Today is World Hepatitis Day, which makes it the right time to highlight the work of the NHS Infectious Diseases in Pregnancy Screening (IDPS) Programme on hepatitis B.
Hepatitis B worldwide
Globally, around 250 million people are living with hepatitis B. The hepatitis B virus can be:
- passed from mother to child (known as vertical transmission)
- acquired through contact with blood or other body fluids of an infected person (for example, through sex or injecting drug use)
Most adults infected with hepatitis B will get rid of the infection spontaneously. This is less likely at younger ages, and up to 90% of babies infected will develop chronic infection.
Chronic hepatitis B is an important cause of liver disease and around 1 in 4 people chronically infected in childhood will develop liver cancer or cirrhosis later on. Hepatitis B is one of the top 10 causes of death worldwide.
Hepatitis B in England
The UK National Screening Committee (UK NSC) recommends hepatitis B screening for all pregnant women in the UK. This is so that interventions can be implemented to reduce the risk of transmission of infection to the babies of infected women. In England, around 0.4% of pregnant women have hepatitis B.
Read more about hepatitis B in pregnancy.
In 90 to 95% of cases, we can prevent mother to child transmission through a combination of vaccination of the baby starting at birth (for all babies born to women with hepatitis B) and hepatitis B specific immunoglobulin (for babies at high risk of infection).
Some women with high levels of the virus may be offered antiviral therapy in late pregnancy to help further reduce the risk of vertical transmission.
National screening standards
The NHS IDPS programme standards, service specification and supporting guidance set out the screening pathway and specific care to be offered to pregnant women with hepatitis B. Data is collected on key points on the pathway to inform quality assurance processes. These include:
- the proportion of pregnant women eligible for hepatitis B screening for whom a confirmed result is available at the day of report
- the number of women who have a face-to-face appointment with the screening team within 10 working days of testing positive for hepatitis B during pregnancy or notification of a known infection
- for those who are newly diagnosed or with high infectivity markers, the number who are seen by a specialist within 6 weeks to plan their clinical management
- the number of babies born to women who have hepatitis B who receive their vaccination (+/- immunoglobulin) within 24 hours of birth
Evaluating implementation of the programme standards
In 2013, we commissioned a national clinical audit of the management of pregnant women with hepatitis B in England.
The audit includes around 2,600 women with hepatitis B who booked for antenatal care in England in 2014. We collected information on maternity care and, for high risk women, care in specialist services. About 30% were newly diagnosed with hepatitis B during their pregnancy, reaching over 50% among women with no previous live birth.
More than two-thirds of the women with hepatitis B were from areas of the world where hepatitis B is endemic (mainly Asia and Africa). This included 13% from China and 8% from Nigeria.
Audit status and next steps
We are currently analysing the data to inform the IDPS pathway and service provision.
It is unclear how widely antivirals are being used in pregnant women with hepatitis B in England, so we will also explore this aspect. We are working in partnership with PHE Immunisation, Hepatitis and Blood Safety team to link audit data with information on whether or not infants born to women in the audit went on to receive the full hepatitis B vaccination schedule at 4 and 8 weeks and vaccination and serology test to ascertain infection status at 1 year. Incomplete vaccination is an important potential risk for mother to child transmission. Identifying infants at increased risk of missing doses in the first year may provide opportunities for intervention.
We will keep you up to date with the audit and publication of final reports in future blogs.
Read the Vaccine Update and PHE Screening blog for further information on the introduction of the hexavalent (6 in 1) vaccine into routine primary immunisations.
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