Authors' objectives: To assess the effectiveness, safety and cost-effectiveness of strategies to achieve elimination mother to child transmission (EMTCT) of hepatitis B which include: a. Antenatal screening for hepatitis B (with linkage-to-care and follow-up of infants) versus hepatitis B vaccination to (unvaccinated) females of reproductive age b. Antenatal screening for hepatitis B (with linkage-to-care and follow-up of infants) versus Status Quo (leveraging on National Immunisation Programme) or Do Nothing Strategy

Authors' results and conclusions: There is paucity of head-to-head comparison between different prophylactic interventions, particularly comparing antenatal screening with vaccination of reproductive age group. There was no study that compared directly screening with no screening to provide direct evidence of the benefit of screening. Majority of the study assessed the effectiveness of antenatal screening (using HBsAg with or without confirmatory test), packaged with linkage-to-care (hepatitis B Immunoglobulin or HBIG, antiviral therapy and follow-up of infants (hepatitis B vaccination with 3 doses. There was high level of evidence that antenatal screening for HBV infection with linkage-to-care and follow-up of infants was effective and cost-effective in reducing perinatal transmission of HBV. Screening for hepatitis B infection in pregnancy was able to identify infants at risk of perinatal transmission to identify them for subsequent immunoprophylaxis with HBIG and antiviral treatment. In terms of vaccinating female in the reproductive age group or catch-up vaccination, limited evidence showed a higher BCR found amongst younger adults (21–39 years) with prior screening, hence policy makers may consider a targeted HBV vaccination program for younger adults as in China. In resource limited settings, HBeAg can be used as a cheaper alternative to assess eligibility for antiviral prophylaxis. HBIG following confirmatory test was found not a cost-effective strategy compared to HBIG following rapid diagnostic test. There was adequate evidence that universal vaccination of all infants against HBV infection and providing postexposure prophylaxis with hepatitis B immune globulin (HBIG) at birth to infants of mothers infected with HBV reduce the risk for acquisition of HBV infection in infants. There was high level of evidence on good diagnostic performance of using HBsAg for screening for HBV infection in pregnant women.

Authors' recommendations: Antenatal screening for HBV infection with linkage-to-care and follow-up of infants is effective and cost-effective in reducing perinatal transmission of HBV. Thus this strategy may be included to eliminate mother to child transmission of hepatitis B, especially among unvaccinated antenatal mothers in Malaysia.

Authors' methods: Electronic databases were searched through Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) 1948 to present, EBM Reviews-Cochrane Database of Systematic review, EBM Reviews-Cochrane Methodology Register of Controlled Trials, EBM Reviews-Health Technology Assessment, EBM Reviews-NHS Economic Evaluation Database, and Embase 1996 to March 2021. Searches were also conducted in PubMed, FDA website and INAHTA for any published reports. Search was limited to year 2000 onwards. Google and Google Scholar were also used to search for additional web-based materials and information about the technology. In addition, articles were also searched by reviewing the references of retrieval articles. Last search was conducted on 10th April 2021.

Authors' identified further research: Outcome research on catch-up vaccination.

Project Status: Completed

Year Published: 2020

URL for published report: http://www.moh.gov.my/index.php/database_stores/store_view_page/30/355

Requestor: Ministry of Health, decision-making committee

English language abstract: An English language summary is available

Publication Type: Mini HTA

Country: Malaysia

Organisation Name: Malaysian Health Technology Assessment

Contact Address: Malaysian Health Technology Assessment Section, Ministry of Health Malaysia, Federal Government Administrative Centre, Level 4, Block E1, Parcel E, 62590 Putrajaya Malaysia Tel: +603 8883 1229

Contact Name: htamalaysia@moh.gov.my

Contact Email: htamalaysia@moh.gov.my

Copyright: Malaysian Health Technology Assessment Section (MaHTAS)