Mother-to-child transmission of hepatitis B in Far North Queensland, 2013-2023

Abstract

With optimal antenatal and perinatal care and immunisation, the risk of perinatal transmission of hepatitis B virus (HBV) approaches zero. However, it can be logistically challenging to deliver this care to culturally and linguistically diverse populations and to those individuals who are living in remote Australian communities. This study examined the management of pregnant women with chronic hepatitis B (CHB) and their children in Far North Queensland (FNQ). It was hoped that this would identify the successes and limitations of the current FNQ HBV programme which was established in June 2017. We used the Queensland notifiable diseases register to identify every female of childbearing age (13-45 years) living in FNQ with CHB during the study period 1 January 2013 - 31 December 2023. We identified the children born to these women during the study period and assessed whether their care was concordant with current Australian HBV management guidelines. We identified 261 women of childbearing age who had 148 live births during the study period: 93/148 children (63%) were born to First Nations Australian mothers; 58/148 (39%) were born to mothers who were born overseas; and 46/148 (31%) were born to mothers who lived in remote locations. After establishment of the FNQ HBV programme, 71/77 pregnancies (92%) had optimal antenatal HBV care; 71/77 (92%) had optimal perinatal HBV care; and 72/77 infants (94%) had complete HBV vaccination. There have been no children confirmed to be hepatitis B surface antigen (HBsAg) positive since the establishment of the FNQ HBV programme. However, only 70/148 children (47%) have had HBsAg testing. Antenatal and perinatal care and infant vaccination is currently concordant with national HBV guidelines in > 90% of pregnancies in the FNQ region. There has been no confirmed mother-to-child HBV transmission since establishment of a local HBV programme, although improved child testing is necessary to substantiate this finding.