Routine prenatal screening of Indian women for HBsAg: benefits derived versus cost.

Abstract

This study finds that pregnant mothers in India should receive prenatal screening for hepatitis B in order to prevent perinatal transmission and spread of the infection within the larger community. Neonates who contract hepatitis B will have an almost 90% risk of developing chronic hepatitis B surface antigen (HBsAg) carriage and chronic liver disease. Infants may spread the disease to siblings and others. Neonatal immunization with HBIG and HBV vaccine interrupts vertical transmission. The US Centers for Disease Control recommend universal screening due to the aforementioned reasons. The study sample included 520 third-trimester pregnant women who attended a prenatal clinic at the Kempegowda Institute of Medical Sciences Hospital in Bangalore, India. Screening was conducted during 1991-92. Serum samples were tested by ELISA using commercial kits from Hoechst India. Positive samples were retested using Abbot's QUANTUM II for final confirmation. A full, detailed medical history of risk factors was collected for each patient. Findings indicate that 24 samples (4.6%) were positive. The positive cases included 8 with blood transfusions, 6 with a bad obstetric history, 4 with experience as health care workers and no immunization, and 6 with no risk factors. The hospital cases fit the pattern among the general population. In India, about 30-40% of pregnant HBsAg carriers are HbeAg positive. The cost of a single ELISA test is about Rs40. At the rate of 17 pregnant women per 1000 population, total costs for obstetric screening would amount to about Rs70 crores. The cost of managing a single clinical case and its complications would amount to several lakhs of rupees, which makes screening very cost-effective.