Screening of pregnant women for hepatitis B virus surface antigen (HBsAg) and subsequent management, Qiandongnan prefecture, Guizhou, China, 2010

• Many pregnant are screened for HBsAg in China.
• Screening is insufficiently followed by prevention for the mother and the child.
• Mothers who are identified as HBsAg positive are insufficiently counselled.
• Few infants born to HBsAg positive mothers receive immune globulin.
• Continuity of care is key for prevention of mother to child transmission.

BackgroundIn China, in 2010, a high proportion of pregnant women were tested for hepatitis B surface antigen (HBsAg). However, the preventive actions taken following screening were unclear. We followed up infants who were born to HBsAg positive mothers to describe the management that took place after screening.MethodsWe selected eight counties with a probability proportional to population size in the Qiandongnan prefecture, Guizhou province. In each county, we selected a hospital at random. In each hospital, we (a) reviewed records to estimate the proportion of pregnant women who had been screened for HBsAg in 2010 and (b) sampled 10 screened women at random to assess management after one year in 2011. We calculated proportions and confidence intervals (CI) using standard formulae.ResultsAmong the 7232 women who delivered in 2010 in the 8 hospitals, 98% (95% CI: 97%–99%) had been tested for HBsAg. Among 82 HBsAg women sampled for follow-up, 45 (55%; 95% CI: 44%–65%) knew they had been tested during pregnancy and 60 (73%; 95% CI: 63%–82%) knew they were HBsAg positive. The 82 infants had received three doses of hepatitis B vaccines and 79 (96%; 95% CI: 90%–99%) had received the first dose within 24 h. However, only 11 infants (13%; 95% CI: 9%–25%) had received HBIG in addition to hepatitis B vaccine and 16 (20%; 95% CI: 12%–29%) had been tested for HBsAg upon completion of the vaccine series as part of their routine management.ConclusionsHBsAg testing of pregnant women was common in Qiandongnan, Guizhou, but post-screening management was limited. There is a need to ensure continuity of care through engaging women in HBsAg testing and following up infants with comprehensive management, including immunoprophylaxis and serological testing.