Yin Yin May Aung Martin Sowter Timthoy Kenealy



To describe current Cook Islands practice for screening and management of Hepatitis B (HB) in pregnant women and their newborns and to consider the implications of an updated screening and management strategy.


Retrospective study of pregnant women booked for antenatal care in Cook Islands from January 2010 to December 2014 was conducted. Data were collected on maternal Hepatitis B serology status, timeliness of hepatitis B immune globulin given if indicated and the completion of hepatitis B immunisation for newborns who were due their vaccinations, special service referral and contact tracing from the electronic health information system. Simple descriptive statistics were used to report the data.

All women who attended the antenatal clinics accepted Hepatitis B screening in pregnancy. Data from 803 women were analysed.


Hepatitis B surface antigen (HBsAg) was detected in 23 of 803 (2.9%) of women of which 21 were Antibody-HBs (Anti-HBs) positive and two were hepatitis B e antigen (HBeAg) positive. Hepatitis B DNA viral load was unable to be tested. Hepatitis B immune globulin was given to 21 of the 23 babies within one day, one was given on day 3 but one was missed. None of the 23 mothers and their babies had any ongoing follow up. The first Hepatitis B vaccine, due within 24 hours of birth, was given within a day to 743 of the 803 (93%) of babies. The second, due at 6 weeks, was given by 8 weeks to 645 of the 778 babies due for their six week vaccination (83%). The third, due at 3 months, was given by 4 months to 648 of the 744 (87%). The fourth, due at 5 months was given by 6 months to 553 of the 712 (78%). Of the 712 babies over 6 months of age, 601 (84%) were recorded as having completed four HB vaccines at any time.


The hepatitis B screening and immunisation in the Cook Islands appears effective but this study indicates that the follow up of both the mother and their infants needs to be improved.


Original Research