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Unprotected People Reports: Hepatitis B |
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Lack of Prenatal Screening for Hepatitis B Causes Multiple Tragedies for One Family |
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| Click here for a fully-formatted PDF version
of this report. |
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| The following case report of a mother who had a
previous history
of hepatitis B, but received no prenatal screening, serves to
illustrate the importance of following the recommendation of the
Advisory Committee on Immunization Practices to screen every
pregnant woman during each pregnancy. Not only did this woman's
baby die of fulminant hepatitis B infection, but when hepatitis B
screening was done for the surviving family members, it was found
that mother, father, and the other two young children were all
positive for HBV. |
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| This case report is excerpted from a former IAC educational piece titled
"Universal prenatal screening for hepatitis B." It was written for IAC by
Deborah K. Freese, MD, pediatric gastroenterologist and member of the transplant
unit at Mayo Clinic. This original piece is no longer available except by
special request to IAC. |
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| The excerpt of Dr. Freese's article follows: |
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An Infant with Fulminant Hepatitis B
The medical and economic costs of failing to screen for HBV can
be illustrated on a more personal level by the case of a single
infant recently cared for in the Twin Cities. This patient was
the child of a middle class couple from a farming community in a
neighboring state.
During her initial prenatal visit, the mother gave a history of
having had hepatitis of some sort 20 years previously. She was
told at that time that she had recovered from the disease and
would subsequently be immune to further hepatitis infections.
Despite the fact that a previous history of hepatitis would place
her in the "high-risk" category, no prenatal HBV screening was
done. Pregnancy and delivery were uncomplicated, and the baby did
well for the first two months of life.
At that time, the parents began noting feeding difficulties,
irritability, and jaundice. Evaluation revealed severe
coagulopathy, markedly elevated liver tests, and hypoglycemia.
The infant was eventually referred for liver transplantation with
the diagnosis of fulminant hepatitis B. The infant was admitted
to the intensive care unit, received very aggressive medical
management, and an urgent search for donor was initiated. No
suitable donor could be located, the child continued to
deteriorate and died after two weeks from hepatic encephalopathy
and herniation.
Hepatitis B screening was then done for the surviving family
members. It was found that mother, father, and the other two
young children were all positive for HBV. Mother and one child
had significantly elevated liver tests and are undergoing further
evaluation. It seems clear that had HBV screening been carried
out, none of the children would have been infected and the death
of the youngest could have been prevented.
The economic impact on the health care system from this one
family alone is significant. It includes the costs of
hospitalizations at two hospitals of the infant who died
(approximately $100,000), the immediate costs of evaluation and
possibly therapy for the surviving child with evidence of chronic
hepatitis, and the long-term costs of monitoring and observation
in both chronically infected children. Had successful liver
transplantation been possible for the infant, the costs of that
procedure and lifetime immuno-suppression would have further
increased the costs.
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| 5/27/99 • REPORT #18 |
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| Disclaimer: The Immunization Action Coalition (IAC) publishes
Unprotected People Reports for the purpose of making them available
for our readers' review. We have not verified the content of this
report. |
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