TITLE Hepatitis B screening, outcomes and management of pregnant women and infants in the Cook Islands. SHORT TITLE Antenatal screening for hepatitis B in the Cook Islands
Authors: Aung Yin Yin May , Sowter Martin , Kenealy Timthoy 
Published: December 2015

<p align="left"><strong>TITLE</strong></p><p align="left"><strong> </strong></p><p>Hepatitis B screening, outcomes and management of pregnant women and infants in the Cook Islands.</p><p align="left"> </p><p align="left"> </p><p><strong>SHORT TITLE</strong></p><p>Antenatal screening for hepatitis B in the Cook Islands</p><p align="left"> </p><p align="left"> </p><p align="left">Dr. Yin Yin May Aung, Ministry of Health Cook Islands, Rarotonga, Cook Islands. Email <a href="mailto:m.aung@health.gov.ck">m.aung@health.gov.ck</a></p><p align="left"> </p><p align="left">Dr. Martin Sowter, Consultant Obstetrician and Gynaecologist, National women’s Health, Auckland New Zealand. Email martinsowter@xtra.co.nz</p><p align="left"> </p><p align="left">Dr. Timothy Kenealy, Associate Professor of Integrated Care, University of Auckland. Email t.kenealy@auckland.ac.nz</p><p align="left"> </p><p align="left"> </p><p align="left">Funding</p><p align="left">Ministry of Health, Cook Islands.</p><p align="left"> </p><p align="left">Competing interests</p><p align="left">All authors declare they have no competing interest.</p><h1>ABSTRACT</h1><h2>Introduction</h2><p>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.</p><h2>Methods</h2><p>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.</p><h2>Findings</h2><p>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.</p><p>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.</p><h2>Conclusion</h2><p>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.</p><p> </p><p align="left">he research question, interpreted the data and revised the manuscript. TK reviewed the research question, analysed and interpret the data and revised the manuscript.</p>