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Seo KI, Bae SH, Sung PS, Park CH, Lee HL, Kim HY, Kim HJ, Jang BH, Jang JW, Yoon SK, Choi JY, Park IY, Lee J, Lee HS, Kim SJ, Kwon JH, Chang UI, Kim CW, Jo SH, Lee Y, Tekle F, Kim JH. Effect of antiviral therapy in reducing perinatal transmission of hepatitis B virus and maternal outcomes after discontinuing them. Clin Mol Hepatol 2018; 24:374-383. [PMID: 29940720 PMCID: PMC6313021 DOI: 10.3350/cmh.2017.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/24/2018] [Accepted: 02/26/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND/AIMS There have been numerous efforts to reduce mother-to-child transmission (MTCT) of hepatitis B virus (HBV) with antiviral agents during pregnancy. However, there are limited data regarding the outcomes of pregnant women after delivery. This study was performed to evaluate the efficacy of antiviral agents in preventing MTCT of HBV and maternal long-term outcomes. METHODS The HBV-infected pregnant women treated with antiviral agents to prevent MTCT were retrospectively reviewed. Forty-one pregnant women who received telbivudine or tenofovir during late pregnancy (28-34 week) were analyzed. Hepatitis B virus surface antibody (HBsAb) positivity was tested in 43 infants after 7 months of birth. Eleven mothers were followed >1 year after delivery. RESULTS The mean HBV DNA titer before antiviral therapy was 8.67 (6.60-9.49) log copies/mL, and the median age at delivery was 32 years (range, 22-40). Eleven patients were treated with tenofovir and 30 with telbivudine. The median duration was 57 days (range, 23-100), and the median HBV DNA titer at birth was 5.06 log copies/mL (range, 2.06-6.50). Antiviral treatments were associated with significant HBV DNA reduction (P<0.001). Among 43 infants (two cases of twins), HBsAb was not detected in two, subsequently confirmed to have HBV infection. Biochemical flare was observed in two of 11 mothers followed >12 months, and an antiviral agent was administered. CONCLUSION Antiviral treatment during late pregnancy effectively reduced MTCT. Long-term follow-up should be required in such cases. In addition, given that maternal biochemical flare occurred in 18% of mothers, re-administration of antiviral agents might be required.
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Affiliation(s)
- Kwang Il Seo
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Si Hyun Bae
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
- The Catholic University Liver Research Center and WHO Collaborating Center of Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
| | - Pil Soo Sung
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
- The Catholic University Liver Research Center and WHO Collaborating Center of Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
| | - Chung-Hwa Park
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hae Lim Lee
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hee Yeon Kim
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hye Ji Kim
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bo Hyun Jang
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Won Jang
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
- The Catholic University Liver Research Center and WHO Collaborating Center of Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
| | - Seung Kew Yoon
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
- The Catholic University Liver Research Center and WHO Collaborating Center of Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
| | - Jong Young Choi
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
- The Catholic University Liver Research Center and WHO Collaborating Center of Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
| | - In-Yang Park
- Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, Korea
| | - Juyoung Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Seung Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sa-Jin Kim
- Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, Korea
| | - Jung Hyun Kwon
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - U Im Chang
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang Wook Kim
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Se Hyun Jo
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Lee
- Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, Korea
| | - Fisseha Tekle
- Department of Gastroentrology and Hepatology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Jong-Hyun Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Malekifar P, Babanejad M, Izadi N, Alavian SM. The Frequency of HBsAg in Pregnant Women from Eastern Mediterranean and Middle Eastern Countries: A Systematic Review and Meta-Analysis. HEPATITIS MONTHLY 2018; In Press. [DOI: 10.5812/hepatmon.58830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Prevalence, Infectivity, and Associated Risk Factors of Hepatitis B Virus among Pregnant Women in Yirgalem Hospital, Ethiopia: Implication of Screening to Control Mother-to-Child Transmission. J Pregnancy 2018; 2018:8435910. [PMID: 30174956 PMCID: PMC6098924 DOI: 10.1155/2018/8435910] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 06/30/2018] [Accepted: 07/15/2018] [Indexed: 02/07/2023] Open
Abstract
Background Hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) positive mother has up to 90% likelihood of mother-to-child transmission (MTCT) of hepatitis B virus (HBV) to newborns in the absence of any prophylaxis or antiviral therapy utilization. However, routine antenatal screening and intervention strategies are not yet practiced in Ethiopia. Therefore, this study was conducted to determine the prevalence, infectivity, and associated risk factors of HBV among pregnant women. Methods A cross-sectional study was conducted from October 2015 to August 2016 in Yirgalem Hospital. A total of 475 pregnant women were recruited, and data on sociodemography and potential risk factors were collected using a structured questionnaire. In addition, blood samples were tested for HBsAg, and HBsAg positive samples were retested for HBeAg using commercially available strip test. The status of HIV was collected from the records. Results The seroprevalence of HBsAg was 34 (7.2%), of whom 13 (38.8%) were positive for HBeAg. The prevalence of HIV infection was 10.1% (48/475). Ten out of 34 HBV positive cases (29.4%) were coinfected with HIV. The overall HBV/HIV coinfection rate was 2.1% (10/475). Women with history of multiple sexual partners and being HIV positive were significantly associated with HBsAg positivity. Among the study participants, 35.4% were aware of MTCT of HBV and only 12 (2.5%) have taken HBV vaccine. Conclusions High prevalence of HBsAg and HBeAg as well as low awareness and practices of HBV prevention methods suggests that perinatal transmission of HBV might be the prevailing mode of HBV transmission in the study area. Thus, screening of all pregnant women, particularly those who had history of multiple sexual partners and HIV coinfection, and provision of health education about HBV prevention methods are inevitable.
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Fouquet A, Jambon AC, Canva V, Bocket-Mouton L, Gottrand F, Subtil D. [Hepatitis B and pregnancy. Part 1. Thirteen practical issues in antenatal period]. ACTA ACUST UNITED AC 2016; 45:531-9. [PMID: 26964700 DOI: 10.1016/j.jgyn.2016.02.004] [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: 07/21/2015] [Revised: 02/03/2016] [Accepted: 02/11/2016] [Indexed: 11/28/2022]
Abstract
In France, the prevalence of chronic hepatitis B is about 1% in pregnant women (usually asymptomatic carriers of HBsAg). The risk of maternal-fetal transmission of hepatitis B is particularly high when viral load measured by PCR is higher in mothers (above 7 log) or HBeAg is present. In case of maternal-fetal transmission of hepatitis B, the risk to the newborn of developing subsequent chronic hepatitis B is very high (90%), with long-term complications such as cirrhosis and hepatocellular carcinoma. The prevention of maternal-fetal transmission is based on systematic testing for hepatitis B during pregnancy, followed by serovaccination of the newborn at birth. If necessary, amniocentesis can be realised but will avoid the realization of a transplacental gesture. In case of high viral load, the establishment of a maternal antiviral treatment with lamivudine or tenofovir from 28SA can further reduce the risk of transmission. Given the low resistance it induces, tenofovir should be used preferentially.
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Affiliation(s)
- A Fouquet
- Université Nord-de-France, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France.
| | - A-C Jambon
- Gynécologie-obstétrique, centre hospitalier de Tourcoing, 59200 Tourcoing, France
| | - V Canva
- Hépato-gastroentérologie, université Nord-de-France, CHRU de Lille, 59037 Lille, France
| | - L Bocket-Mouton
- Virologie, pôle biologie-pathologie, université Nord-de-France, CHRU de Lille, 59037 Lille, France
| | - F Gottrand
- Université Nord-de-France, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France
| | - D Subtil
- Université Nord-de-France, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France; EA 2694, PRES université Lille-Nord-de-France, 59000 Lille, France
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Salman K, Rashmi, Priti S, Molly M, Kumar VS, Zeenat S. Hepatitis B virus infection in pregnant women and transmission to newborns. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2015. [DOI: 10.1016/s2222-1808(15)60809-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abdi F, Novin MG, Afrakhteh M, Khorvash F. Hepatitis B and pregnancy: An update review article. World J Obstet Gynecol 2015; 4:1-8. [DOI: 10.5317/wjog.v4.i1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/24/2014] [Accepted: 11/03/2014] [Indexed: 02/05/2023] Open
Abstract
Chronic hepatitis B, as a global health problem, is a disease that begins in the prenatal period and its complications gradually become clear later in life. About 5% of women worldwide are carriers of chronic hepatitis B virus (HBV). The most common method of transmission of HBV around the world is from mother to infant. This article aims to review the unique challenges of hepatitis B in pregnancy. Data for this review were collected from our previous studies and experiences plus various data banks, such as PubMed, EMBASE, ISI Web of science, Scopus, Google Scholar and Iranian databases. A comprehensive search was performed using the combinations of the keywords to review relevant literature and higher education journals. All published data up to February 2014 have been included in this review. This article addresses several interesting aspects. First, hepatitis B in pregnancy can vary regarding prevalence, virus behavior, prenatal transmission and outcome of the pregnancy. Second, the women of reproductive age with chronic HBV remain a major source for continued spread of the virus. Finally, pregnant women need screening in prenatal care to enable early intervention when necessary.
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Zhang Z, Chen C, Li Z, Wu YH, Xiao XM. Individualized management of pregnant women with high hepatitis B virus DNA levels. World J Gastroenterol 2014; 20:12056-12061. [PMID: 25232243 PMCID: PMC4161794 DOI: 10.3748/wjg.v20.i34.12056] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 01/09/2014] [Accepted: 04/03/2014] [Indexed: 02/06/2023] Open
Abstract
Hepatitis B is a major health concern in the Asia-Pacific region, and is endemic in China, Southeast Asia, and Africa. Chronic hepatitis B virus (HBV) infection may cause hepatic cirrhosis and liver cancer. It is estimated that there are more than 350 million chronic HBV carriers worldwide, of whom approximately one quarter will die of chronic hepatitis B-related liver diseases. HBV is transmitted horizontally through blood and blood products or by sexual transmission, and vertically from mother to infant. Perinatal infection is the predominant mode of transmission in countries with a high prevalence of hepatitis B surface antigen (HBsAg) carriage, and perinatal transmission leads to high rates of chronic infection. Therefore, it is important to prevent the mother-to-child transmission (MTCT) of HBV. Research has shown that pregnant women with high HBV DNA levels have an increased risk of MTCT. However, most of the obstetrics guidelines do not make a distinction between pregnant women with high HBV DNA levels and those who are HBsAg positive only. This review addresses the management of pregnant women with high levels of HBV viremia, in terms of antiviral therapy, use of hepatitis B immunoglobulin (HBIG), the combined application of hepatitis B vaccine and HBIG, choice of delivery mode and feeding practices.
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Choe BH. A disappearing vertical infection: will hepatitis B be a forgotten disease in children? Korean J Intern Med 2014; 29:296-300. [PMID: 24851062 PMCID: PMC4028517 DOI: 10.3904/kjim.2014.29.3.296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 04/18/2014] [Indexed: 11/27/2022] Open
Affiliation(s)
- Byung-Ho Choe
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea
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Kim JH, Kim JS, Lee JJ, Kim JH, Kim SY, Jung YK, Kwon OS, Kim YS, Choi DJ, Kim JH. Survey of perinatal hepatitis B virus transmission after Korean National Prevention Program in a tertiary hospital. Korean J Intern Med 2014; 29:307-14. [PMID: 24851065 PMCID: PMC4028520 DOI: 10.3904/kjim.2014.29.3.307] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 07/12/2013] [Accepted: 08/13/2013] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND/AIMS The Ministry of Health and Welfare and the Korea Centers for Disease Control and Prevention in South Korea have been organizing hepatitis B virus (HBV) vertical infection prevention projects since July 2002. In this single-institute study, the results of surveys conducted in target mothers who delivered babies in a tertiary hospital were investigated and analyzed. METHODS Of the 9,281 mothers and their 9,824 neonates born between July 2002 and December 2012, 308 hepatitis B surface antigen (HBsAg)-positive mothers and their 319 neonates were selected for this study, and their records were analyzed retrospectively. RESULTS A total of 308 mothers were HBsAg-positive, with an HBV prevalence of 3.32% (308/9,281). There were 319 neonates born to these HBsAg-positive mothers, and 252 were confirmed to as either HBsAg-positive or -negative. Four were confirmed as HBsAg-positive, with a 1.59% (4/252) HBV vertical infection rate. All the mothers of neonates who had an HBV vertical infection were hepatitis B e antigen (HBeAg)-positive. Among the HBsAg-positive neonates, three were HBeAg-positive and had an HBV DNA titer of 1.0 × 10(8) copies/mL. CONCLUSIONS The HBV prevalence of mothers was 3.32% (308/9,281), and their vertical infection rate was 1.59% (4/252). Thus, the South Korean HBV vertical infection prevention projects are effective, and, accordingly, HBV prevalence in South Korea is expected to decrease continuously.
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Affiliation(s)
- Jae Hoon Kim
- Gachon University School of Medicine, Incheon, Korea
| | - Ju Seung Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jong Joon Lee
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jung Ho Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Suk Young Kim
- Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Incheon, Korea
| | - Young Kul Jung
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Oh Sang Kwon
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Yun Soo Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Duck Joo Choi
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Ju Hyun Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
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Xu H, Zeng T, Liu JY, Lei Y, Zhong S, Sheng YJ, Zhou Z, Ren H. Measures to reduce mother-to-child transmission of Hepatitis B virus in China: a meta-analysis. Dig Dis Sci 2014; 59:242-58. [PMID: 24193353 DOI: 10.1007/s10620-013-2918-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 10/07/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Mother-to-child transmission (MTCT) is the main mode of spread of hepatitis B virus (HBV) in China. We performed a meta-analysis to compare the effects of three measures for prevention of MTCT. METHODS A meta-analysis was performed on randomized controlled trials and non-randomized studies comparing the index of MTCT among five groups of pregnant women: hepatitis B immunoglobulin (HBIG) administration, antiviral treatment, placebo, elective caesarean section, and vaginal delivery. RESULTS Compared with the control group, the incidence of HBV intrauterine infection (RR = 0.42, 95 % CI 0.27-0.64, P < 0.0001) and the number of chronic hepatitis B (CHB) infants (RR = 0.44, 95 % CI 0.32-0.61, P < 0.00001) were lower in the HBIG administration group. In the antiviral treatment group, serum HBV DNA levels were lower (MD = -4.01, 95 % CI -5.07 to -2.94, P < 0.00001) at the time of delivery, and normalization of ALT levels was better (RR = 1.11, 95 % CI 1.06-1.17, P < 0.0001). Infant serum HBsAg positivity (RR = 0.45, 95 % CI 0.22-0.91, P = 0.03) and incidence of infant HBV transmission RR = 0.06, 95 % CI 0.01-0.24, P < 0.0001) were reduced in antiviral the treatment group. Infant serum anti-HBs positivity at birth (RR = 1.24, 95 % CI 0.89-1.74, P = 0.2) or at 6-7 months (RR = 0.98, 95 % CI 0.86-1.11, P = 0.73) was not significantly different between the caesarean section and vaginal delivery groups. The incidence of infant CHB infection may have been higher in the vaginal delivery group (RR = 2.20, 95 % CI 1.02-4.74, P = 0.04). CONCLUSIONS Administration of HBIG or antiviral therapy to HBV carrier mothers during pregnancy is effective in reducing MTCT.
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Affiliation(s)
- Hua Xu
- The Second College of Clinical Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Lingjiang Road, Central District, Chongqing, 400010, China,
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Abstract
Chronic hepatitis B virus (HBV) infection in pregnancy presents a unique and important challenge. Over 50% of chronic HBV carriers in endemic areas acquire infection vertically from their mothers. More importantly, over 90% of perinatally acquired infections progress to chronic HBV infection. Thus, management of chronic HBV during pregnancy and strategies to prevent mother-to-child transmission is an important step in eradicating or reducing the global burden of chronic hepatitis B. In addition, chronic HBV infection in pregnancy presents a unique clinical challenge because of the complex relationship between the physiological changes of pregnancy and the pathophysiological response to HBV. This review will present the current knowledge and a practical approach to management of HBV in pregnancy.
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Affiliation(s)
- Teerha Piratvisuth
- Department of Medicine, NKC Institute of Gastroenterology & Hepatology, Prince of Songkla University, Hat Yai, Thailand.
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Kumar A. Hepatitis B virus infection and pregnancy: a practical approach. Indian J Gastroenterol 2012; 31:43-54. [PMID: 22528342 DOI: 10.1007/s12664-012-0174-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 03/12/2012] [Indexed: 02/04/2023]
Abstract
Hepatitis B virus (HBV) infection is a global problem and the world has 350 million carriers of chronic hepatitis B. Over 50 % of these have acquired their infection vertically from their mothers (mother-to-child transmission [MTCT]). Majority (>90 %) of vertically-acquired infection results into chronic infection, due to induction of an immune-tolerant state. Hence, management of chronic HBV during pregnancy and strategies to prevent MTCT would go a long way in global control of HBV infection and the morbidity and mortality associated with it. However, chronic HBV infection in pregnancy presents a unique challenge, because of existence of a complex relationship between the physiological changes of pregnancy and the pathophysiological response of body to HBV. This relationship may lead to a varied presentation of the patient to the doctor depending on the period of her pregnancy and stage of her liver disease. Each of these modes of presentation raises issues that need to be addressed for successful maternal and fetal outcome, including prevention of MTCT of HBV. This review will try to give a practical approach in addressing these issues.
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Affiliation(s)
- Ashish Kumar
- Department of Gastroenterology and Hepatology, Sir Ganga Ram Hospital, New Delhi 110 060, India.
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Su WJ, Liu CC, Liu DP, Chen SF, Huang JJ, Chan TC, Chang MH. Effect of age on the incidence of acute hepatitis B after 25 years of a universal newborn hepatitis B immunization program in Taiwan. J Infect Dis 2012; 205:757-62. [PMID: 22262790 DOI: 10.1093/infdis/jir852] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Raising concerns about the waning immunity of cohorts receiving hepatitis B virus (HBV) vaccination in infancy persuaded us to identify the changing incidence of acute hepatitis B (AHB) in children and young adults. METHODS Data on AHB surveillance through the National Notifiable Disease Surveillance System from July 2001 to June 2009 were collected and described. Cases were divided into 2 cohorts according to their birth year: before or after the universal newborn HBV vaccination program. Age-specific incidence was compared for the 2 birth cohorts with diagnosis at age 15-24 years. RESULTS In total, 2226 patients with AHB were identified. AHB rates varied by age; the highest rates occurred among unvaccinated individuals aged 25-39 years (2.33/100 000). Due to breakthrough HBV infection from mother-to-infant transmission, vaccinated infants (0.78/100 000) had higher rates than those aged 1-14 years (0.04/100 000), who had the lowest rates. The incidence in vaccinated birth cohorts was significantly lower than in unvaccinated birth cohorts among patients 15-24 years old, with an adjusted-relative risk of 0.42. CONCLUSIONS Implementation of universal-at-birth HBV immunization programs has effectively reduced the occurrence of AHB among adolescents and young adults in Taiwan for >25 years, making infants and the 25-39-year-old cohort additional targets for preventing AHB.
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Affiliation(s)
- Wei-Ju Su
- Centers for Disease Control, Department of Health, Taipei, Taiwan
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Zhu XF, Lu LX, Wang Y, Xu KW, Li DJ, Zhu X, Liu L, Liu C, Wang JR, Tang H, Wang LC. Effect and Predictive Elements for 52 Weeks' Telbivudine Treatment on Naïve HBeAg positive Chronic Hepatitis B. HEPATITIS MONTHLY 2011; 11:980-5. [PMID: 22368682 PMCID: PMC3282031 DOI: 10.5812/kowsar.1735143x.4203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 09/03/2011] [Accepted: 12/07/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND Antiviral treatment with nucleoside analogs has been used for chronic hepatitis B (CHB). Each kind of nucleoside analog has its own characteristics and suitability for patients. Telbivudine (LdT, brand name: Sebivo, Beijing Novartis Pharma Ltd) is the newest nucleoside analog, with strong and rapid viral suppression. However, its resistance rate is relatively high during long-term application, due to low genetic barriers to resistance. So, it is necessary to increase the effect and reduce resistance with effective management, according to baseline factors and early on-treatment responses. OBJECTIVES To reveal possible predictive factors of the effect of telbivudine (LdT) treatment on naïve HBeAg-positive chronic hepatitis B (CHB) patients to optimize treatment. PATIENTS AND METHODS A total 71 naïve chronic hepatitis B (CHB) patients who met the inclusion criteria were enrolled. All patients were treated with LdT 600 mg Qd for at least 52 weeks. Multiple logistic regression analyses were done to investigate the predictive values of baseline factors and responses at Week 24. RESULTS The reduction in hepatitis virus B (HBV) DNA level was 6.44 ± 2.38 lg copies/mL at Week 52 compared with baseline. The complete virus response (CVR), biochemical response (BR), serological response (SR), and drug resistance (DR) were 61.99%, 77.46%, 35.21%, and 8.45% respectively. By multiple regression analysis, baseline alanine aminotransferase (ALT) levels significantly affected CVR (P = 0.024, OR = 1.008), and baseline ALT and baseline HBV DNA levels were independent compact factors of SR (P = 0.012, OR = 1.007; P = 0.001, OR = 0.423). The differences in CVR, SR, and DR in patients with ALT > 120 Iu/mL compared with patients with ALT ≤ 120 Iu/mL were statistically significant. The differences in SR in patients with HBV DNA > 107 copies/mL compared with patients with HBV DNA ≤ 107 copies/mL were statistically significant. Additionally, CVR, BR, and SR were differed significantly between patients with HBV DNA lower than 300 copies/mL at Week 24 and patients with HBV DNA higher than 300 copies/mL (P = 0.000, P = 0.0016, and P = 0.000, respectively). CONCLUSIONS There were more responders among naïve HBeAg-positive chronic hepatitis B patients with lower HBV DNA levels (especially lower than 107 copies/mL) and higher ALT values (especially higher than 120 Iu/mL at baseline) to LdT treatment. Adjustments for treatment strategy should be considered if HBV DNA > 300 copies/mL at Week 24 is observed.
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Affiliation(s)
- Xiao-Feng Zhu
- Epidemiology Department,West China School of public Health, Sichuan University, Chengdu, China
| | - Li-Xia Lu
- Center of Infectious Diseases,West China Hospital, Sichuan University, Chengdu, China
- Division of Infectious Diseases,State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
| | - Ying Wang
- Center of Infectious Diseases,West China Hospital, Sichuan University, Chengdu, China
- Division of Infectious Diseases,State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
| | - Kong-wen Xu
- Center of Infectious Diseases,West China Hospital, Sichuan University, Chengdu, China
- Division of Infectious Diseases,State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
| | - Da-jiang Li
- Center of Infectious Diseases,West China Hospital, Sichuan University, Chengdu, China
| | - Xia Zhu
- Center of Infectious Diseases,West China Hospital, Sichuan University, Chengdu, China
- Division of Infectious Diseases,State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
| | - Li Liu
- Center of Infectious Diseases,West China Hospital, Sichuan University, Chengdu, China
- Division of Infectious Diseases,State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
| | - Cong Liu
- Center of Infectious Diseases,West China Hospital, Sichuan University, Chengdu, China
- Division of Infectious Diseases,State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
| | - Jin-Rong Wang
- Center of Infectious Diseases,West China Hospital, Sichuan University, Chengdu, China
- Division of Infectious Diseases,State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
| | - Hong Tang
- Center of Infectious Diseases,West China Hospital, Sichuan University, Chengdu, China
- Division of Infectious Diseases,State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
| | - Li-Chun Wang
- Center of Infectious Diseases,West China Hospital, Sichuan University, Chengdu, China
- Division of Infectious Diseases,State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
- Corresponding author: Li-Chun Wang, Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, Sichuan province, people’s Republic of China. Tel.: +86-2885422650, Fax: +86-2885423052, E-mail:
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