Ethical issues in preventing mother-to-child transmission of hepatitis B by immunisation.

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Vaccine. 2011 Jun 29. [Epub ahead of print]

Ethical issues in preventing mother-to-child transmission of hepatitis B by

immunisation.

Isaacs D, Kilham HA, S, Wood N, Buckmaster A, Royle J.

Source

Clinical Ethics Advisory Group, Children's Hospital at Westmead, Westmead, NSW,

2145, Australia; University of Sydney, NSW, 2006, Australia.

Abstract

Without intervention, a pregnant woman who is a chronic hepatitis B carrier is

at risk of transmitting hepatitis B and of her infant becoming a chronic carrier

and having a significantly increased lifetime risk of developing liver cancer or

cirrhosis. Hepatitis B vaccine and immunoglobulin reduce the risk of the baby

becoming a carrier, but with only a short window period after birth to deliver

this potentially life-saving intervention. We reviewed the evidence on the

magnitude of the risk. If the carrier mother is e antigen positive (highly

infective), the calculated risk to the infant without intervention is 75.2%,

reduced to 6.0% by giving vaccine and immunoglobulin at birth. If the mother is

surface antigen positive but e antigen negative, the risk to the infant without

intervention is 10.3%, reduced to 1.0% by giving vaccine and immunoglobulin. If

vaccine is accepted but immunoglobulin refused, as for example by some Jehovah's

Witnesses, the risk to babies of e antigen positive mothers is reduced to 21.0%

and to babies of e antigen negative mothers to 2.6%. These figures can be used

to inform parents and as a possible basis for child protection proceedings if

parents decline vaccine and/or immunoglobulin. We argue from the perspective of

the best interests of the child that the severity of the condition justifies

initiating child protection proceedings whenever a baby is born to a hepatitis B

carrier mother and, despite concerted attempts to persuade them, the parents

refuse vaccine and/or immunoglobulin.

Copyright © 2011. Published by Elsevier Ltd.

PMID: 21723352 [PubMed - as supplied by publisher]