Objectives: Universal screening for the identification of hepatitis B surface antigen [HBsAg(+)] mothers is essential to prevent perinatal hepatitis B virus (HBV) infection. In Greece, although adherence to HBV prenatal testing has improved significantly, there are still pregnant women who do not receive testing, and there is concern that this group may include women with a higher disease burden.

Methods: The seroprevalence of HBV markers among parturient women escaping HBsAg prenatal testing was assessed prospectively. Seropositivity rates were compared with those from a control group of women [n=1304, Greek: 1156 (88.7%), Albanian: 148 (11.3%)], with appropriate prenatal HBsAg documentation, who delivered in the same public hospital.

Results: Between January 2007 and March 2009, 9546 women delivered at the Alexandra Hospital, Athens, Greece, and 1000 (10.6%, mean age: 26.6±6.2 years) were unable to document their HBsAg status. Among women tested for the first time in the delivery room, 70.4% were immigrants (Albanians: 41.7%, Eastern European: 14.7%, African: 7.2%, Asian: 6.9%), 15.2% were of Roma origin, and 14.4% were Greek. Overall, 53/1000 (5.3%, 95% confidence interval: 4.1-6.9%) HBsAg(+) cases were found (Albanians: 7.4%, Roma: 5.3%, Asians: 4.3%, Eastern European: 3.4%, Greeks: 2.8%, African: 2.8%, P<0.05 between Greek and Albanian women) versus 15/1304 (1.2%, 95% confidence interval: 0.7-1.9%) in the control group (P<0.0001). Greek women nonadherent to HBV maternal testing were more likely to be chronically infected with HBV (0.6 vs. 2.8%, P<0.05), whereas a similar trend was observed in Albanian women (5.4 vs. 7.4%, P=0.45). Disappointingly low vaccination-induced protection rates (mean 21.4%) were observed among women escaping HBV maternal testing.

Conclusion: Higher HBV disease burden and low vaccination-induced protection are characteristic in pregnant women nonadherent to HBsAg prenatal testing. More intense surveillance and implementation of immunization programs should be applied in these populations.