23 Preventing Perinatal Transmission of Hepatitis B: A Quality Assurance Review
Notice bibliographique
Résumé
Although the hepatitis B vaccination has an efficacy of 95%, the CDC reports that 275 million people are infected with chronic hepatitis B, with 700,000 deaths per year. In Ontario, a publicly-funded, 2-dose vaccine series is routinely offered to grade 7 students. However, the vertical transmission of hepatitis B is a risk for infants born to carrier mothers. Therefore, prospective mothers are routinely screened for HBsAg during the first trimester of pregnancy. The Canadian Immunization Guide recommends that all infants born to infected mothers should receive vaccine and hepatitis B immune globulin (HBIg) within 12 hours of birth. As there is no published literature on the timeliness of hepatitis B immunization, this study aimed to investigate time of HBIg and vaccine administration in infants born to HBsAg positive mothers. The primary outcome was the proportion of infants receiving HBIg and Hepatitis B vaccine within 12 hours of birth. Mother-infant dyads were identified where the hepatitis B vaccine was ordered. Full review was conducted for infants born to HBsAg positive mothers between 2010 and 2015. Mother and infant charts were paired and retrospectively reviewed across 6 hospital sites in Ontario, including 2 community hospitals, 2 academic hospitals, and 2 satellite teaching hospitals. Between-group differences were tested through Welch’s analysis of variance and associations were explored through Spearman’s rank correlation. Statistical significance was set for P<0.05. 460 mother-infant dyads were identified that were eligible for comprehensive chart review. 269 dyads were excluded as the mother was not HBsAg positive but the vaccine was ordered because the father was hepatitis B positive, the mother’s HBsAg status was unknown, or the mother was hepatitis C positive. Of 460 total infants, 23 infants (5.0%) were vaccinated later than 12 hours and 22 infants (4.8%) received HBIg later than 12 hours. 50 infants (10.9%) had at least one undocumented time of administration. The mean vaccination time was 5.0 hours (95% CI [4.4, 5.2]) with significant differences between sites (WF5,58=21.3, p<0.001, η2= 0.31). The mean time of HBIg administration was 5.0 hours (95% CI [4.5, 5.2]) with significant differences between sites (Welch’s F5,61=18.7, p<0.001, η2= 0.23). Infants born between midnight and 08:00 were vaccinated 66 mins. later than infants born between 08:00 and 16:00 (p<0.05). Infants born to married mothers were vaccinated 65 mins. earlier than infants born to single mothers (p<0.05). The majority of neonates are immunized within 12 hours but variation exists across sites. Improved recording of hepatitis B immunization times is needed. A focus on standardizing care pathways regardless of site or time of delivery should correct immunization delays. Further research is needed to explore best practices to reduce immunization delays and evaluate the cost-benefit of universal neonatal hepatitis B immunization.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,040 | 0,106 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,003 | 0,003 |
| Bibliométrie | 0,015 | 0,013 |
| Études des sciences et des technologies | 0,001 | 0,002 |
| Communication savante | 0,004 | 0,003 |
| Science ouverte | 0,004 | 0,002 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».