23 Preventing Perinatal Transmission of Hepatitis B: A Quality Assurance Review
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.040 | 0.106 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.003 |
| Bibliometrics | 0.015 | 0.013 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.004 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".