Hospitals blamed for Hepatitis B Virus spread in Japan

Main Category: Liver Disease / Hepatitis
Article Date: 20 Apr 2004 - 0:00 PDT


At least 30 percent of Hepatitis B Virus (HBV) infections transferred from mother to child were caused by the failure of medical institutions to follow proper procedures, according to a survey conducted by a research team at the Health, Labor and Welfare Ministry, Japan.

The cases include those in which the institutions failed to administer drugs and vaccinations to prevent infants from being infected with the virus by their mothers, according to the survey.

Due to the seriousness of the findings, the ministry has decided to instruct doctors to make sure appropriate treatment is provided.

Mother-to-child HBV infection takes place at birth, and is caused by contact with the mother's blood, either during the passage through the birth canal or through the cesarean section. When a newborn baby is infected with the virus, the symptoms of fulminant hepatitis develop only rarely. In the most serious cases, the baby can die, sources said.

In 1986, the then Health and Welfare Ministry launched a project to prevent such infections from occurring. Medical institutions are required to conduct a virus test on all pregnant women. If any of the women test positive for the virus, the medical institution is obliged to administer antiviral medicine, called HBIG, and vaccinate the baby immediately after birth.

With those preventive measures in place, the number of mother-to-child HBV infections dropped from about 4,000 annually in 1986 to about 400 10 years later. Excluding rare cases of intrauterine infection, it is believed that mother-to-child infections can be almost entirely prevented, a ministry official said.

But the study, which surveyed 272 hospitals, found there were 41 cases of such infections reported in 2000. Twelve of these cases are believed to have been caused by failure to administer antiviral medicines and vaccinations or failure to do so at the appropriate time.

The research team on the prevention of mother-to-child virus infections has called for preventive measures to be taken with the cooperation of obstetricians and pediatricians.

Another survey, conducted last year by Takamatsu-based pediatricians in cooperation with specialists in liver diseases, found that among 149 mother-to-child infection cases, 51 cases, or 34 percent, were caused by a lack of preventive measures or incomplete preventive treatment.

In Nagano Prefecture, a 6-month-old boy who was infected with the virus from his mother and did not receive preventive measures contracted fulminant hepatitis. His life was saved by a liver transplant from a brain-dead donor.

"Measures to prevent mother-to-child hepatitis B virus infections are established treatments and should be taken on every patient concerned. If these measures are being neglected often, it's a serious problem that must not be overlooked," an official at the ministry's Maternal and Child Health Division said. The ministry intends to call for the thorough implementation of measures through the Japan Association of Obstetricians and Gynecologists and other related organizations.

HBV is a liver disease contracted through blood and body fluids. The virus can pass from a mother to a child or be sexually transmitted. The number of those infected with the virus in Japan is estimated at about 1.5 million. The viral load can be heavy or light. When it is heavy, children born to mothers with the virus are infected with the virus in most cases unless preventive treatment is provided.

--- The guilt that cannot be passed

Although Japan has the infrastructure to prevent the spread of HBV from mothers to children, many mothers have found themselves in the dreadful position of learning they have passed the virus onto their children because hospitals failed to take preventive measures.

One Gifu woman has been plagued by anxiety since discovering at the end of 1999 that the HBV she was carrying had infected her eldest son.

As the woman knew she had HBV, she asked the staff at the Nagoya hospital where her son was delivered in 1998 to take appropriate precautions to ensure the virus was not passed on to her son.

However, the hospital failed to take any preventive measures.

"I was sure they'd done as I asked. I can't describe how worried I am about the possibility my son might develop the disease," she said.

When she had her second child, at a different hospital, preventive measures were taken and infection was prevented.

"Why on earth wasn't my eldest son protected in the same way?" the woman asked.

Although her infected son is fit and healthy, the woman makes sure he never misses his half-yearly medical checkups.

"I want the proper systems to be put in place to prevent any more mothers having to suffer the same anxiety I do," she said.

With help from her local medical association, the woman is pressing the Nagoya hospital to explain why it failed to take preventive measures as requested.

According to Tomoo Fujisawa, a professor at the International University of Health and Welfare who specializes in pediatrics and liver research, people have become less alert to the risks of infection than they once were.

From: http://www.yomiuri.co.jp/newse/20040420wo31.htm

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