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Alemayehu T, Daba MD, Buonsenso D. Long-Term Hepatitis B Vaccine Immunity in Ethiopian Children That Received a Pentavalent Vaccine Series: A Retrospective Cohort Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:136. [PMID: 38275446 PMCID: PMC10814694 DOI: 10.3390/children11010136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Chronic hepatitis B affects close to 300 million people globally with 1.5 million new infections per year. It causes the highest numbers of cirrhosis and liver cancer diagnoses each year. In children, perinatal transmission and contact with infected blood or body fluids remain the main methods of transmission. There are increasing reports of breakthrough hepatitis B infections in fully vaccinated children born to hepatitis B-negative mothers, especially in low- and middle-income countries. Our study aimed to measure the adequacy of hepatitis B surface antibody levels among children and adolescents who received three rounds of hepatitis B vaccination during infancy and delivered to hepatitis B-negative mothers in Addis Ababa, Ethiopia. METHOD This was a retrospective cohort study analyzing results of paired serology tests for hepatitis B surface antibody and antigen tests performed for children aged 1-18 years from July 2022 to June 2023. All recorded data were transferred to SPSS version 29.0. The prevalence of adequate hepatitis B surface antibody levels was determined and sub-group analysis conducted using descriptive statistics, frequencies and tables. The magnitude of association between different variables and vaccine-induced hepatitis B immunity was assessed using logistic regression. Statistically significant differences were taken at p < 0.05. RESULTS A total of 256 children were included in the study (mean age: 7.53 years). Six children (2.3%) had breakthrough hepatitis B infections. Overall, 37 children (14.4%) were categorized as having optimal hepatitis B surface antibody levels (vaccine-induced antibody titers of >10 IU/mL), while 219 (85.6%) had low titers of <10 IU/mL. Nearly all (97.4%) of the sub-group aged 10 years and above had below-par antibody levels, with adolescents (11-18 years) being ten times more likely to have low seroprotection than those aged less than 5 years. CONCLUSIONS Our study showed markedly low vaccine-induced hepatitis B surface antibody levels among the study population, especially adolescents. The presence of breakthrough infections may suggest a genuine lack of response and not just a mere drop in antibody titers and thus could highlight a significant public health problem in Ethiopia. Further immunologic studies and a thorough analysis of vaccine storage and administration should be conducted to inform prevention programs.
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Affiliation(s)
- Tinsae Alemayehu
- Department of Pediatrics and Adolescent Health, University of Botswana, Private Bag UB, Gaborone 00713, Botswana;
- Department of Pediatrics and Adolescent Health, St. Paul’s Hospital Millennium Medical College, Addis Ababa P.O. Box 1271, Ethiopia;
| | - Million Dechassa Daba
- Department of Pediatrics and Adolescent Health, St. Paul’s Hospital Millennium Medical College, Addis Ababa P.O. Box 1271, Ethiopia;
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Centro di Salute Globale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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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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Duri K, Munjoma PT, Mataramvura H, Mazhandu AJ, Chandiwana P, Marere T, Gumbo FZ, Mazengera LR. Antenatal hepatitis B virus sero-prevalence, risk factors, pregnancy outcomes and vertical transmission rate within 24 months after birth in a high HIV prevalence setting. BMC Infect Dis 2023; 23:736. [PMID: 37891471 PMCID: PMC10612272 DOI: 10.1186/s12879-023-08523-2] [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: 09/05/2022] [Accepted: 08/08/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Despite the availability of an effective vaccine, chronic hepatitis B virus (HBV) infections remain a major cause of liver cirrhosis and hepatocellular carcinoma. HBV burden in pregnancy, risk factors and the timing of mother to child transmission remain poorly described especially during this era of lifelong use of Tenofovir/Lamivudine/Efavirenz as firstline for HIV treatment. We aimed to determine the burden of HBV in pregnancy and infants receiving their first dose of HBV vaccine 6 weeks after birth in a high HIV-prevalence setting. METHODS Pregnant women ≥ 20 weeks' gestational age were enrolled and followed up as mother-infant dyads from delivery, 6, 24 and 96 weeks after birth. HBV surface antigen (HBsAg) was tested (fresh plasma, immunochromatography) in pregnancy. Women testing HBsAg-seropositive were further evaluated for other four HBV-biomarkers. Maternally HBV exposed babies were tested for HBsAg from birth and HBs-antibodies from 6 months of age. Maternal-infant factors were tested in univariable and multivariable analyses for predictors of HBsAg-seropositivity. RESULTS Six hundred HIV-uninfected and 608 HIV-infected women on Tenofovir/Lamivudine/Efavirenz-regimen with median (interquartile range) 350: (87-1477) days of therapy use were enrolled. The overall HBsAg-seroprevalence was 32/1208: 2.65%, 95% confidence interval (CI) [1.74, 3.55]; being 7/600: 1.17%, 95% CI [0.37, 1.97] and 25/608: 4.11%, 95% CI [2.52, 5.68] in HBsAg-monoinfected and HBsAg/HIV-coinfected respectively, disproportionately detected in 31/32: 96.9%, 95% CI [90.8, 100] women presumably HBV-unvaccinated in infancy. HBV exposed babies tended to be born prematurely (< 37 weeks); 15.2% versus 9.9% in the HBV-unexposed, p = 0.009. In multivariate logistic regression-models with variable elimination, HIV-infection and reported tooth extractions predicted antenatal HBsAg-seropositivity; odds ratios (CI): 3.85 (1.61-10.7) and 2.46 (1.07-5.34), respectively. None of the exposed infants were HBsAg-seropositive neither before nor after 6 weeks of age. No HBs-antibodies were detected in 23.3% of HBsAg-exposed infants at two years despite having successfully completed the HBV vaccination schedule. CONCLUSION Low and moderate HBV endemics were observed in HIV-uninfected and HIV-infected pregnant women, respectively. This underscores the need to routinely screen for HBV in pregnancy, especially the HIV-infected attending antenatal-care. Being HIV-infected and reported tooth extractions were independent risk factors for maternal HBsAg-seropositivity. Vertical and child horizontal transmissions were both absent, probably due to ~ the 50% frequency of antenatal anti-HBe-antibodies observed. Of concern was the absence of anti-HBs-antibodies in 23.3% of fully vaccinated/maternally HBV-exposed infants by two years. Absence of molecular diagnosis may have underestimated HBV burden. TRIAL REGISTRATION www. CLINICALTRIALS gov , trial registration number: NCT04087239.
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Affiliation(s)
- Kerina Duri
- Immunology Unit, Faculty of Medicine and Health Sciences (UZ-FMHS), University of Zimbabwe, P.O. Box A178, Avondale, Harare, Zimbabwe.
| | - Privilege Tendai Munjoma
- Immunology Unit, Faculty of Medicine and Health Sciences (UZ-FMHS), University of Zimbabwe, P.O. Box A178, Avondale, Harare, Zimbabwe
| | - Hope Mataramvura
- Immunology Unit, Faculty of Medicine and Health Sciences (UZ-FMHS), University of Zimbabwe, P.O. Box A178, Avondale, Harare, Zimbabwe
| | - Arthur John Mazhandu
- Immunology Unit, Faculty of Medicine and Health Sciences (UZ-FMHS), University of Zimbabwe, P.O. Box A178, Avondale, Harare, Zimbabwe
| | - Panashe Chandiwana
- Immunology Unit, Faculty of Medicine and Health Sciences (UZ-FMHS), University of Zimbabwe, P.O. Box A178, Avondale, Harare, Zimbabwe
| | - Tarisai Marere
- Obstetrics and Gynecological Unit, UZ-FMHS, Harare, Zimbabwe
| | | | - Lovemore Ronald Mazengera
- Immunology Unit, Faculty of Medicine and Health Sciences (UZ-FMHS), University of Zimbabwe, P.O. Box A178, Avondale, Harare, Zimbabwe
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Jiang H, Chen C, Yuan D, Ye X, Chen Y, Han G, Zhou G, Ju Y, Cao M. The relationship of maternal hepatitis B e antigen and response to vaccination of infants born to women with chronic infection. BMC Pregnancy Childbirth 2023; 23:518. [PMID: 37454068 DOI: 10.1186/s12884-023-05815-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND The relationship of maternal HBeAg and infants' response to hepatitis B vaccine remains controversial. This study aims to observe the dynamic changes in infant birth HBV markers and study the time-varying effects of maternal HBeAg on vaccination response of infants born to women with chronic HBV infection. METHODS 3163 infants born to HBsAg positive mothers including 1737 with maternal HBeAg positive in group A and 1426 negative in group B were enrolled eventually. Demographic information and laboratory tests were collected at birth, 7-12th and 24th month. The dynamic changes of infant HBV markers and HBsAb titers at different time points were compared between the two groups. RESULTS The infant HBV markers at birth displayed different modes. During the follow-up, we observed a significant downward trend in the positive rates of HBsAg, HBeAg, HBeAb and HBcAb. The HBsAg of two groups switched to negative at 7-12 months and HBeAg in Group A became negative at 24 months. The HBsAb titers of the infants in the two groups were 576.91(192.8-1000.0) vs 719.67(208.1-1000.0) at 7-12 months (Z = -3.049, P = 0.002) and 783.5(227.8-1000.0) vs 891.4(234.0-1000.0) at 24 months (Z = -0.853, P = 0.394). High HBV DNA viral load (OR 1.260, 95% CI 1.139-1.395, P < 0.001) and maternal HBeAg level (OR 1.003, 95% CI 1.002-1.003, P < 0.001) were associated with the higher HBeAg positive rate of infants. CONCLUSIONS Maternal HBeAg did affect the infants' immune response to vaccination and reduce the anti-response at 7-12th month temporarily, but these influences were negligible by 24th months after birth, which proved that the maternal HBeAg would not induce immune tolerance of infants from a long-term perspective.
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Affiliation(s)
- Hongxiu Jiang
- Department of Obstetrics and Gynecology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, 210003, Jiangsu, China
| | - Chao Chen
- Department of Obstetrics and Gynecology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, 210003, Jiangsu, China
| | - Deping Yuan
- Department of Obstetrics and Gynecology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, 210003, Jiangsu, China
| | - Xiajun Ye
- Department of Obstetrics and Gynecology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, 210003, Jiangsu, China
| | - Yan Chen
- Department of Pediatrics, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, 210003, Jiangsu, China
| | - Guorong Han
- Department of Obstetrics and Gynecology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, 210003, Jiangsu, China.
| | - Guanlun Zhou
- Department of Obstetrics and Gynecology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, 210003, Jiangsu, China
| | - Yuhao Ju
- Department of Obstetrics and Gynecology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, 210003, Jiangsu, China
| | - Minkai Cao
- Department of Obstetrics and Gynecology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, 210003, Jiangsu, China
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Lu H, Cao W, Zhang L, Yang L, Bi X, Lin Y, Deng W, Jiang T, Sun F, Zeng Z, Lu Y, Zhang L, Liu R, Gao Y, Wu S, Hao H, Chen X, Hu L, Xu M, Xiong Q, Dong J, Song R, Li M, Xie Y. Effects of hepatitis B virus infection and strategies for preventing mother-to-child transmission on maternal and fetal T-cell immunity. Front Immunol 2023; 14:1122048. [PMID: 36875136 PMCID: PMC9978148 DOI: 10.3389/fimmu.2023.1122048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/31/2023] [Indexed: 02/18/2023] Open
Abstract
One of the most common routes of chronic hepatitis B virus (HBV) infection is mother-to-child transmission (MTCT). Approximately 6.4 million children under the age of five have chronic HBV infections worldwide. HBV DNA high level, HBeAg positivity, placental barrier failure, and immaturity of the fetal immune are the possible causes of chronic HBV infection. The passive-active immune program for children, which consists of the hepatitis B vaccine and hepatitis B immunoglobulin, and antiviral therapy for pregnant women who have a high HBV DNA load (greater than 2 × 105 IU/ml), are currently two of the most important ways to prevent the transmission of HBV from mother to child. Unfortunately, some infants still have chronic HBV infections. Some studies have also found that some supplementation during pregnancy can increase cytokine levels and then affect the level of HBsAb in infants. For example, IL-4 can mediate the beneficial effect on infants' HBsAb levels when maternal folic acid supplementation. In addition, new research has indicated that HBV infection in the mother may also be linked to unfavorable outcomes such as gestational diabetes mellitus, intrahepatic cholestasis of pregnancy, and premature rupture of membranes. The changes in the immune environment during pregnancy and the hepatotropic nature of HBV may be the main reasons for the adverse maternal outcomes. It is interesting to note that after delivery, the women who had a chronic HBV infection may spontaneously achieve HBeAg seroconversion and HBsAg seroclearance. The maternal and fetal T-cell immunity in HBV infection is important because adaptive immune responses, especially virus-specific CD8 T-cell responses, are largely responsible for viral clearance and disease pathogenesis during HBV infection. Meanwhile, HBV humoral and T-cell responses are important for the durability of protection after fetal vaccination. This article reviews the literature on immunological characteristics of chronic HBV-infected patients during pregnancy and postpartum, blocking mother-to-child transmissions and related immune mechanisms, hoping to provide new insights for the prevention of HBV MTCT and antiviral intervention during pregnancy and postpartum.
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Affiliation(s)
- Huihui Lu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China.,Department of Obstetrics and Gynecology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weihua Cao
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China.,Department of Infectious Diseases, Miyun Teaching Hospital, Capital Medical University, Beijing, China
| | - Luxue Zhang
- Infectious Disease Department, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liu Yang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xiaoyue Bi
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yanjie Lin
- Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China
| | - Wen Deng
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Tingting Jiang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Fangfang Sun
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Zhan Zeng
- Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China
| | - Yao Lu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Lu Zhang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Ruyu Liu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yuanjiao Gao
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Shuling Wu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hongxiao Hao
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xiaoxue Chen
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Leiping Hu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Mengjiao Xu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Qiqiu Xiong
- Department of General Surgery, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jianping Dong
- Department of Infectious Disease, Haidian Hospital, Beijing Haidian Section of Peking University Third Hospital, Beijing, China
| | - Rui Song
- Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Minghui Li
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China.,Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China
| | - Yao Xie
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China.,Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China
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Johannessen A, Mekasha B, Desalegn H, Aberra H, Stene-Johansen K, Berhe N. Mother-to-Child Transmission of Hepatitis B Virus in Ethiopia. Vaccines (Basel) 2021; 9:vaccines9050430. [PMID: 33925930 PMCID: PMC8145487 DOI: 10.3390/vaccines9050430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 11/16/2022] Open
Abstract
High viral load and positive hepatitis B e-antigen (HBeAg) results are risk factors for mother-to-child transmission (MTCT) of hepatitis B virus (HBV). In sub-Saharan Africa, little is known about the distribution of these risk factors, as well as early childhood HBV transmission. In this study, Ethiopian women aged 18–45 years with chronic hepatitis B were assessed for the presence of HBeAg and high viral load. Their children below 4 years of age were invited for assessment of viral markers, defining active HBV infection as a positive hepatitis B s-antigen (HBsAg) and/or detectable HBV DNA. In total, 61 of 428 HBV-infected women (14.3%) had a positive HBeAg result and/or a high viral load. Of note, 26 of 49 women (53.1%) with viral load above 200,000 IU/mL were HBeAg negative. Among 89 children born of HBV-infected mothers (median age 20 months), 9 (10.1%) had evidence of active HBV infection. In conclusion, one in seven women with chronic hepatitis B had risk factors for MTCT, and HBeAg was a poor predictor of high viral load. One in ten children born of HBV-infected women acquired HBV-infection despite completing their scheduled HBV vaccination at 6, 10 and 14 weeks of age.
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Affiliation(s)
- Asgeir Johannessen
- Department of Infectious Diseases, Vestfold Hospital Trust, 3103 Tønsberg, Norway
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo, 0315 Oslo, Norway
- Regional Centre for Imported and Tropical Diseases, Ullevål, Oslo University Hospital, 0424 Oslo, Norway;
- Correspondence: ; Tel.: +47-97983264
| | - Bitsatab Mekasha
- Medical Department, St. Paul’s Hospital Millennium Medical College, 1230 Addis Ababa, Ethiopia; (B.M.); (H.D.); (H.A.)
| | - Hailemichael Desalegn
- Medical Department, St. Paul’s Hospital Millennium Medical College, 1230 Addis Ababa, Ethiopia; (B.M.); (H.D.); (H.A.)
| | - Hanna Aberra
- Medical Department, St. Paul’s Hospital Millennium Medical College, 1230 Addis Ababa, Ethiopia; (B.M.); (H.D.); (H.A.)
| | | | - Nega Berhe
- Regional Centre for Imported and Tropical Diseases, Ullevål, Oslo University Hospital, 0424 Oslo, Norway;
- Aklilu Lemma Institute of Pathobiology, University of Addis Ababa, 1230 Addis Ababa, Ethiopia
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Kang L, Pian Y, Gao Z, Hu J, Nie J. The influence of hepatitis B virus infection in pregnant women. Health Care Women Int 2021; 42:251-260. [PMID: 33724163 DOI: 10.1080/07399332.2021.1883024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We carried out the investigation to evaluate hepatitis B virus (HBV) infection status and the influence of HBV infection in pregnant women in Tianjin of China. We founded that the prevalence of HBsAg was 3.77% (69/1829). 88.57% (1620/1829) pregnant women conducted HBsAg screening in last pregnancy. Spontaneous abortion and premature delivery did not show significant differences between HBV infected and uninfected pregnant women. But ALT and AST levels were significantly higher in infected women. And 56.65% of participants (997/1760) were anti-HBs positive. In conclusion, HBsAg prevalence was moderate in pregnant women in this region, which was consistent with the total population in western Pacific regions. And HBV infection did not influence spontaneous abortion and premature delivery. But the HBsAg screening was conducted mostly in the last pregnancy. Early screening and intervention were suggested in pregnant women within countries of moderately endemic regions.
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Affiliation(s)
- Lina Kang
- Department of Clinical Laboratory, Tianjin Binhai New Area Dagang Hospital, Tianjin, China
| | - Yaya Pian
- National Center for Clinical Laboratories, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhenxiang Gao
- National Center for Clinical Laboratories, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jihong Hu
- National Center for Clinical Laboratories, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jingjing Nie
- National Center for Clinical Laboratories, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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8
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Hepatitis B - Vertical transmission and the prevention of mother-to-child transmission. Best Pract Res Clin Obstet Gynaecol 2020; 68:78-88. [PMID: 32249130 DOI: 10.1016/j.bpobgyn.2020.02.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/21/2020] [Accepted: 02/26/2020] [Indexed: 12/20/2022]
Abstract
Hepatitis B virus (HBV) infection is the commonest cause of chronic hepatitis, with an estimated global prevalence of 3.5%, and which leads to significant morbidity and mortality. Mother-to-child transmission (MTCT) during pregnancy is the leading form of transmission in endemic populations, and its interruption is thus crucial as the initial step in the elimination of HBV infection, notwithstanding the availability of potent antiviral medications. The risk of MTCT is dramatically reduced by timely neonatal HBV vaccination and the administration of hepatitis B immunoglobulin after birth in high-risk infants. Maternal HBV DNA quantification during pregnancy allows the assessment of the risk of newborn immunoprophylaxis failure (IF). Maternal antiviral treatment in highly viremic women can reduce the risk of IF. However, the optimal HBV DNA cutoff level for the initiation of antiviral treatment remains to be determined.
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Wang F, Kang W, Zhou W, Su Q, Bi S, Qiu F, Li Q. Investigation of the risk factors associated with the failure of hepatitis B vaccination of neonates in Yunnan province, China. Int J Infect Dis 2018; 77:90-95. [PMID: 30296573 DOI: 10.1016/j.ijid.2018.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/28/2018] [Accepted: 09/29/2018] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE This study aimed to investigate HBsAg positive rates and risk factors of HBV infection among the children less than 15 years old in Yunnan province, a remote southwest part of mainland China. METHODS Multi-stage sampling was used to randomly select study subjects from 9,360,000 individuals. Hepatitis B vaccine inoculation rate and HBsAg positive rate were investigated, and then propensity score and generalized linear mixed model (GLMMs) were applied to the case-control study. RESULTS The average HBsAg positive rate was 1.81%, with 1.2% in urban areas and 2.4% in rural areas. Rate of first-dose-in-time in urban areas was 77.7%, obviously higher than 49.5% in rural areas (χ2=2811.71, P<0.01). Similarly, 3-dose completion coverage rate in urban areas was 93.7%, also higher than 79.0% in rural areas (χ2=1561.43, P<0.01). Maternal HBeAg positivity and HBsAg positivity were proved to be the main risk factors of children with HBV infection. Moreover, paternal HBeAg positivity, paternal HBsAg positivity, the absence and unknown status of HBV vaccine inoculation were risk factors of children with HBV infection as well. CONCLUSION It was very important to improve the HBV vaccine inoculation rates. Delivering babies in hospital and timely inoculation with HBV vaccine were efficient ways to prevent HBV vertical transmission.
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Affiliation(s)
- Feng Wang
- Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping District, Beijing 102206, PR China
| | - Wenyu Kang
- Center for Disease Control and Prevention of Yunnan Province, Kunming 650022, PR China
| | - Wenting Zhou
- Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping District, Beijing 102206, PR China
| | - Qiudong Su
- Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping District, Beijing 102206, PR China
| | - Shengli Bi
- Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping District, Beijing 102206, PR China
| | - Feng Qiu
- Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping District, Beijing 102206, PR China.
| | - Qiongfen Li
- Center for Disease Control and Prevention of Yunnan Province, Kunming 650022, PR China.
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10
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Kar P, Sengupta A. Synthetic therapeutics for the treatment of hepatitis B during pregnancy. Expert Opin Pharmacother 2018; 19:1771-1778. [PMID: 30273073 DOI: 10.1080/14656566.2018.1527313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Hepatitis B infection in pregnancy mandates careful monitoring and specialized management according to the phase of hepatitis B infection. Perinatal transmission may be prevented by antiviral therapy in mothers with high viral load and timely immunoprophylaxis of the infant. AREAS COVERED This review focuses on the current first-line therapies for treating hepatitis B in pregnancy, timing of therapy, and prevention of perinatal transmission. Strategies to manage disease at the various phases and potential emerging therapies in phase III of development are also covered. Medline/PubMed and Cochrane databases were searched systematically from 1990 to April 2018 with the relevant articles selected for the review. EXPERT OPINION Universal antenatal screening for hepatitis B and strict immunoprophylaxis for infants form the cornerstones to prevent hepatitis B virus (HBV) perinatal transmission. Tenofovir is the preferred drug for treatment in pregnancy in view of its good efficacy and high barrier to resistance. Most of the data on antivirals are from cohort studies which are prone to bias and more randomized controlled trials (RCTs) are needed to establish the benefits and safety of these drugs in pregnancy. Various novel drugs are in the pipeline which may pave the way for a cure in the near future.
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Affiliation(s)
- Premashis Kar
- a Department of Gastroenterology and Hepatology , Max Super Speciality Hospital, Vaishali , Ghaziabad , India
| | - Anando Sengupta
- a Department of Gastroenterology and Hepatology , Max Super Speciality Hospital, Vaishali , Ghaziabad , India
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11
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Kang W, Li Q, Shen L, Zhang L, Tian Z, Xu L, Qiu F, Wang F. Risk factors related to the failure of prevention of hepatitis B virus Mother-to-Child transmission in Yunnan, China. Vaccine 2016; 35:605-609. [PMID: 28017429 DOI: 10.1016/j.vaccine.2016.12.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/05/2016] [Accepted: 12/08/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the relationship between the failure of prevention of hepatitis B virus Mother-to-Child transmission and HBV serological pattern, viral load as well as HBV genotypes. METHODS 2765 pairs of mother-infant matched samples were collected. These pregnant women were HBsAg positive and delivered at hospital from January 1st, 2011 to June 30th, 2011. Of these samples, 26 pairs of sera samples were randomly selected from 114 pairs of samples which failed in the prevention of hepatitis B virus Mother-to-Child transmission. Serological tests, viral load and genotype detection were performed for further analysis. Additionally, the selected subjects were followed and tested again in 2014. RESULTS HBeAg positive rates were 76.92% and 69.23% in mother group and infant group respectively, showed no statistical difference. The average HBV DNA levels were >2×105IU/ml in both mother group and infant group. Genotype analysis revealed that 11 pairs of mother-infant matched samples belonged to C gene type and another 11 pairs were B gene type. Different genotypes were observed in 4 pairs of mother-infant matched samples. CONCLUSION HbeAg positive and high HBV DNA level were two major risk factors of HBV mother to child transmission. Additionally, nosocomial infection was another potential way of HBV vertical transmission, especially in remote area of Yunnan province.
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Affiliation(s)
- Wenyu Kang
- Center for Disease Control and Prevention of Yunnan Province, Kunming 650022, China
| | - Qiongfen Li
- Center for Disease Control and Prevention of Yunnan Province, Kunming 650022, China
| | - Liping Shen
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Lifen Zhang
- Center for Disease Control and Prevention of Yunnan Province, Kunming 650022, China
| | - Ziying Tian
- Center for Disease Control and Prevention of Yunnan Province, Kunming 650022, China
| | - Lin Xu
- Center for Disease Control and Prevention of Yunnan Province, Kunming 650022, China
| | - Feng Qiu
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Feng Wang
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
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12
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Lu Y, Liang XF, Wang FZ, Yan L, Li RC, Li YP, Zhu FC, Zhai XJ, Li J, Zhuang H. Hepatitis B vaccine alone may be enough for preventing hepatitis B virus transmission in neonates of HBsAg (+)/HBeAg (-) mothers. Vaccine 2016; 35:40-45. [PMID: 27894717 DOI: 10.1016/j.vaccine.2016.11.061] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/14/2016] [Accepted: 11/15/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND AIM To prospectively evaluate the efficacy of vaccine alone compared with vaccine plus HBIG for preventing HBV transmission in neonates of HBsAg (+)/HBeAg (-) mothers. METHODS Combined immunization is currently recommended for neonates of HBsAg (+) mothers in China. As a result, a randomized design is infeasible due to ethical reasons. In practice, Guangxi Zhuang Autonomous Region and Jiangsu Province implement vaccine alone and vaccine plus HBIG strategies for neonates born to HBsAg (+)/HBeAg (-) mothers, respectively. We alternatively enrolled neonates of HBsAg (+)/HBeAg (-) mothers from these two regions. Three doses of a recombinant yeast-derived hepatitis B vaccine were given at 0, 1 and 6months with or without HBIG at birth. RESULTS At 7months, sera were collected from 132 neonates in Guangxi Zhuang Autonomous Region and 752 neonates in Jiangsu Province. Baseline characteristics of both mothers and neonates were comparable in the two regions. No differences were revealed regarding the occurrence of perinatal HBV transmission with or without HBIG at birth [0.1% (1/752) vs. 0.0% (0/132), p=1.000]. The anti-HBs response rates were 97.7% (129/132) and 98.5% (740/751) for the neonates with vaccine alone and with HBIG (p=0.758), respectively. Vaccine alone induced a significantly higher anti-HBs GMC as compared to vaccine plus HBIG at 7months of age (1555.3mIU/mL vs. 654.9mIU/mL, p<0.0001). At 12months of age, protective levels of anti-HBs remained in 97.4% (596/612) and 98.3% (118/120) of the neonates receiving and not receiving HBIG, respectively (p=0.771). The neonates receiving combined prophylaxis had a markedly lower anti-HBs GMC (210.7mIU/mL vs. 297.0mIU/mL, p=0.011). Horizontal HBV transmission occurred in none of the successfully immunized neonates for both compared groups at 12months of age. CONCLUSIONS Vaccine alone may be enough for preventing HBV transmission in neonates of HBsAg (+)/HBeAg (-) mothers.
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Affiliation(s)
- Ying Lu
- Department of Microbiology and Center of Infectious Diseases, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China
| | - Xiao-Feng Liang
- Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Fu-Zhen Wang
- Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Ling Yan
- Department of Microbiology and Center of Infectious Diseases, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China
| | - Rong-Cheng Li
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning 530028, China
| | - Yan-Ping Li
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning 530028, China
| | - Feng-Cai Zhu
- Department of Infectious Disease, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Xiang-Jun Zhai
- Department of Infectious Disease, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Jie Li
- Department of Microbiology and Center of Infectious Diseases, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China.
| | - Hui Zhuang
- Department of Microbiology and Center of Infectious Diseases, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China.
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13
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Lu Y, Liu YL, Nie JJ, Liang XF, Yan L, Wang FZ, Zhai XJ, Liu JX, Zhu FC, Chang ZJ, Li J. Occult HBV Infection in Immunized Neonates Born to HBsAg-Positive Mothers: A Prospective and Follow-Up Study. PLoS One 2016; 11:e0166317. [PMID: 27835694 PMCID: PMC5106040 DOI: 10.1371/journal.pone.0166317] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 10/26/2016] [Indexed: 01/04/2023] Open
Abstract
Objective Occult HBV infection (OBI) has been reported in infants born to HBsAg-positive mothers despite immunization. This study aims to determine the maintenance of this status in a prospective birth cohort. Methods A total of 158 neonates born to HBsAg-positive mothers were enrolled. All received passive-active immunization against HBV according to a 0-1-6 schedule. Sera were collected at 7 months of age. Those diagnosed with OBI were serially followed up at 12, 24 and 36 months of age. HBV serological markers were determined by Abbott i2000 system. HBV DNA was quantitated by Abbott m2000 system. Standard PCR followed by direct sequencing were applied for mother-child HBV pairs. Homology and phylogenetic comparisons were done by BLAST and Mega 5. Results All the 158 neonates were HBsAg-negative and anti-HBs-positive at 7 months of age, and 32 (20.3%) of them were diagnosed with OBI, with a median HBV DNA level of 1.97 (1.20–3.71) log IU/mL. Of them, HBV DNA was positive in 25.0%, 21.9% and 7.7% at 12, 24 and 36 months of age, respectively. HBV DNA disappeared at one of the follow-up points in 31 neonates, however, rebounded to low levels in 6 of them thereafter. HBV DNA persisted at low levels during follow-ups in the other one neonate apart from the above 31. All remained negative for HBsAg. Only two (6.3%) neonates were positive for anti-HBc after 24 months of age. HBV showed close homology and phylogenetic relationships for mother-child pairs. S-escape mutant, G145R, was not discovered. The first vaccine dose within 6 hours of birth significantly reduced the occurrence of OBI (59.4% vs. 83.3%, p = 0.003). Conclusions HBV may be controlled in immunized neonates of HBsAg-positive mothers, after being diagnosed with OBI. Timely vaccination against HBV may provide the utmost protection. Long-term and close monitorings are needed.
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Affiliation(s)
- Ying Lu
- Department of Microbiology and Center of Infectious Disease, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China
| | - Ya-Lin Liu
- Department of Microbiology and Center of Infectious Disease, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China
| | - Jing-Jing Nie
- Department of Microbiology and Center of Infectious Disease, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China
| | - Xiao-Feng Liang
- Chinese Center for Disease Control and Prevention, Beijing, 102206, China
| | - Ling Yan
- Department of Microbiology and Center of Infectious Disease, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China
| | - Fu-Zhen Wang
- Chinese Center for Disease Control and Prevention, Beijing, 102206, China
| | - Xiang-Jun Zhai
- Department of Infectious Disease, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Jian-Xun Liu
- Department of Major Projects, Zhengzhou Municipal Center for Disease Control and Prevention, Zhengzhou, 450053, China
| | - Feng-Cai Zhu
- Department of Infectious Disease, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Zhan-Jun Chang
- Department of Major Projects, Zhengzhou Municipal Center for Disease Control and Prevention, Zhengzhou, 450053, China
| | - Jie Li
- Department of Microbiology and Center of Infectious Disease, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China
- * E-mail:
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14
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Zhang L, Gui XE, Wang B, Fan JY, Cao Q, Mullane K, Liang XL. Serological positive markers of hepatitis B virus in femoral venous blood or umbilical cord blood should not be evidence of in-utero infection among neonates. BMC Infect Dis 2016; 16:408. [PMID: 27515176 PMCID: PMC4982401 DOI: 10.1186/s12879-016-1754-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 08/01/2016] [Indexed: 01/17/2023] Open
Abstract
Background Maternal-infant transmission of hepatitis B virus(HBV) occurs even after passive-active immunization. Some scholars speculate that in-utero infection may be the main cause of immunoprophylaxis failure. However, there is a lack of evidence about the possible occurrence periods of perinatal transmission. Methods From 2008 to 2012, 428 pairs of HBsAg-positive mothers and neonates were enrolled and 385 infants aged 8–12 months were followed. HBV markers (HBsAg, anti-HBs, HBeAg, anti-HBe, anti-HBc, HBV-DNA) were performed on all subjects. Results Of mothers who were positive for HBsAg, HBeAg, HBV-DNA, 35.1 %, 94.3 %, 12.7 % of their neonates were positive for those indices, respectively. Neonates’ mean titers of those indices were significantly lower than their mothers’. There were no significant differences in rates of positivity and mean titers of anti-HBe and anti-HBc between neonates and mothers. Most of the positive indices turned negative during the follow-up period. Immunoprophylaxis failed in seventeen infants: four infants had HBV-DNA > 6 log 10copies/mL both at birth and in follow-up; in six infants, mean viral load was 3.72 ± 0.17 log 10copies/mLat birth and 7.62 ± 0.14 log 10copies/mL at follow-up; seven infants were HBV-DNA negative at birth but were found to have > 6 log 10copies/mL during follow-up. Infants that were immunoprophylaxis failures were all born to HBeAg-positive mothers with HBV-DNA > 6 log 10copies/mL. Conclusions The placental barrier can partly prevent maternal HBsAg, HBeAg, HBV-DNA from passing through to fetus. Performing HBsAg, HBeAg, HBV-DNA once at birth can neither diagnose nor exclude maternal-infant transmission. The diagnosis of infection period depends on the dynamic changes in viral load from birth through the follow-up period but whether the infection occurred in utero, at delivery or during the neonatal period could not be determined.
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Affiliation(s)
- Lei Zhang
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuchang District, Wuhan City, Hubei Province, People's Republic of China.,Department of Infection Control, Qingdao Municipal Hospital, Qingdao, China
| | - Xi-En Gui
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuchang District, Wuhan City, Hubei Province, People's Republic of China.
| | - Bo Wang
- Department of gynaecology and obstetrics, Infectious Disease Hospital, Taiyuan, China
| | - Jing-Yi Fan
- Department of Paediatrics, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qian Cao
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuchang District, Wuhan City, Hubei Province, People's Republic of China
| | - Kathleen Mullane
- Department of Medicine/Division of Infectious Diseases, University of Chicago, Chicago, USA
| | - Xiao-Li Liang
- Department of gynaecology and obstetrics, Infectious Disease Hospital, Taiyuan, China
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15
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Wang C, Wang C, Jia ZF, Wu X, Wen SM, Kong F, Hu KQ, Li J, Jiang J, Niu JQ. Protective effect of an improved immunization practice of mother-to-infant transmission of hepatitis B virus and risk factors associated with immunoprophylaxis failure. Medicine (Baltimore) 2016; 95:e4390. [PMID: 27559947 PMCID: PMC5400313 DOI: 10.1097/md.0000000000004390] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Although routine immunoprophylaxis has been known to reduce hepatitis B virus (HBV) transmission, immunoprophylaxis failure still occurs. The study aimed to investigate the protective efficacy of an improved immunoprophylaxis protocol to prevent mother-to-infant transmission of HBV and to explore the potential risk factors associated with immunoprophylaxis failure and low antibody response.A prospective observational cohort study was conducted from July 2012 to April 2015. A total of 863 HBsAg-positive mothers and their 871 infants (8 pairs of twins) were included in the study. Two different hepatitis B vaccine doses (20 or 10 μg) were administered to the infants based on the hepatitis B e-antigen (HBeAg) status of their mothers. Simultaneously, hepatitis B immunoglobulin (HBIG) was administered to the infants. Initial injections of HBIG and the hepatitis vaccine were given within 2 hours after birth. Rates of HBV infections among the infants were evaluated at 7 months of age. Factors associated with immunoprophylaxis failure and low responses to vaccination were analyzed by unconditional logistic regression..At 7 months of age, no immunoprophylaxis failure was observed in the 565 infants born to HBeAg-negative mothers. Among the 306 infants born to HBeAg-positive mothers, immunoprophylaxis failed in 16 infants (5.2%) of the infants and they were found to be HBsAg-positive. Further analysis showed that HBV DNA levels ≥10 IU/mL [odds ratio (OR) = 4.53, 95% confidence interval (95% CI): 1.19-17.34], delayed vaccination (OR = 4.14, 95% CI: 1.00-17.18), and inadequate initial injections (OR = 7.69, 95% CI: 1.71-34.59) were independently associated with immunoprophylaxis failure. Adequate titers of antibody to HBsAg (anti-HBs, ≥100 mIU/mL) were present in 96.5% of immunoprophylaxis-successful infants. For full-term infants, birth weights <3000 g were correlated with low immune responses to vaccination.This improved immunoprophylaxis protocol is effective in preventing perinatal transmission of HBV. Among infants with HBeAg-positive mothers, high HBV viral loads and inadequate and delayed initial injections were associated with immunoprophylaxis failure. The majority of the infants in our study produced adequate levels of protective anti-HBs titers after immunoprophylaxis. Additional efforts to further reduce perinatal transmission should be considered, especially for HBeAg-positive mothers.
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Affiliation(s)
| | - Chuan Wang
- Division of Clinical Epidemiology, First Hospital of Jilin University, Changchun, Jilin, China
- Maternal and Child Health Center of Chaoyang District, Beijing, China
| | - Zhi-Fang Jia
- Division of Clinical Epidemiology, First Hospital of Jilin University, Changchun, Jilin, China
| | - Xing Wu
- Division of Clinical Epidemiology, First Hospital of Jilin University, Changchun, Jilin, China
| | - Si-Min Wen
- Division of Clinical Epidemiology, First Hospital of Jilin University, Changchun, Jilin, China
| | | | - Ke-Qin Hu
- Division of Gastroenterology and Hepatology, University of California, Irvine Medical Center, Orange, CA
| | - Jie Li
- Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
- Correspondence: Jing Jiang, Division of Clinical Epidemiology, First Hospital of Jilin University, Changchun, Jilin 130021, China (e-mail: ); Junqi Niu, Department of Hepatology, First Hospital of Jilin University, Changchun, Jilin 130021, China (e-mail: ); Jie Li, Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China (e-mail: )
| | - Jing Jiang
- Division of Clinical Epidemiology, First Hospital of Jilin University, Changchun, Jilin, China
- Correspondence: Jing Jiang, Division of Clinical Epidemiology, First Hospital of Jilin University, Changchun, Jilin 130021, China (e-mail: ); Junqi Niu, Department of Hepatology, First Hospital of Jilin University, Changchun, Jilin 130021, China (e-mail: ); Jie Li, Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China (e-mail: )
| | - Jun-Qi Niu
- Department of Hepatology
- Correspondence: Jing Jiang, Division of Clinical Epidemiology, First Hospital of Jilin University, Changchun, Jilin 130021, China (e-mail: ); Junqi Niu, Department of Hepatology, First Hospital of Jilin University, Changchun, Jilin 130021, China (e-mail: ); Jie Li, Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China (e-mail: )
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16
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Changes in the anti-HBc profile of infants born to HBV infected mothers from Iran. Vaccine 2016; 34:4475-4477. [PMID: 27475475 DOI: 10.1016/j.vaccine.2016.07.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 07/22/2016] [Accepted: 07/22/2016] [Indexed: 11/24/2022]
Abstract
From 2007 to 2014, 328 infants born to hepatitis B surface antigen (HBsAg) positive mothers, who received passive-active immunization against hepatitis B at birth were tested for HBsAg, antibody to hepatitis B core antigen (anti-HBc) and antibody to hepatitis B surface antigen (anti-HBs) at 12-15months of age. Thirteen (4%) cases were HBsAg positive. Forty-four infants who were anti-HBs, anti-HBc positive (group 1) and twenty-one infants who were anti-HBc positive alone (group 2) were identified. Both groups were followed-up annually for testing anti-HBs and anti-HBc to verify if anti-HBc was of maternal origin. In group 1, anti-HBc disappeared in 41 cases at month 24, and it disappeared from the remaining 3 cases at month 36. In group 2, anti-HBc disappeared in 18 cases at month 24 and in the remaining 3 cases at month 36. The results show that maternal anti-HBc may persist up to 3years in some children.
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17
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Salama II, Sami SM, Said ZNA, El-Sayed MH, El Etreby LA, Rabah TM, Elmosalami DM, Abdel Hamid AT, Salama SI, Abdel Mohsen AM, Emam HM, Elserougy SM, Hassanain AI, Abd Alhalim NF, Shaaban FA, Hemeda SA, Ibrahim NA, Metwally AM. Effectiveness of hepatitis B virus vaccination program in Egypt: Multicenter national project. World J Hepatol 2015; 7:2418-2426. [PMID: 26464758 PMCID: PMC4598613 DOI: 10.4254/wjh.v7.i22.2418] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 07/10/2015] [Accepted: 09/16/2015] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the effectiveness of hepatitis B virus (HBV) vaccination program among fully vaccinated children.
METHODS A national community based cross-sectional study was carried out in 6 governorates representing Egypt. A total of 3600 children aged from 9 mo to 16 years who were fully vaccinated with HBV vaccine during infancy were recruited. Face to face interviews were carried out and sera were evaluated for hepatitis B surface antigen (HBsAg), anti-HBV core antibodies (total) and quantitative detection of hepatitis B surface antibody using enzyme linked immunoassays techniques. Samples positive to HBsAg/anti-HBV core antibodies were subjected to quantitative HBV-DNA detection by real time polymerase chain reaction with 3.8 IU/L detection limit.
RESULTS Sero-protection was detected among 2059 children (57.2%) with geometric mean titers 75.4 ± 3.6 IU/L compared to 3.1 ± 2.1 IU/L among non-seroprotected children. Multivariate logistic analysis revealed that older age and female gender were the significant predicting variables for having non sero-protective level, with adjusted odds ratio 3.3, 9.1 and 14.2 among children aged 5 to < 10, 10 to < 15 and ≥ 15 years respectively compared to those < 5 years and 1.1 among girls compared to boys with P < 0.01. HBsAg was positive in 0.11% and breakthrough infection was 0.36% and 0.39% depending on positivity of anti-HBc and DNA detection respectively. The prevalence of HBV infection was significantly higher among children aged ≥ 7 years (0.59%) compared to 0.07% among younger children with odds ratio equal to 8.4 (95%CI: 1.1-64.2) and P < 0.01.The prevalence was higher among girls (0.48%) than boys (0.29%) with P > 0.05.
CONCLUSION The Egyptian compulsory HBV vaccination program provides adequate protection. Occult HBV infection exists among apparently healthy vaccinated children. Adherence to infection control measures is mandatory.
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Affiliation(s)
- Iman I Salama
- Community Medicine Research Department, National Research Center, Cairo 12311, Egypt
| | - Samia M Sami
- Child Health Department, National Research Center, Cairo 12311, Egypt
| | - Zeinab Nabil Ahmed Said
- Micro-biology and Immunology Department, Faculty of Medicine (for girls), Al-Azhar University, Cairo 11754, Egypt
| | - Manal H El-Sayed
- Pediatrics Department, Faculty of Medicine, Ain-Shams University, Cairo 11566, Egypt
| | - Lobna A El Etreby
- Community Medicine Research Department, National Research Center, Cairo 12311, Egypt
| | - Thanaa M Rabah
- Community Medicine Research Department, National Research Center, Cairo 12311, Egypt
| | - Dalia M Elmosalami
- Community Medicine Research Department, National Research Center, Cairo 12311, Egypt
| | - Amany T Abdel Hamid
- Community Medicine Research Department, National Research Center, Cairo 12311, Egypt
| | - Somaia I Salama
- Community Medicine Research Department, National Research Center, Cairo 12311, Egypt
| | - Aida M Abdel Mohsen
- Community Medicine Research Department, National Research Center, Cairo 12311, Egypt
| | - Hanaa M Emam
- Dermatology and Venereology Department, National Research Center, Cairo 12311, Egypt
| | - Safaa M Elserougy
- Environmental and Occupational Medicine Department, National Research Center, Cairo 12311, Egypt
| | - Amal I Hassanain
- Child Health Department, National Research Center, Cairo 12311, Egypt
| | - Naglaa F Abd Alhalim
- Micro-biology and Immunology Department, Faculty of Medicine (for girls), Al-Azhar University, Cairo 11754, Egypt
| | - Fatma A Shaaban
- Child Health Department, National Research Center, Cairo 12311, Egypt
| | - Samia A Hemeda
- Community Medicine Research Department, National Research Center, Cairo 12311, Egypt
| | - Nihad A Ibrahim
- Community Medicine Research Department, National Research Center, Cairo 12311, Egypt
| | - Ammal M Metwally
- Community Medicine Research Department, National Research Center, Cairo 12311, Egypt
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18
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Attallah AM, Abdallah SO, El-Far M, Omran MM, Tabll AA, Ghaly MF, Ezzat SM, Elhamshary MO, El-Gohary ZM, Mohamedin AH, El-Morsi AA, Askora AA, Abdelrazek MA, El-Kafrawy HM, Keneber MH, Khalil MR, Aggag MM, Elbendary MS, El-Deeb MM, Abuzaid MS, Mansour AT, Attallah AA. Perinatal transmission of hepatitis C antigens: envelope 1, envelope 2 and non-structural 4. Infect Dis (Lond) 2015; 47:568-74. [PMID: 25922972 DOI: 10.3109/23744235.2015.1042035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Perinatal exposure to hepatitis C virus (HCV) antigens during pregnancy may affect the developing immune system in the fetus. We aimed to study the perinatal transmission of HCV structural and non-structural antigens. METHODS Sera from 402 pregnant mothers were tested for anti-HCV antibody and HCV RNA. HCV antigens were determined in sera from 101 HCV-infected mothers and their cord blood. RESULTS In both serum and cord blood samples, HCV NS4 (non-structural 4) at 27 kDa, E1 (envelope 1) at 38 kDa and E2 (envelope 2) at 40 kDa were identified, purified and quantified using western blotting, electroelution and ELISA. Maternal sera and neonate cord blood samples had similar detection rates for NS4 (94.1%), E1 (90.1%) and E2 (90.1%). The mean maternal serum levels (optical density, OD) of HCV NS4 (0.87 ± 0.01), E1 (0.86 ± 0.01) and E2 (0.85 ± 0.01) did not differ significantly (p > 0.05) from those of neonatal cord blood (0.83 ± 0.01, 0.87 ± 0.01 and 0.85 ± 0.01, respectively). Also, strong correlations (p < 0.0001) were shown between sera and cord blood sample levels of HCV NS4, r = 0.77; E1, r = 0.76 and E2, r = 0.80. The vertical transmission of these antigens in vaginal delivery did not differ significantly (p > 0.05) from those in caesarean section. CONCLUSIONS These findings indicate that vertical transmission of HCV NS4, E1 and E2 antigens was very high. Thus, exposure to these antigens may influence the developing immune responses to natural infection or future vaccination.
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Jin H, Zhao Y, Tan Z, Zhang X, Zhao Y, Wang B, Liu P. Immunization interventions to interrupt hepatitis B virus mother-to-child transmission: a meta-analysis of randomized controlled trials. BMC Pediatr 2014; 14:307. [PMID: 25526664 PMCID: PMC4297423 DOI: 10.1186/s12887-014-0307-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 12/07/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND This study aimed to determine the clinical efficacy of various immune interventions on mother-to-child transmission (MTCT) of hepatitis B virus (HBV). METHODS We retrieved different immune strategies on how to prevent MTCT reported in the literature from Chinese and English electronic databases from the viewpoint of intrauterine and extrauterine prevention. Relative risk (RR) and 95% confidence interval (CI) methods were used. RESULTS Twenty-five articles on intrauterine prevention and 16 on extrauterine prevention were included in the analysis. Intrauterine prevention could reduce infants' HBV infection rate (RR = 0.36, 95% CI: 0.28-0.45) and increase their anti-hepatitis B surface-positive rate (RR = 2.42, 95% CI: 1.46-4.01) at birth. Compared with passive immunization, passive-active immunization could reduce infants' HBV infection rate (RR = 0.66, 95% CI: 0.52-0.84) at birth, even at more than 12 months of age (RR = 0.54, 95% CI: 0.42-0.69). Subgroup analysis demonstrated similar results except for pregnant women who were hepatitis B surface antigen-positive. Funnel plots and Egger's tests showed publication bias mainly in intrauterine prevention not in extrauterine one. CONCLUSIONS The long-term protective effect of pregnant women injected with hepatitis B immunoglobulin during pregnancy should be further validated by large-scale randomized trials. Newborns of pregnant women who carried HBV should undergo a passive-active immunization strategy.
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Affiliation(s)
- Hui Jin
- Department of Epidemiology and Health Statistics, Southeast University, Nanjing, China. .,Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China.
| | - Yueyuan Zhao
- Department of Epidemiology and Health Statistics, Southeast University, Nanjing, China.
| | - Zhaoying Tan
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China.
| | - Xuefeng Zhang
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China.
| | - Yaoyun Zhao
- Department of Epidemiology and Health Statistics, Southeast University, Nanjing, China.
| | - Bei Wang
- Department of Epidemiology and Health Statistics, Southeast University, Nanjing, China. .,Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China.
| | - Pei Liu
- Department of Epidemiology and Health Statistics, Southeast University, Nanjing, China. .,Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China.
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20
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Dunkelberg JC, Berkley EMF, Thiel KW, Leslie KK. Hepatitis B and C in pregnancy: a review and recommendations for care. J Perinatol 2014; 34:882-91. [PMID: 25233195 PMCID: PMC4777346 DOI: 10.1038/jp.2014.167] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 07/31/2014] [Accepted: 08/06/2014] [Indexed: 12/17/2022]
Abstract
Our objective was to provide a comprehensive review of the current knowledge regarding pregnancy and hepatitis B virus (HBV) or hepatitis C virus (HCV) infection as well as recent efforts to reduce the rate of mother-to-child transmission (MTCT). Maternal infection with either HBV or HCV has been linked to adverse pregnancy and birth outcomes, including MTCT. MTCT for HBV has been reduced to approximately 5% overall in countries including the US that have instituted postpartum neonatal HBV vaccination and immunoprophylaxis with hepatitis B immune globulin. However, the rate of transmission of HBV to newborns is nearly 30% when maternal HBV levels are greater than 200 000 IU ml(-1) (>6 log10 copies ml(-1)). For these patients, new guidelines from the European Association for the Study of the Liver (EASL) and the Asian Pacific Association for the Study of the Liver (APASL) indicate that, in addition to neonatal vaccination and immunoprophylaxis, treating with antiviral agents such as tenofovir disoproxil fumarate or telbivudine during pregnancy beginning at 32 weeks of gestation is safe and effective in preventing MTCT. In contrast to HBV, no therapeutic agents are yet available or recommended to further decrease the risk of MTCT of HCV, which remains 3 to 10%. HCV MTCT can be minimized by avoiding fetal scalp electrodes and birth trauma whenever possible. Young women with HCV should be referred for treatment post delivery, and neonates should be closely followed to rule out infection. New, better-tolerated treatment regimens for HCV are now available, which should improve outcomes for all infected individuals.
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Affiliation(s)
- JC Dunkelberg
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - EMF Berkley
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - KW Thiel
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - KK Leslie
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Abstract
Hepatitis B virus (HBV) vertical transmission remains a worldwide issue but is fairly uncommon in the western world due to routine screening and vaccination. Universal screening of pregnant women during the second trimester facilitates interruption of mother-to-child transmission (MTCT) by identifying HBV-infected mothers for whom intervention may reduce MTCT risk. HBV DNA level is the single most important predictor of MTCT. Other risk factors include HBeAg, HBe Ab, anti-HB core IgG, and HIV status. Current recommendations for infants born to HBsAg-positive mothers include administration of HBIG within 12 hours of birth and first dose of HBV vaccine within 24 hours of birth. Antiviral therapy is recommended in the third trimester of pregnancy in a subset of patients based on HBeAg and HBV DNA status for prophylaxis of MTCT, although discontinuation of antivirals after delivery is associated with significant increased risk of flares. This article outlines the data for prevention of vertical transmission of HBV.
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A study of immunoprophylaxis failure and risk factors of hepatitis B virus mother-to-infant transmission. Eur J Pediatr 2014; 173:1161-8. [PMID: 24699981 DOI: 10.1007/s00431-014-2305-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 02/11/2014] [Accepted: 03/24/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED Hepatitis B virus (HBV) infection is of high prevalence in China. Mother-to-infant transmission is the major route for HBV transmission and subsequent chronicity. This study aimed to investigate current HBsAg-positive rate among pregnant women and immunoprophylaxis outcome in China. Multicenter prospective study was conducted in 10 centers. From 2008 to 2012, 67,720 pregnant women were screened and 1,150 HBsAg-carrier mothers and their infants aged 8-12 months were studied in four out of all centers, among whom HBV markers (HBsAg, HBsAb, HBeAg, HBeAb, and HBcAb) and HBV DNA (in three centers) were measured. The results showed that HBsAg-positive rate of pregnant women was 6.7 % (4,533/67,720) and infants' immunoprophylaxis failure rate was 3.4 % (39/1,150). Immunoprophylaxis failure infants were all born to mothers of HBeAg-positive and HBV DNA ≥6 log10 copies/ml. Among infants of HBeAg-positive mothers, multivariable analyses showed the following: mother's age <28 years vs ≥28 years, RR = 0.157, 95 % confidence interval (CI) [0.067, 0.369], p = 0.000; Neonates receiving vaccine vs vaccine plus hepatitis B immune globulin (HBIG), RR = 0.371, 95 % CI [0.167, 0.825], p = 0.015. Pregnant women receiving HBIG in the third trimester, vaginal delivery and breastfeeding had no significant effects on HBV mother-to-infant transmission. CONCLUSIONS Pregnant women are still of high HBsAg prevalence in China. HBV mother-to-infant transmission still occurs after passive-active immunization. Pregnant women of high HBV replication levels are the major risk population of HBV mother-to-infant transmission. Passive-active immunization is necessary for neonates of HBeAg-positive mothers. Mother's age <28 years and neonate receiving vaccine only were the risk factors for HBV mother-to-infant transmission. Breastfeeding did not put children at risk of mother-to-infant transmission.
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Immunoprophylaxis failure against vertical transmission of hepatitis B virus in the Chinese population: a hospital-based study and a meta-analysis. Pediatr Infect Dis J 2014; 33:897-903. [PMID: 25361021 DOI: 10.1097/inf.0000000000000315] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Despite effective immunoprophylaxis, vertical transmission of hepatitis B virus (HBV) from infected mothers still occurs. This study aimed to provide an estimate of the prevalence of immunoprophylaxis failure and evaluate associated risk factors. METHODS A hospital-based prospective study was conducted from June 1, 2008, to June 30, 2012. In this prospective study, 294 HBsAg-positive mothers were followed up from their first prenatal care visits until their infants completed the proposed vaccination schedule. Further, studies providing prevalence rates of immunoprophylaxis failure in the Chinese population were identified from electronic databases and were collected for a meta-analysis. RESULTS In the prospective study, 16 (5.44%) infants developed HBV infection despite passive-active immunoprophylaxis. Twelve of these infants were born to HBeAg-positive mothers with cord blood that was positive for HBV DNA. After adjusting for maternal and infant factors, HBV DNA detectable in cord blood (odds ratio: 22.32, 95% confidence interval: 4.00-124.47) was associated with a significantly greater risk of immunoprophylaxis failure. The prospective study and 23 previous studies were included in the meta-analysis, constituting a total of 7561 Chinese participants. The overall estimated rates of immunoprophylaxis failure for infants with HBsAg-positive and HBeAg-positive mothers were 4.87% and 9.66% respectively. CONCLUSIONS Immunoprophylaxis failure is an extensive problem, and further studies should design and assess novel strategies for the prevention of immunoprophylaxis failure, especially for cases involving HBeAg-positive mothers and infants with cord blood that is positive for HBV DNA.
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Ma L, Alla NR, Li X, Mynbaev OA, Shi Z. Mother-to-child transmission of HBV: review of current clinical management and prevention strategies. Rev Med Virol 2014; 24:396-406. [DOI: 10.1002/rmv.1801] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 05/25/2014] [Accepted: 05/26/2014] [Indexed: 12/14/2022]
Affiliation(s)
- Lin Ma
- Department of Obstetrics and Gynecology; Third Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Nageswara R. Alla
- Department of Pulmonary, Allergy and Critical Care Medicine; University of Pittsburgh; Pittsburgh PA USA
| | - Xiaomao Li
- Department of Obstetrics and Gynecology; Third Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Ospan A. Mynbaev
- Department of ObGyn and Reproductive Medicine, Moscow State University of Medicine & Dentistry; Peoples' Friendship University of Russia; Moscow Russia
- The International Translational Medicine and Biomodeling Research Team, MIPT center for human physiology studies; The Department of Applied Mathematics, Moscow Institute of Physics and Technology (State University); Dolgoprudny Moscow Region Russia
- Laboratory of Pilot Projects; Moscow State University of Medicine & Dentistry; Moscow Russia
| | - Zhongjie Shi
- Department of Obstetrics and Gynecology; Third Affiliated Hospital of Sun Yat-sen University; Guangzhou China
- Department of Microbiology & Immunology; Thomas Jefferson University; Philadelphia PA USA
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25
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Gentile I, Borgia G. Vertical transmission of hepatitis B virus: challenges and solutions. Int J Womens Health 2014; 6:605-11. [PMID: 24966696 PMCID: PMC4062549 DOI: 10.2147/ijwh.s51138] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
More than 240 million people worldwide are chronically infected with hepatitis B virus (HBV). Mother-to-child transmission remains the most important mechanism of infection in countries with a high prevalence of HBV. Universal screening of all pregnant women, at-birth prophylaxis with specific anti-HBV immune globulin, as well as HBV vaccination for newborns of infected mothers are effective in reducing the risk of vertical transmission. However, in cases of a high viral load and hepatitis B e antigen positivity, there is a residual risk of HBV transmission to the newborn despite prophylaxis. This review focuses on the above-indicated strategies and on the efficacy and safety of antiviral drugs administered during the third trimester of pregnancy.
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Affiliation(s)
- Ivan Gentile
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Guglielmo Borgia
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
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26
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Frequencies of dendritic cells and Toll-like receptor 3 in neonates born to HBsAg-positive mothers with different HBV serological profiles. Epidemiol Infect 2014; 143:62-70. [PMID: 24650439 DOI: 10.1017/s0950268814000624] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
To investigate the frequencies of dendritic cells (DCs) and Toll-like receptor 3 (TLR3) in neonates of HBsAg-positive mothers with different HBV serological profiles, we conducted a study in Taiyuan, China. The study included 144 HBsAg-positive mothers and their neonates. The frequencies of DCs and TLR3 were determined using four-colour flow-cytometric analysis. DC and TLR3 frequencies were not related to HBV intrauterine transmission, maternal HBeAg positivity, maternal HBV DNA positivity and HBeAg/HBV DNA double-positivity. The plasmacytoid dendritic cell (pDC) frequencies in neonates whose maternal HBV DNA was >5 × 107 copies/ml decreased significantly compared to that in neonates whose maternal HBV DNA was ⩽5 × 107 copies/ml (Z = - 2·170, P = 0·03) or whose maternal HBV DNA was negative (Z = - 1·981 P = 0·048). This study suggests that neonatal pDC frequencies decrease when maternal HBV DNA loads are >5 × 107 copies/ml.
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27
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Khamduang W, Ngo-Giang-Huong N, Gaudy-Graffin C, Jourdain G, Suwankornsakul W, Jarupanich T, Chalermpolprapa V, Nanta S, Puarattana-Aroonkorn N, Tonmat S, Lallemant M, Goudeau A, Sirirungsi W. Prevalence, risk factors, and impact of isolated antibody to hepatitis B core antigen and occult hepatitis B virus infection in HIV-1-infected pregnant women. Clin Infect Dis 2013; 56:1704-12. [PMID: 23487379 DOI: 10.1093/cid/cit166] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Prevalence and risk factors for isolated antibody to hepatitis B core antigen (anti-HBc) and occult hepatitis B virus (HBV) infection are not well known in human immunodeficiency virus type 1 (HIV-1)-infected pregnant women. It is unclear if women with occult infections are at risk of transmitting HBV to their infants. METHODS HIV-1-infected and HBV surface antigen (HBsAg)-negative pregnant women were tested for antibody to HBsAg (anti-HBs) and anti-HBc using enzyme immunoassay. Women with isolated anti-HBc were assessed for occult HBV infection, defined as HBV DNA levels >15 IU/mL, using the Abbott RealTime HBV DNA assay. Infants born to women with isolated anti-HBc and detectable HBV DNA were tested at 4 months of age for HBV DNA. Logistic regression analysis was used to identify factors associated with isolated anti-HBc and occult HBV infection. RESULTS Among 1812 HIV-infected pregnant women, 1682 were HBsAg negative. Fourteen percent (95% confidence interval [CI], 12%-15%) of HBsAg-negative women had an isolated anti-HBc that was independently associated with low CD4 count, age >35 years, birth in northern Thailand, and positive anti-hepatitis C virus serology. Occult HBV infection was identified in 24% (95% CI, 18%-30%) of women with isolated anti-HBc, representing 2.6% (95% CI, 1.9%-3.5%) of HIV-1-infected pregnant women, and was inversely associated with HIV RNA levels. None of the women with isolated anti-HBc and occult HBV infection transmitted HBV to their infants. CONCLUSIONS HIV-1-infected pregnant women with isolated anti-HBc and occult HBV infection have very low HBV DNA levels and are thus at very low risk to transmit HBV to their infants.
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Affiliation(s)
- Woottichai Khamduang
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai. Thailand
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Liu MH, Sheng YJ, Liu JY, Hu HD, Zhang QF, Ren H. Efficacy of telbivudine on interruption of hepatitis B virus vertical transmission: a meta-analysis. Ann Saudi Med 2013; 33:169-76. [PMID: 23563007 PMCID: PMC6078630 DOI: 10.5144/0256-4947.2013.169] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Hepatitis B virus (HBV) infection is one of the most common infections in the world. Vertical transmission is the main reason for the continued endemic infection rates, at least in Asia. This study aimed to investigate the efficacy of telbivudine on mother-to-child transmission (MTCT) interruption. METHODS Studies up to April 2012 were collected by searching Pubmed, EMBASE, the Cochrane Library, EBM Review, WangFang Database and China National Knowledge Infrastructure. Serum hepatitis B surface antigen (HBsAg) and HBV DNA in newborns and infants, maternal HBV DNA negative conversion and alanine trans.aminase (ALT) normalization and adverse events were analyzed. RESULTS Seven clinical trials involving 644 pregnant women were included in this meta-analysis. Telbivudine resulted in lower HBsAg and HBV DNA seroprevalence in newborns and infants. When maternal viral load prior to delivery was higher than 103copies/mL, HBsAg or HBV DNA positivity had no statistical difference. CONCLUSIONS Telbivudine treatment has efficacy and safety on MTCT interruption during late pregnancy. In addition, we demonstrated benefit of telbivudine for mothers in terms of HBV DNA negative conversion and ALT normalization. Telbivudine treatment at the end of pregnancy should be considered in women with high viral load.
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Affiliation(s)
- Min-Hui Liu
- Department of Infectious Diseases, Institute of Viral Hepatitis, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
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29
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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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30
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Abstract
Hepatitis B is a serious public health problem all around the world. It is a blood-borne and sexually transmitted DNA virus in adults, but mother to child transmission of hepatitis B virus also occurs in infants born to hepatitis B surface antigen positive mothers.
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Kumar M, Singh T, Sinha S. Chronic hepatitis B virus infection and pregnancy. J Clin Exp Hepatol 2012; 2:366-81. [PMID: 25755458 PMCID: PMC3940289 DOI: 10.1016/j.jceh.2012.09.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 09/06/2012] [Indexed: 02/06/2023] Open
Abstract
Planning of pregnancy and management of chronic hepatitis B virus during pregnancy includes recognition of maternal virological status, assessment of liver disease severity and minimization of risk for mother to infant transmission of infection. Decisions regarding the use of antivirals during pregnancy need to be individualized. Monitoring for infection and immunization in newborns is also important. For mothers on antiviral therapy, breastfeeding is not recommended.
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Key Words
- ALT, alanine aminotransferase
- APASL, Asian Pacific Association for the Study of the Liver
- APR, Antiretroviral Pregnancy Registry
- CDC, Centers for Disease Control and Prevention
- CI, confidence interval
- DART, Development of Antiretroviral Therapy Study
- EASL, European Association for the Study of the Liver
- ECS, elective caesarian section
- FDA, Food and Drug Administration
- HBIg, hepatitis B immunoglobulin
- HBV, hepatitis B virus
- HBeAg, hepatitis B e antigen
- HBsAg, hepatitis B surface antigen
- HIV, human immunodeficiency virus
- NA, nucleot(s)ide analog
- PEG-IFN, pegylated interferon
- PHACS, Pediatric HIV/AIDS Cohort Study
- RCTs, randomized clinical trials
- breast feeding
- chronic hepatitis B
- pregnancy
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Affiliation(s)
- Manoj Kumar
- Department of Hepatology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi 110070, India
| | - Tarandeep Singh
- Department of Hepatology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi 110070, India
| | - Swati Sinha
- Department of Obstetrics and Gynecology, Sitaram Bhartia Institute of Science and Research, B-16, Qutab Institutional Area, New Delhi 110016, India
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32
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Abstract
During hepatitis B virus (HBV) infection, at least four antigen-antibody systems are observed: HBsAg and anti-HBs; preS antigen and anti-preS antibody; HBcAg and anti-HBc; and HBeAg and anti-HBe. Through the examination of these antigen-antibody systems, hepatitis B infection is diagnosed and the course of the disorder may be observed. Although the serologic findings that allow both the diagnosis of HBV infection as well as assessing of its clinical course are already well established, the dynamics of viral proteins expression and of the antibodies production may vary during the infection natural course. This causes the HBV infection to be occasionally associated with the presence of uncommon serological profiles, which could lead to doubts in the interpretation of results or suspicion of a serological result being incorrect. This paper is dedicated to the discussion of some of these profiles and their significance.
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Cai QX, Zhu YY. Is hepatitis B virus transmitted via the male germ line? A seroepidemiological study in fetuses. Int J Infect Dis 2012; 17:e54-8. [PMID: 23154176 DOI: 10.1016/j.ijid.2012.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 08/18/2012] [Accepted: 09/03/2012] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To detect father-to-fetus transmission of hepatitis B virus (HBV) in utero. METHODS We conducted a study at the prenatal diagnosis center of Taizhou City. Fetuses with one or both parents carrying the hepatitis B surface antigen (HBsAg) were identified before genetic testing during the period 2008-2010. Intrauterine samples were obtained by amniocentesis or cordocentesis and tested for serological markers and by quantitative DNA assays. All neonates received combined hepatitis B immunoprophylaxis after delivery, and serological follow-up tests were performed at 1 year of age. RESULTS Of the 407 couples enrolled in the study, HBV was carried by fathers only in 164, and none of their fetuses were found to be HBV DNA-positive in utero. All fetal serological markers were found to be of maternal but not paternal origin. The response rate to postnatal vaccination was 98.6%, and none of the children who failed immunoprophylaxis were the offspring of the HBV carrier fathers. CONCLUSIONS The infection of fetuses with HBV from the spermatozoa of carrier fathers seems unlikely, especially in an area where pre-conception hepatitis B vaccination is routinely provided.
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Affiliation(s)
- Qun-Xi Cai
- Department of Obstetrics and Gynecology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai City, China
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34
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Borgia G, Carleo MA, Gaeta GB, Gentile I. Hepatitis B in pregnancy. World J Gastroenterol 2012; 18:4677-83. [PMID: 23002336 PMCID: PMC3442205 DOI: 10.3748/wjg.v18.i34.4677] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 12/05/2011] [Accepted: 03/28/2012] [Indexed: 02/06/2023] Open
Abstract
Chronic hepatitis B virus (HBV) infection affects about 350 million individuals worldwide. Management of HBV infection in pregnancy is difficult because of several peculiar and somewhat controversial aspects. The aim of the present review is to provide a tool that may help physicians to correctly manage HBV infection in pregnancy. This review focuses on (1) the effect of pregnancy on HBV infection and of HBV infection on pregnancy; (2) the potential viral transmission from mother to newborn despite at-birth prophylaxis with immunoglobulin and vaccine; (3) possible prevention of mother-to-child transmission through antiviral drugs, the type of antiviral drug to use considering their efficacy and potential teratogenic effect, and the timing of their administration and discontinuation; and (4) the evidence for the use of elective caesarean section vs vaginal delivery and the possibility of breastfeeding.
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Abstract
UNLABELLED It is estimated that 350 to 400 million individuals worldwide are chronically infected with hepatitis B virus (HBV). In regions of high endemicity, many of these are females of reproductive age who are an important source for perinatal transmission. There are a number of issues specific to the women of childbearing age who have chronic HBV infection, including the safety of antiviral therapy during pregnancy and breast-feeding, the changes in the immune system during pregnancy and postpartum that may impact on the natural history of HBV, and the emerging role of antivirals to reduce perinatal transmission of HBV. For women in their reproductive years who require treatment, many of the available antivirals have not been studied in pregnant or breast-feeding women and their use requires the development of a carefully considered strategy, considering the impact of both the disease and treatment on the mother and fetus/infant. The purpose of this article is to (1) review data regarding the mechanisms and timing of perinatal HBV infection; (2) review data on interventions, particularly antiviral therapy, to reduce perinatal transmission beyond the protection afforded by hepatitis B immunoglobulin and vaccination; (3) summarize the immunological changes associated with pregnancy and the potential effect these may have on the natural history of HBV infection; and (4) summarize the information currently available for antiviral therapy available for HBV treatment, focusing specifically on safety data pertaining to reproduction, pregnancy, and breast-feeding. TARGET AUDIENCE Obstetricians & Gynecologists and Family Physicians. LEARNING OBJECTIVES After completing this CME activity physicians should be better able to classify the interventions to reduce mother-to-child transmission of hepatitis B including antivirals, caesarean section, hepatitis B immunoglobulin and hepatitis B vaccine, assess the immunological changes associated with pregnancy and the potential effect this may have on the natural history of HBV infection and apply the information currently available for antiviral therapy licensed for HBV treatment, focusing specifically on safety data in pregnancy and during breastfeeding.
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Pan CQ, Duan ZP, Bhamidimarri KR, Zou HB, Liang XF, Li J, Tong MJ. An algorithm for risk assessment and intervention of mother to child transmission of hepatitis B virus. Clin Gastroenterol Hepatol 2012; 10:452-9. [PMID: 22079509 DOI: 10.1016/j.cgh.2011.10.041] [Citation(s) in RCA: 181] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 10/11/2011] [Accepted: 10/30/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Despite immunoprophylaxis, mother to child transmission (MTCT) of hepatitis B virus (HBV) still occurs in infants born to hepatitis B surface antigen (HBsAg)-positive mothers. We analyzed methods of risk assessment and interventions for MTCT. METHODS We reviewed 63 articles and abstracts published from 1975-2011 that were relevant to MTCT; articles were identified using the PubMed bibliographic database. RESULTS Administration of HB immunoglobulin and HB vaccine to infants at birth (within 12 hours), followed by 2 additional doses of vaccines within 6-12 months, prevented approximately 95% of HBV transmission from HBsAg-positive mothers to their infants. However, HBV was still transmitted from 8%-30% of mothers with high levels of viremia. It is important to assess the risk for MTCT and identify mothers who are the best candidates for intervention. The most important risk factor is maternal level of HBV DNA >200,000 IU (10(6) copies)/mL; other factors include a positive test result for the HB e antigen, pregnancy complications such as threatened preterm labor or prolonged labor, and failure of immunoprophylaxis in prior children. Antiviral therapy during late stages of pregnancy is the most effective method to reduce transmission from mothers with high levels of viremia, but elective cesarean section might also be effective. Antepartum administration of HB immunoglobulin, giving infants a double dose of HB vaccine, or avoiding breastfeeding had no impact on MTCT. CONCLUSIONS HBsAg-positive mothers should be assessed for risk of MTCT, and infants should receive immunoprophylaxis. Pregnant women with levels of HBV DNA >200,000 IU/mL should be considered for strategies to reduce the risk for MTCT. We propose an algorithm for risk assessment and patient management that is based on a review of the literature and the opinion of a panel of physicians with expertise in preventing MTCT.
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Affiliation(s)
- Calvin Q Pan
- Division of Liver Diseases, Mount Sinai Medical Center, Mount Sinai School of Medicine, New York, New York 11355, USA.
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Han L, Zhang HW, Xie JX, Zhang Q, Wang HY, Cao GW. A meta-analysis of lamivudine for interruption of mother-to-child transmission of hepatitis B virus. World J Gastroenterol 2011; 17:4321-33. [PMID: 22090789 PMCID: PMC3214708 DOI: 10.3748/wjg.v17.i38.4321] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 04/07/2011] [Accepted: 04/14/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the therapeutic effect of lamivudine in late pregnancy for the interruption of mother-to-child transmission (MTCT) of hepatitis B virus (HBV).
METHODS: Studies were identified by searching available databases up to January 2011. Inclusive criteria were HBV-carrier mothers who had been involved in randomized controlled clinical trials (RCTs) with lamivudine treatment in late pregnancy, and newborns or infants whose serum hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg) or HBV DNA had been documented. The relative risks (RRs) for interruption of MTCT as indicated by HBsAg, HBV DNA or HBeAg of newborns or infants were calculated with 95% confidence interval (CI) to estimate the efficacy of lamivudine treatment.
RESULTS: Fifteen RCTs including 1693 HBV-carrier mothers were included in this meta-analysis. The overall RR was 0.43 (95% CI, 0.25-0.76; 8 RCTs; Pheterogeneity = 0.04) and 0.33 (95% CI, 0.23-0.47; 6 RCTs; Pheterogeneity = 0.93) indicated by newborn HBsAg or HBV DNA. The RR was 0.33 (95% CI, 0.21-0.50; 6 RCTs; Pheterogeneity = 0.46) and 0.32 (95% CI, 0.20-0.50; 4 RCTs; Pheterogeneity = 0.33) indicated by serum HBsAg or HBV DNA of infants 6-12 mo after birth. The RR (lamivudine vs hepatitis B immunoglobulin) was 0.27 (95% CI, 0.16-0.46; 5 RCTs; Pheterogeneity = 0.94) and 0.24 (95% CI, 0.07-0.79; 3 RCTs; Pheterogeneity = 0.60) indicated by newborn HBsAg or HBV DNA, respectively. In the mothers with viral load < 106 copies/mL after lamivudine treatment, the efficacy (RR, 95% CI) was 0.33, 0.21-0.53 (5 RCTs; Pheterogeneity = 0.82) for the interruption of MTCT, however, this value was not significant if maternal viral load was > 106 copies/mL after lamivudine treatment (P = 0.45, 2 RCTs), as indicated by newborn serum HBsAg. The RR (lamivudine initiated from 28 wk of gestation vs control) was 0.34 (95% CI, 0.22-0.52; 7 RCTs; Pheterogeneity = 0.92) and 0.33 (95% CI, 0.22-0.50; 5 RCTs; Pheterogeneity = 0.86) indicated by newborn HBsAg or HBV DNA. The incidence of adverse effects of lamivudine was not higher in the mothers than in controls (P = 0.97). Only one study reported side effects of lamivudine in newborns.
CONCLUSION: Lamivudine treatment in HBV carrier-mothers from 28 wk of gestation may interrupt MTCT of HBV efficiently. Lamivudine is safe and more efficient than hepatitis B immunoglobulin in interrupting MTCT. HBV MTCT might be interrupted efficiently if maternal viral load is reduced to < 106 copies/mL by lamivudine treatment.
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Abstract
Hepatitis B virus (HBV) during pregnancy presents unique management challenges. Varying aspects of care must be considered, including the effects of HBV on maternal and fetal health, effects of pregnancy on the course of HBV infection, treatment of HBV during and after pregnancy, and prevention of perinatal infection. Antiretroviral therapy has not been associated with increased risk of birth defects or toxicity, but despite studies designed to elucidate the drug efficacy and safety in affected individuals and the developing fetus, recommendations are inconclusive. Clinicians and patients must make individualized decisions after carefully evaluating the risks and benefits summarized in this article.
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Elefsiniotis IS, Tsoumakas K, Papadakis M, Vlachos G, Saroglou G, Antsaklis A. Importance of maternal and cord blood viremia in pregnant women with chronic hepatitis B virus infection. Eur J Intern Med 2011; 22:182-6. [PMID: 21402250 DOI: 10.1016/j.ejim.2010.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 11/30/2010] [Accepted: 12/07/2010] [Indexed: 01/28/2023]
Abstract
BACKGROUND/AIM The spontaneous preterm birth (SPB) rates in a group of HBeAg-negative chronic HBV infected pregnant women without several known risk factors for preterm delivery as well as the mother to infant HBV transmission rates was evaluated. Moreover the role of maternal data during perinatal period as well as the role of HBsAg and/or HBV-DNA presence in cord blood in respect to preterm labour and vertical transmission of the infection was examined. METHODS 138 consecutive chronic HBV infected pregnant women were haematologically, serologically and virologically evaluated during the perinatal period. 102 women were finally evaluated and fifteen of them (14.7%) exhibited SPB. Overall, 44 infants who had completed the proposed vaccination schedule were evaluated at month 12 of their life. RESULTS A significant association between SPB and HBV-DNA presence in cord blood was observed (p=0.007). HBV-DNA positivity in cord blood was significantly associated with maternal HBV-DNA levels (p=0.002). The relative risk of HBV-DNA presence in cord blood was 6.43 times higher among women with serum HBV-DNA ≥ 10.000 copies/ml and lymphocyte count<1500 compared to those with all the other combinations of both parameters (p=0.001). All infants evaluated at month 12 were HBsAg-negative and exhibited undetectable HBV-DNA levels. CONCLUSION The presence of HBV-DNA in cord blood is significantly associated with SPB in chronic HBV infected pregnant women. Maternal or cord blood viremia does not pose an additional risk factor for vertical transmission of HBV infection, in passive-active immunoprotected infants from HBeAg-negative chronic HBV infected mothers.
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Affiliation(s)
- Ioannis S Elefsiniotis
- University Department of Internal Medicine-Hepatology Unit, Elena Venizelou Hospital, Athens, Greece.
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Shao ZJ, Zhang L, Xu JQ, Xu DZ, Men K, Zhang JX, Cui HC, Yan YP. Mother-to-infant transmission of hepatitis B virus: a Chinese experience. J Med Virol 2011; 83:791-5. [PMID: 21360547 DOI: 10.1002/jmv.22043] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2010] [Indexed: 01/05/2023]
Abstract
Over 90% of infants infected with hepatitis B virus (HBV) caused by mother-to-infant transmission will evolve to carrier status, and this cannot be prevented until widespread administration of the HB vaccine and hepatitis B immune globulin (HBIG) is implemented. This prospective study of 214 infants born to HBsAg-positive mothers was carried out to determine if either perinatal or intrauterine HBV transmission could be effectively prevented with HBIG and the HB vaccine. Peripheral blood was collected from mothers and from newborns before they received HBIG and the HB vaccine, as well as at 0, 1, 7, 24, and 36 months after birth. Infants born with an ratio of signal to noise(S/N) value of >5 for HBsAg (ABBOTT Diagnostic Kit) were defined as mother-to-infant transmission cases, those with an S/N between 5 and 50 were classified as perinatal transmission cases, and those with an S/N >50 were considered intrauterine transmission cases. Mother-to-infant transmission occurred in approximately 4.7% (10/214) of the infants; the perinatal transmission and intrauterine transmission rates were 3.7% (8/214) and 0.9% (2/214), respectively. The risk of mother-to-infant transmission increased along with maternal HBeAg or HBVDNA levels. After 36 months of follow-up, all perinatal cases became HBsAg-negative, whereas all intrauterine transmission cases evolved into carrier status. These results indicate that infants infected via intrauterine transmission cannot be effectively protected by HBIG and HB vaccine.
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Affiliation(s)
- Zhong-Jun Shao
- Department of Epidemiology, School of Public Health, The Fourth Military Medical University, Xi'an, China
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Lamivudine in late pregnancy to interrupt in utero transmission of hepatitis B virus: a systematic review and meta-analysis. Obstet Gynecol 2010; 116:147-159. [PMID: 20567182 DOI: 10.1097/aog.0b013e3181e45951] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To evaluate efficacy of lamivudine in reducing in utero transmission of hepatitis B virus (HBV). DATA SOURCES A database was constructed from Medline, EMBASE, Cochrane Library, National Science Digital Library, China Biological Medicine Database, and through contact with experts in the field from January 1990 to October 2009. METHODS OF STUDY SELECTION We used the Jadad score and Cochrane Collaboration's tool for assessing risk of bias. TABULATION, INTEGRATION, AND RESULTS We abstracted data regarding HBV intrauterine infection, mother-to-child transmission, maternal HBV DNA level, treatment methods, and adverse effects. All newborns followed joint immune prophylaxis schedule of hepatitis B vaccine and hepatitis B immunoglobulin after delivery. The Mantel-Haenszel random-effects model was employed for all analyses using odds ratio (OR) and 95% confidence interval. Compared with the no-treatment group or placebo group, newborns in the lamivudine group had a 10.7–23.7% lower incidence of intrauterine infection, indicated by newborn hepatitis B surface antigen (0.38,0.15–0.94, six randomized controlled trials [RCTs], P5.04) and HBV DNA (0.22, 0.12–0.40, four RCTs, P,.001) seropositivity, and a 12.7–33.2% lower mother-to child transmission rate at 9–12 months, indicated by infant hepatitis B surface antigen (0.31, 0.15–0.63, five RCTs, P,.01) and HBV DNA (0.20, 0.10–0.39, two RCTs,P,.001) seropositivity [corrected].No significant higher adverse effects or complications in pregnancy were observed. CONCLUSION Lamivudine in HBV carrier-mothers with high degree of infectiousness in late pregnancy effectively prevented HBV intrauterine infection and mother-to-child transmission.
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Does hepatitis B virus prenatal transmission result in postnatal immunoprophylaxis failure? CLINICAL AND VACCINE IMMUNOLOGY : CVI 2010; 17:1836-41. [PMID: 20943880 DOI: 10.1128/cvi.00168-10] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The objective of this work was to evaluate whether postnatal hepatitis B immunization failure in children is caused by prenatal infections. A prospective study was conducted from October 2006 to September 2008. Fetal samples from HBsAg-positive mothers were retrieved by either amniocentesis or cordocentesis (percutaneous umbilical blood sampling [PUBS]). Hepatitis B virus (HBV) serologic markers (HBVM) and quantitative HBV DNA assays were performed to assess prenatal infection. All neonates were given combined HBV immunoprophylaxis after delivery. The newborns were followed up with HBV serologic testing at 1 year old. For the 252 pregnant women recruited, 16 fetuses were found to be HBV DNA positive, with all HBV DNA levels under 10(4) copies/ml. HBsAg and HBV DNA detected in the uterus were uncommon and were expressed at low levels. In contract to the case with prenatal statuses, neonatal serologies were more similar to their mothers'. The response rate of vaccination was 95%. Six children for whom immunoprophylaxis failed were born to HBeAg-positive mothers with high HBV DNA levels (>10(8) copies/ml), but only one of them was found to be positive for intrauterine HBV DNA (8.5 × 10(2) copies/ml). The presence of intrauterine hepatitis B antigen and DNA does not indicate postnatal HBV infection and vaccination failure.
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Pondé RADA. The underlying mechanisms for the "isolated positivity for the hepatitis B surface antigen (HBsAg)" serological profile. Med Microbiol Immunol 2010; 200:13-22. [PMID: 20458499 DOI: 10.1007/s00430-010-0160-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Indexed: 12/16/2022]
Abstract
During HBV infection, four structural antigen/antibody systems are observed: hepatitis B surface antigen (HBsAg) and its antibody (anti-HBs); the pre-S antigens associated with HBsAg particles and their antibodies; the particulate nucleocapsid antigen (HBcAg) and anti-HBc; and an antigen structurally related to HBcAg, namely HBeAg and its antibody (anti-HBe). Through the examination of this antigen-antibodies system, hepatitis B infection is diagnosed and the course of the disorder may be observed. Isolated HBsAg seropositivity is a peculiar serological pattern in HBV infection observed some times in routine laboratory. In most cases is not clear how this profile should be interpreted neither its significance. This pattern, however, may be associated with some clinical and laboratorial situations of great relevance, some of which will be addressed in this article.
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Affiliation(s)
- Robério Amorim de Almeida Pondé
- Laboratório de Virologia Humana, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia-Goiás, Brazil.
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Komatsu H, Inui A, Sogo T, Hiejima E, Tateno A, Klenerman P, Fujisawa T. Cellular immunity in children with successful immunoprophylactic treatment for mother-to-child transmission of hepatitis B virus. BMC Infect Dis 2010; 10:103. [PMID: 20423521 PMCID: PMC2879245 DOI: 10.1186/1471-2334-10-103] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2010] [Accepted: 04/28/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The administration of hepatitis B immunoglobulin followed by hepatitis B vaccine can result in a protective efficacy of almost 90% in mother-to-child transmission of hepatitis B virus (HBV). However, little is known about immunity against HBV infection in children after immunoprophylactic treatment. We tried to assess the association between T-cell responses and viremia in children after successful prophylactic treatment. METHODS Thirteen children and their 8 HBV carrier mothers (8 families), who were positive for human leukocyte antigen (HLA)-A24, were enrolled in this study. All of the 13 children received immunoprophylactic treatment and became negative for hepatitis B surface antigen (HBsAg) after birth. HBV-specific cytotoxic T lymphocyte (CTL) responses were evaluated using IFNgamma - enzyme-linked immunosorbent spot (ELISPOT) and major histocompatibility complex class I peptide pentamer assays. Serum HBV DNA was measured by real-time PCR. RESULTS Significant HBV-specific T-cell responses were detected in 2 (15%) of the 13 children by ELISPOT. However, the frequency of HLA-A24-HBV-specific CTLs was very low in both HBV carrier mothers and children using pentamers. Of the 13 children, 4 (31%) were positive for serum HBV DNA. However, the levels of serum HBV DNA were 100 copies/ml or less. One of the 2 children in whom significant HBV-specific CTL responses were detectable was positive for serum HBV DNA. CONCLUSIONS HBV core and polymerase-specific T-cell responses were detected and a low-dose viremia was observed in children after successful immunoprophylaxis treatment. Although the presence of viremia was not related to HBV-specific T-cell responses, CTLs might play a role in the control of HBV infection in children born to HBsAg-positive mothers after immunoprophylactic treatment.
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Affiliation(s)
- Haruki Komatsu
- Department of Pediatrics, Yokohama Eastern Hospital, 3-6-1 Shimosueyoshi Tsurumi Yokohama, Kanagawa 230-0012, Japan.
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Abstract
Hepatitis B and its complications are one of the major global health problems. Around 2 billion individuals are infected by hepatitis B virus (HBV) worldwide, more than 350 million are chronically infected, and approximately 15 to 40 percents of them will develop serious complications such as liver cirrhosis, hepatic failure, or hepatocellular carcinoma (HCC). The worldwide prevalence of chronic HBV infection ranges from 0.1 to 20 percent and varies widely in different geographic areas. According to the prevalence rate, WHO has classified countries into 3 levels: high areas (>8%) such as Africa, Asia, Western Pacific and Middle East; intermediate areas (2–8%) such as South America and Eastern Europe, and low areas (<2%) such as Western Europe, North America, and Australia.
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Lou H, Ding W, Dong M, Zhu Y, Zhou C, Wang Z, Yang X, Yao Q, Li D, Miao M. The Presence of Hepatitis B Surface Antigen in the Ova of Pregnant Women and Its Relationship with Intra-Uterine Infection by Hepatitis B Virus. J Int Med Res 2010; 38:214-9. [PMID: 20233532 DOI: 10.1177/147323001003800125] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Vertical transmission of hepatitis B virus (HBV) has been proposed to play an important role in mother-to-child transmission, although the extent to which vertical transmission via oocytes contributes to neonatal HBV infection remains unknown. Ovarian biopsies were collected during caesarean sections in 68 clinically asymptomatic pregnant women who were carriers of HBV. The presence of hepatitis B surface antigen (HBsAg) in the ova of pregnant women was determined by immunohistochemistry. Serum markers of HBV infection in pregnant women and their neonates were analysed. It was found that, of 68 women, the ova were positive for HBsAg in only one woman and her neonate was negative for any serum HBV markers 3 days after birth. Of 68 neonates, one was positive for serum HBV markers 3 days after birth and his mother's ova were negative for HBsAg. These findings indicate that vertical transmission via oocytes may not be the major route of HBV intra-uterine infection.
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Affiliation(s)
- H Lou
- Department of Obstetrics, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - W Ding
- Department of Pathology, The First Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - M Dong
- Department of Obstetrics, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Y Zhu
- Department of Obstetrics, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - C Zhou
- Department of Pathology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Z Wang
- Department of Obstetrics, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - X Yang
- Department of Obstetrics, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Q Yao
- Department of Obstetrics, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - D Li
- Department of Obstetrics, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - M Miao
- Department of Obstetrics, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Wiseman E, Fraser MA, Holden S, Glass A, Kidson BL, Heron LG, Maley MW, Ayres A, Locarnini SA, Levy MT. Perinatal transmission of hepatitis B virus: an Australian experience. Med J Aust 2009; 190:489-92. [PMID: 19413519 DOI: 10.5694/j.1326-5377.2009.tb02524.x] [Citation(s) in RCA: 281] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2008] [Accepted: 01/27/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the rate of perinatal hepatitis B virus (HBV) transmission in an Australian setting and to identify maternal virological factors associated with highest risk of transmission. DESIGN, PARTICIPANTS AND SETTING A prospective, observational study of perinatal transmission of HBV. Participants were pregnant women attending Sydney South West Area Health Service antenatal clinics who tested positive for hepatitis B surface antigen (HBsAg), and their babies. All babies were routinely offered hepatitis B immunoglobulin (HBIG) and HBV vaccination. Babies positive for HBsAg at 9-month follow-up underwent further virological testing, including HBV DNA sequencing. The study was conducted between August 2002 and May 2008. MAIN OUTCOME MEASURES HBV DNA levels and demographic characteristics of HBsAg-positive pregnant women; proportion of their infants with active HBV infection at 9-month follow-up; maternal characteristics affecting transmission rate; HBV DNA sequencing of infected infants and their mothers. RESULTS Of 313 HBsAg-positive pregnant women, 213 (68%) were HBV DNA-positive and 92 (29%) were positive for hepatitis B "e" antigen (HBeAg); 138 babies born to HBV DNA-positive mothers were tested for HBV infection (HBsAg positivity) at about 9 months of age. Four cases of transmission were identified. All four mothers had very high HBV DNA levels (> 10(8) copies/mL) and were HBeAg-positive. Three of the four infants were infected with wild-type HBV strains, with identical maternal/infant isolates. The fourth mother-infant pair had an S gene variant, HBV D144E, which has been previously reported in association with vaccine/HBIG escape. (Unfortunately, HBIG was inadvertently omitted from the immunisation schedule of this infant.) Transmission rates were 4/138 (3%) from HBV DNA-positive mothers overall, 4/61 (7%) from HBeAg-positive mothers, and 4/47 (9%) from mothers with very high HBV DNA levels. No transmission was seen in 91 babies of mothers with HBV DNA levels < 10(8) copies/mL. CONCLUSION In this cohort, HBV perinatal transmission was restricted to HBeAg-positive mothers with very high viral loads.
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Affiliation(s)
- Elke Wiseman
- Liverpool Hospital, Sydney South West Area Health Service, Sydney, NSW, Australia
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Abstract
In countries with a high prevalence of chronic hepatitis B, perinatal transmission from mother to infant accounts for the majority of cases of chronic hepatitis B. Passive-active immunoprophylaxis with hepatitis B immunoglobulin and hepatitis B vaccine at birth is 95% efficacious in reducing the risk of HBV transmission but is less effective in HBeAg-positive mothers with very high serum HBV DNA levels. In the last 4 weeks of pregnancy lamivudine may provide additional protection in pregnant women who have high-level viremia. Further studies are needed to evaluate the use of nucleos(t)ide analogues to treat chronic hepatitis B during pregnancy.
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Affiliation(s)
- Maya Gambarin-Gelwan
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College of Cornell University, 1305 York Avenue, 4th floor, New York, NY 10021, USA.
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Bai H, Zhang L, Ma L, Dou XG, Feng GH, Zhao GZ. Relationship of hepatitis B virus infection of placental barrier and hepatitis B virus intra-uterine transmission mechanism. World J Gastroenterol 2007; 13:3625-30. [PMID: 17659715 PMCID: PMC4146804 DOI: 10.3748/wjg.v13.i26.3625] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the mechanism of intra-uterine transmission, the HBV infection status of placental tissue and in vitro cultured placental trophoblastic cells was tested through in vivo and in vitro experiments.
METHODS: A variety of methods, such as ELISA, RT-PCR, IHC staining and immunofluorescent staining were employed to test the HBV marker positive pregnant women's placenta and in vitro cultured placental trophoblastic cells.
RESULTS: The HBV DNA levels in pregnant women's serum and fetal cord blood were correlated. For those cord blood samples positive for HBV DNA, their maternal blood levels of HBV DNA were at a high level. The HBsAg IHC staining positive cells could be seen in the placental tissues and the presence of HBV DNA detected. After co-incubating the trophoblastic cells and HBV DNA positive serum in vitro, the expressions of both HBsAg and HBV DNA could be detected.
CONCLUSION: The mechanism of HBV intra-uterine infection may be due to that HBV breaches the placental barrier and infects the fetus.
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Affiliation(s)
- Han Bai
- Department of Infectious Diseases, Shengjing Hospital Affiliated to CMU, Shenyang 110004, Liaoning Province, China
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Bai H, Zhang L, He LX, Feng GH, Shi LL, Dou XG, Zhao GZ. Relationship between the infection and apoptosis of placental trophoblastic cells and the mechanism of hepatitis B virus intrauterine transmission. Shijie Huaren Xiaohua Zazhi 2007; 15:1695-1700. [DOI: 10.11569/wcjd.v15.i15.1695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the mechanism of hepatitis B virus (HBV) intrauterine transmission by infecting the cultured human trophoblastic cells in vitro.
METHODS: Primary cultured trophoblastic cells from human first-trimester placenta and serial subcultivation of JEG-3 cell line were investigated. The primary cultured and subcultured cells were cultured in the HBV-infected serum for 8 to 48 h. The appearance of the cells and intercellular conjunctions were observed under inverted microscope. The protein expression of HBsAg and HBcAg were detected by cell immunofluorescence and immunohistochemical staining. HBV DNA of the infected trophoblastic cells was detected by fluorescent quantitative polymerase chain reaction (FQ-PCR). Cell apoptosis was tested by TUNEL technique.
RESULTS: The appearance of the cells and intercellular conjunction were not obviously affected after co-culturing with HBV-positive serum. Cell immunofluorescence and immunohistochemistry showed that HBsAg and HBcAg can be detected in the trophoblastic cells after co-culturing with HBV-infected serum for 8, 24 and 48 h, and HBsAg-positive cells were at the most level after 24-h culturing (8 h: 18.0% ± 3.67%; 24 h: 30.6% ± 2.88%; 48 h: 24.8% ± 4.21%). FQ-PCR demonstrated the existence of HBV DNA in the infected cells. TUNEL exhibited that the co-culturing resulted in an increase of cell apoptosis (24 h: 18.6 % ± 3.05%; 48 h: 26.8% ± 2.86%; P < 0.01).
CONCLUSION: The infection of trophoblastic cells may be one of the routes for HBV passing through the placental membrane. HBV infection may induce the apoptosis of trophoblastic cells, which may be a protective mechanism for placental membrane to block up the vertical transmission of HBV.
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