Timely Immunization, Delayed Follow-up: Challenges in Preventing Vertical Hepatitis B Transmission, A Single Center Experience

Abstract

Background: Hepatitis B virus (HBV) is a major public health issue, leading to cirrhosis and hepatocellular carcinoma. Vertical transmission of HBV can be effectively prevented with timely immunoprophylaxis, post-vaccination follow-up, and serological testing. Objectives: The aim of this study is to assess real-life adherence to follow-up protocols for hepatitis B surface antigen (HBsAg)-positive mothers and their infants in our center. Methods: We retrospectively reviewed records of 137 HBsAg-positive mothers and 167 infants born between 2017 and 2022. Data on hepatitis B immunoglobulin (HBIG) and vaccine administration at birth, as well as rates and timing of postnatal serological testing (anti-HBs, HBsAg, anti-HBc IgG), were analyzed. Hepatitis B e antigen (HBeAg), HBV DNA results, and antiviral treatment data of the mothers during pregnancy follow-up were also analyzed. Results: All infants received the first dose of the hepatitis B vaccine at birth, and 163 infants (97.6%) received HBIG at birth. However, only 12.5% of infants underwent anti-HBs testing, and just 10.6% were tested at the recommended age. Among those tested appropriately, 70.5% achieved protective anti-HBs levels. It was determined that serologic follow-up was performed more frequently in infants of mothers who received antiviral treatment during pregnancy (P < 0.001). Conclusions: While birth-dose immunoprophylaxis rates were high, post-vaccination serological follow-up was markedly insufficient. This discrepancy emphasizes the necessity of implementing uniform follow-up procedures, educating healthcare professionals, and raising awareness among families to ensure better adherence to established HBV management protocols.