Euler et al., 2003a).

Adequately funded perinatal hepatitis B programs are effective. Among women enrolled in such programs for case management, the rate of administration of the birth dose of hepatitis B vaccine and HBIG was as high as 94%, with a three-dose completion rate of 71% (Jacques-Carroll, 2008). Perinatal hepatitis B programs identify twice as many household and sexual contacts per infant as was reported to the national database, with high rates of programmatic compliance in households of foreign-born people (Euler et al., 2003a). Most US programs are understaffed and underfunded, however, making adequate case management difficult. This gap has a two-fold effect in that chronically infected women do not receive the appropriate medical management and referral and perinatal transmission continues to occur. CDC estimates that only 50% of HBsAg-positive pregnant women are identified for case management (CDC, 2005). It has been estimated that failure of perinatal HBV-prevention efforts result in about 1,000 cases of chronic HBV infection in newborns each year (Ward, 2008b).

Hepatitis B Medical Management of Pregnant Women

An estimated 20,000 infants a year are born to women who test positive for HBV (Euler et al., 2003b). Those women require followup services to ensure that they are knowledgeable about risks posed by their chronic infection and that they receive appropriate referral for long-term medical management. Their close contacts at home should be tested for HBV infection, those who are uninfected should be vaccinated, and medical referral should be provided to those found to have chronic HBV infection. Cases among household contacts are not uncommon when this risk group is pursued aggressively for testing. Data reported by Euler et al. (2003a) showed that 7–35% of household contacts of HBsAg-positive pregnant women were HBsAg-positive.

Deficiencies in health-care providers’ knowledge or appropriate followup of HBsAg-positive pregnant women are noteworthy and require special emphasis in HBV prevention and control strategies. Obstetricians’ knowledge and preventive practices are suboptimal. In a 1997 study of San Francisco obstetricians, over 90% of respondents acknowledged the public-health importance of HBV infection and believed that HBV education was feasible, but only 53% of the responding obstetricians offered



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