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USPSTF: Screen All Pregnant Women Early for Hepatitis B

All pregnant women should be screened for hepatitis B (HBV) at their first prenatal visit in order to avoid transmitting the disease to their newborns, the U.S. Preventive Services Task Force (USPSTF) reaffirmed.

Net benefits of screening are “substantial,” the task force concluded with “high certainty” (A recommendation) in a draft recommendation statement on their website. The draft is available for public comment on the website through February 4, 2019.

Similar to other recent USPSTF statements on ocular prophylaxis to prevent gonococcal ophthalmia neonatorum in newborns, and screening all pregnant women for syphilis, the Task Force used a reaffirmation process for this recommendation, where only a very high level of evidence would change their recommendation.

However, this has been an A recommendation since 1996, and again in 2009 when it was last reviewed, the task force said in a statement.

“In children, the primary source of hepatitis B infection is transmission at birth from an infected mother,” said task force member Alex Kemper, MD. “But we know that screening for hepatitis B in pregnant women can keep babies from getting the virus and prevent the onset of potentially lifelong serious health problems.”

Task force member Melissa A. Simon, MD, added that since 1998, rates of maternal hepatitis B virus have increased by 5.5%. Moreover, children exposed to hepatitis B during infancy or childhood are more likely to progress to chronic infection, the authors said.

The task force found substantial benefits to screening, and “adequate” evidence of the accuracy of serologic testing for hepatitis B (hepatitis B surface antigen, or HBsAg) in pregnancy, with a sensitivity and specificity of >98%.

There was “adequate” evidence that vaccination against HBV infection and providing post-exposure prophylaxis with hepatitis B immune globulin (HBIG) at birth to infants leads to a substantial reduction in the risk that infants will acquire hepatitis B infection.

Examining potential harms, there was “limited” evidence on the harms of screening, which were judged as “no greater than small” because of the accuracy of screening tests and “low likelihood of harms from preventive interventions.”

Currently, 26 states have laws mandating perinatal HBV screening, the authors said. Though rates of screening during pregnancy range from 84% to 88%, rates of first trimester screening range from 60% of commercially insured women to 39% of Medicaid-enrolled women, while 71% of infants receive HBV vaccination within 3 days of birth.

“Primary care clinicians and delivery settings must establish effective systems for the accurate and timely transfer of maternal HBsAg test results to labor, delivery, and newborn medical records to maximize benefit,” the authors argued.

HBV screening during pregnancy with HBsAg and anti-HBs is also recommended by professional societies such as the American College of Obstetricians and Gynecologists (ACOG), the CDC Advisory Committee on Immunization Practices, and the American Association for the Study of Liver Diseases.

Additional studies on prenatal antiviral medication to reduce perinatal transmission, as well as “continued research on effective implementation of case management in vulnerable populations” most at risk for HBV infection are needed, the task force argued.

The task force member disclosed no relevant relationships with industry.