Should pregnant urban south African women be screened for hepatitis B?

The prevalence of hepatitis B virus (HBV) infection in the South African urban obstetric population, which consists of white, black, coloured and Asian patients from different socio-economic, cultural and geographical backgrounds, is unknown. Routine screening performed in 3,469 urban pregnant women revealed that 42 patients were HBV surface antigen-positive (a prevalence of 1.21%). Only 2 patients (4.6%) were hepatitis B e antigen (HBeAg)-positive (0.06% of the entire cohort), whereas the remaining 40 were identified as hepatitis B e antibody-positive. Despite a significant increase in the numbers of black patients, there has not been an accompanying increase in the number of HBV carriers. Replicative infection was equally distributed among white and black pregnant women. Because the low prevalence of HBeAg results in lack of perinatal transmission and the prevention of a single case of neonatal hepatitis B infection is costly, we conclude that in South African urban hospitals, routine screening for hepatitis B is not cost-effective.