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Tang J, Zhao H, Zhou YH. Screening for viral hepatitis carriage. Best Pract Res Clin Obstet Gynaecol 2024:102523. [PMID: 38908915 DOI: 10.1016/j.bpobgyn.2024.102523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 05/15/2024] [Accepted: 06/12/2024] [Indexed: 06/24/2024]
Abstract
Viral hepatitis during pregnancy is common globally. In this review, we focus on the antenatal screen for hepatitis A, B, C and E, the prevention of mother-to-child transmission (MTCT) of hepatitis B and C, and the management of hepatitis A, B, C and E during pregnancy. Neonatal timely administration of hepatitis B immunoglobulin and hepatitis B vaccine is the cornerstone for preventing MTCT of hepatitis B virus (HBV), and perinatal antiviral prophylaxis with tenofovir disoproxil fumarate in mothers with positive HBeAg or HBV DNA >2 × 105 IU/ml also plays important roles in further reducing MTCT. Avoidance of risk practices in managing labor and delivery process of women with HCV infection may be useful to reduce MTCT of HCV. Early recognition of severe hepatic injury or liver failure associated with hepatitis viruses by regular liver function tests is critical to prevent maternal mortality associated with hepatitis.
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Affiliation(s)
- Jie Tang
- Department of Obstetrics and Gynecology, Wujin Hospital Affiliated with Jiangsu University, Jiangsu, China; Department of Obstetrics and Gynecology, The Wujin Clinical College of Xuzhou Medical University, Jiangsu, China
| | - Hong Zhao
- Department of Infectious Diseases, Nanjing Second Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yi-Hua Zhou
- Departments of Laboratory Medicine and Infectious Diseases and Obstetrics & Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China.
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Zhang C, Huang Y, Ji L, Zhu Q, Wang L, Wang J. Effectiveness of health management team program to enhance prevention of mother-to-child transmission of hepatitis B virus in Ningxia, China. BMC Public Health 2024; 24:67. [PMID: 38166770 PMCID: PMC10763679 DOI: 10.1186/s12889-023-17550-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Hepatitis B mother-to-child transmission interruption (PMTCT) poses a formidable challenge in underdeveloped regions of China. This study aims to evaluate the effectiveness of PMTCT and the health management team (HMT) model in Ningxia, China, as well as the risk factors for adverse outcomes. METHODS The PMTCT + HMT model was established, and 360 pregnant women diagnosed with HBV infection in 2020-2022 were selected and divided into the control and the study groups based on different intervention modes. HBV serum markers and HBV DNA levels were assessed, the indicators of compliance behaviors and adverse outcomes were compared, and the factors influencing adverse outcomes were analyzed. RESULTS The majority of subjects were residents of the local city, married, with secondary school or higher education, and employees of public sectors. The proportion of ethnic minorities was 40.8% and 34.2% in the control group and study group. HBeAg positivity was 23.3% and 26.3%, and the proportion with HBV DNA levels ≥ 2 × 105 IU/mL was 9.2% and 7.1%. Compared with the control group (PMTCT alone), the PMTCT + HMT model led to improved maternal knowledge (17.5% vs. 57.1%), voluntary counseling (34.2% vs. 63.3%), and testing (37.5% vs. 70.4%). The incidence of adverse pregnancy outcomes ((including miscarriage, preterm birth) decreased significantly (17.5% vs. 6.2%), as did adverse neonatal outcomes (low birth weight and congenital HBV) (26.9% vs. 10.5%). Adverse outcomes were associated with low educational attainment, non-locals, unmarried status, and ethnic minority identity. Additionally, HBeAg positivity and HBV DNA levels ≥ 2 × 105 IU/mL were risk factors for adverse outcomes. CONCLUSIONS The PMTCT + HMT model demonstrates significant effectiveness in preventing mother-to-child transmission of hepatitis B in Ningxia. The unique demographic structure of Ningxia region is closely linked to poor outcomes, emphasizing the importance of monitoring HBeAg status and HBV DNA viral load level.
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Affiliation(s)
- Chenglei Zhang
- Medical Laboratory, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750003, China
| | - Yongxiang Huang
- Medical Laboratory, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750003, China
| | - Liying Ji
- Department of laboratory, Yinchuan women and children healthcare hospital, Yinchuan, Ningxia, 750001, China
| | - Qian Zhu
- Medical Laboratory, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750003, China
| | - Lixin Wang
- Medical Laboratory, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750003, China
| | - Jingjiao Wang
- Department of Periodontics, Stomatological Hospital, General Hospital of Ningxia Medical University, 804 Shengli South Street, Xingqing District, Yinchuan, Ningxia, 750003, China.
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Sobajo OA, Oguzie JU, Adegboyega B, Eromon P, Happi C, Komolafe I, Folarin O. Detection of Immune Escape and Basal Core Promoter/Precore Gene Mutations in Hepatitis B Virus Isolated from Asymptomatic Hospital Attendees in Two Southwestern States in Nigeria. Viruses 2023; 15:2188. [PMID: 38005866 PMCID: PMC10674980 DOI: 10.3390/v15112188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/22/2023] [Accepted: 10/29/2023] [Indexed: 11/26/2023] Open
Abstract
Several mutations in the surface (S), basal core promoter (BCP), and precore (PC) genes of the hepatitis B virus have been linked to inaccurate diagnosis and the development of immune escape mutants (IEMs) of the infection, which can lead to chronic infection. Understanding the prevalence and spread of these mutations is critical in the global effort to eliminate HBV. Blood samples were collected from 410 people in Osun and Ekiti states, southwest Nigeria, between 2019 and 2021. Participants were drawn from a group of asymptomatic people who were either blood donors, outpatients, or antenatal patients with no record of HBV infection at the medical outpatients' unit of the hospital. DNA was extracted from plasma using a Qiagen DNEasy kit, followed by nested PCR targeting HBV S and BCP/PC genes. The Sanger sequencing method was used to sequence the positive PCR amplicons, which were further analyzed for IEMs, BCP, and PC mutations. HBV-DNA was detected in 12.4% (51/410) of individuals. After DNA amplification and purification, 47.1% (24) of the S gene and 76.5% (39) of the BCP/PC gene amplicons were successfully sequenced. Phylogenetic analysis showed that all the HBV sequences obtained in this study were classified as HBV genotype E. Mutational analysis of the major hydrophilic region (MHR) and a-determinant domain of S gene sequences revealed the presence of three immune escape mutations: two samples harbored a T116N substitution, six samples had heterogenous D144A/N/S/H substitution, and one sample had a G145E substitution, respectively. The BCP/PC region analysis revealed a preponderance of major BCP mutants, with the prevalence of BCP double substitutions ranging from 38.5% (A1762T) to 43.6% (G1764A). Previously reported classical PC mutant variants were observed in high proportion, including G1896A (33.3%) and G1899A (12.8%) mutations. This study confirms the strong presence of HBV genotype E in Nigeria, the ongoing circulation of HBV IEMs, and a high prevalence of BCP/PC mutants in the cohorts. This has implications for diagnosis and vaccine efficacy for efficient management and control of HBV in the country.
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Affiliation(s)
- Oguntope Adeorike Sobajo
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer’s University, Ede 232102, Osun State, Nigeria or (O.A.S.); (J.U.O.); (C.H.); (I.K.)
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer’s University, Ede 232102, Osun State, Nigeria; (B.A.); (P.E.)
- Department of Biological Science, College of Sciences, Afe Babalola University, Ado-Ekiti 360101, Ekiti State, Nigeria
| | - Judith Uche Oguzie
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer’s University, Ede 232102, Osun State, Nigeria or (O.A.S.); (J.U.O.); (C.H.); (I.K.)
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer’s University, Ede 232102, Osun State, Nigeria; (B.A.); (P.E.)
| | - Benjamin Adegboyega
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer’s University, Ede 232102, Osun State, Nigeria; (B.A.); (P.E.)
| | - Philomena Eromon
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer’s University, Ede 232102, Osun State, Nigeria; (B.A.); (P.E.)
| | - Christian Happi
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer’s University, Ede 232102, Osun State, Nigeria or (O.A.S.); (J.U.O.); (C.H.); (I.K.)
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer’s University, Ede 232102, Osun State, Nigeria; (B.A.); (P.E.)
| | - Isaac Komolafe
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer’s University, Ede 232102, Osun State, Nigeria or (O.A.S.); (J.U.O.); (C.H.); (I.K.)
| | - Onikepe Folarin
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer’s University, Ede 232102, Osun State, Nigeria or (O.A.S.); (J.U.O.); (C.H.); (I.K.)
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer’s University, Ede 232102, Osun State, Nigeria; (B.A.); (P.E.)
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Matthews PC, Ocama P, Wang S, El-Sayed M, Turkova A, Ford D, Torimiro J, Garcia Ferreira AC, Espinosa Miranda A, De La Hoz Restrepo FP, Seremba E, Mbu R, Pan CQ, Razavi H, Dusheiko G, Spearman CW, Hamid S. Enhancing interventions for prevention of mother-to-child- transmission of hepatitis B virus. JHEP Rep 2023; 5:100777. [PMID: 37554925 PMCID: PMC10405098 DOI: 10.1016/j.jhepr.2023.100777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 08/10/2023] Open
Abstract
Prevention of mother-to-child transmission of hepatitis B virus (HBV) infection is a cornerstone of efforts to support progress towards elimination of viral hepatitis. Current guidelines recommend maternal screening, antiviral therapy during the third trimester of high-risk pregnancies, universal and timely HBV birth dose vaccination, and post-exposure prophylaxis with hepatitis B immunoglobulin for selected neonates. However, serological and molecular diagnostic testing, treatment and HBV vaccination are not consistently deployed, particularly in many high endemicity settings, and models predict that global targets for reduction in paediatric incidence will not be met by 2030. In this article, we briefly summarise the evidence for current practice and use this as a basis to discuss areas in which prevention of mother-to-child transmission can potentially be enhanced. By reducing health inequities, enhancing pragmatic use of resources, filling data gaps, developing advocacy and education, and seeking consistent investment from multilateral agencies, significant advances can be made to further reduce vertical transmission events, with wide health, societal and economic benefits.
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Affiliation(s)
- Philippa C. Matthews
- The Francis Crick Institute, 1 Midland Road, London, NW1 1AT, UK
- Division of Infection and Immunity, University College London, Gower St, London WC1E 6BT, UK
- Department of Infection, University College London Hospitals, 235 Euston Rd, London NW1 2BU, UK
| | - Ponsiano Ocama
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Su Wang
- Cooperman Barnabas Medical Center, Florham Park, NJ, USA
- Hepatitis B Foundation, Doylestown, PA, USA
| | - Manal El-Sayed
- Department of Paediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Anna Turkova
- Medical Research Council Clinical Trials Unit, University College London, 90 High Holborn, London WC1V 6LJ, UK
| | - Deborah Ford
- Medical Research Council Clinical Trials Unit, University College London, 90 High Holborn, London WC1V 6LJ, UK
| | - Judith Torimiro
- Chantal Biya International Reference Centre for Research on Prevention and Management of HIV/AIDS (CIRCB), Yaounde, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon
| | - Ana Cristina Garcia Ferreira
- Ministry of Health, Health Surveillance Department, Department of Chronic Diseases and Sexually Transmitted Infections, SRTVN Quadra 701, Lote D, PO700 Building, CEP: 70719-040, Brasília/DF, Brazil
| | - Angélica Espinosa Miranda
- Ministry of Health, Health Surveillance Department, Department of Chronic Diseases and Sexually Transmitted Infections, SRTVN Quadra 701, Lote D, PO700 Building, CEP: 70719-040, Brasília/DF, Brazil
| | | | - Emmanuel Seremba
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Robinson Mbu
- Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon
| | - Calvin Q. Pan
- Division of Gastroenterology and Hepatology, NYU Langone Health, NYU Grossman School of Medicine, NY, USA
| | - Homie Razavi
- Center for Disease Analysis Foundation, 1120 W South Boulder Rd Suite 102, Lafayette, CO 80026, USA
| | - Geoffrey Dusheiko
- Liver Unit, King’s College Hospital, Denmark Hill, London SE5 9RS, UK
| | - C. Wendy Spearman
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Saeed Hamid
- Department of Medicine, Aga Khan University, Karachi, Pakistan
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