Applicability and efficacy of a model for prevention of perinatal transmission of hepatitis B virus infection: Single center study in Egypt

Seroprevalence of hepatitis B virus surface antigen (HBsAg) in Egypt (2000-2022): a systematic review with meta-analysis

BACKGROUND

Hepatitis B infection seriously threatens global public health, especially in developing nations. Despite several investigations on HBV incidence, the national pooled prevalence remains unknown, particularly in populations at-risk at whom interventions should be primarily aimed.

METHODS

A comprehensive literature search of the following databases: Medline [PubMed], Scopus, Google Scholar, and Web of Science was conducted following the PRISMA guidelines. I-squared and Cochran's Q were used to measure the heterogeneity between the studies. Publications that matched the following were included: Primary studies published in Egypt from 2000 to 2022 reported HBV prevalence based on HBsAg. We excluded any studies that were not performed on Egyptians or that were performed on patients suspected of acute viral hepatitis or studies focusing on occult hepatitis or vaccination evaluation studies, or national surveys.

RESULTS

The systematic review included 68 eligible studies reporting a total of 82 incidences of HBV infection based on hepatitis B surface antigen with a total sample size of 862,037. The pooled national prevalence among studies was estimated to be 3.67% [95% CI; 3: 4.39]. Children under 20 with a history of HBV vaccination during infancy had the lowest prevalence of 0.69%. The pooled prevalence of HBV infection among pregnant women, blood donors, and healthcare workers was 2.95%, 1.8%, and 1.1%, respectively. While patients with hemolytic anemia and hemodialysis patients, patients with malignancies, HCC patients, and chronic liver disease patients had the highest prevalences at 6.34%, 25.5%, 18.6%, and 34%, respectively. Studies reporting HBV prevalence in urban settings compared to rural settings revealed a similar HBV prevalence of 2.43% and 2.15%, respectively. Studies comparing HBV prevalence in males and females revealed a higher prevalence among males (3.75%) than females (2.2%).

CONCLUSION

In Egypt, hepatitis B infection is a significant public health issue. The blocking of mother-to-infant hepatitis B transmission, the scaling up of the scope of the existing vaccination program, and implementing new strategies, including screen-and-treat, may reduce the prevalence of the disease.

Pattern and interpretation of hepatitis B virus markers among pregnant women in North East Egypt

INTRODUCTION

Hepatitis B vaccination of newborns (HBV) and surveillance of pregnant women during antenatal care are complementary to prevent mother to child transmission (MTCT) of HBV infection.

AIM

The aim was to identify the prevalence and pattern of HBV infection in pregnant women born before and after implementing HBV vaccination of newborn in Egypt.

METHODS

The study included 600 women attended antenatal clinic of the Suez Canal University Hospital, Ismailia, Egypt. All were inquired about risk factors of HBV infection, vaccination, and screened for hepatitis markers. HBsAg carriers were tested for HBeAg, HBeAb, ALT, and HBV DNA. Participants were divided into group 1 of 285 (47.5%) vaccinated women ≤ 25 years, and 315 (52.5%) non-vaccinated > 25 years.

RESULTS

The prevalence of HBcAg, HBsAg, and HBsAb were 18.3%, 5.0%, and 30.7%. Of the 110 women exposed to infection, 40 (36.4%) cleared infection, 30 (27.2%) were HBsAg carriers, and 40 (36.4%) showed isolated HBcAb. HBsAg carriers were HBeAg negative, HBeAb positive, and HBV-DNA positive and had high ALT. Group 1 had significantly higher frequency of vaccination-related immunity, lower frequency of isolated HBcAb, and susceptibles than group 2 (44.9%, 3.5%, and 38.6% vs. 4.1%, 9.5%, and 75.9% ). The prevalence of HBV exposure and chronic HBsAb carriers in both groups were close (4.9% and 16.5% for group 1 vs. 5.1% and 20% for group 2, p > 0.05).

CONCLUSION

Although the outcomes of HBV infection were favorable in vaccinated group, chronic HBV represents a potential risk for MTCT that necessitates screening during pregnancy in all public health care settings.

A clinical and immunological study of children with chronic hepatitis B virus infection

Aim

To identify the clinical status and immunological profile of a cohort of children with chronic hepatitis B virus (HBV) infection to assess the short-term consequences of this infection.

Material and methods

This prospective case-control study included 30 children in the age range 1–15 years with positive HBsAg attending the Hepatology clinic of Alexandria University Children’s Hospital. Twenty children received lamivudine (3 mg/kg, oral, once a day), and 10 children were lamivudine-resistant and received entecavir treatment (10–11 kg/0.3 mg to > 30 kg/1 mg). They were followed up every 3 months for 1 year.

Results

The study showed that 97% of the studied cases were discovered accidentally during routine investigations and only 3% presented by acute hepatitis. Ninety percent of them had family member infection with HBV, of which 70% were the mother. Eighty-seven percent of cases had no clinical signs, and only 13% of cases had hepatomegaly. All of the cases were HBsAg positive, 50% were HBeAg positive, 56.7% were HBeAb positive, 33.3% were HBcAb positive, and 100% were HBsAb negative.

Conclusions

Most of children with HBV infection had associated family member infection and were accidentally discovered. Despite a marked decrease in HBV DNA level after treatment, there was no clearance of HBsAg and no HBsAb seroconversion. Screening for the HBsAb level in children with family members with HBV is recommended.

Lamivudine use in pregnant HBsAg-females effectively reduces maternal viremia

BACKGROUND AND STUDY AIMS

Mother-infant hepatitis B virus (HBV) transmission is the current leading cause of chronic infection. We aimed to assess the efficacy of lamivudine use in hepatitis B surface antigen (HBsAg)-positive pregnant women to decrease viral load and thus aid in the prevention of transmission.

PATIENTS AND METHODS

A study of 73 mother-infant pairs. All mono-infected HBsAg-positive pregnant females of any age, who were a candidate for lamivudine during pregnancy were recruited, and a comparison group of HBsAg-positive pregnant females who did not receive any antiviral treatment. All infants received HBV immunoglobulin and vaccine at birth and completed the vaccination schedule and tested after 6 months of age. HBV viral markers and viral load quantitation were performed to all enrolled participants.

RESULTS

34 (46.6%) females were enrolled in the lamivudine group; 9 (26.5%) received the drug in the last trimester, 25 (73.5%) all through. The comparison group was 39 (53.4%) females; 32 (82.1%) were not candidate for antiviral during pregnancy, and 7 (17.9%) were diagnosed late near delivery. Seventy-one infants tested after full immunization, with their ages ranged between 6.5 and 18 months. Only one infant (1.4%) was positive for HBsAg and HBV DNA in the non-treated group. Maternal viremia near delivery showed a significant reduction in cases that used lamivudine during pregnancy.

CONCLUSION

The use of lamivudine during pregnancy can effectively lower maternal viral load. Timely conducted post-vaccination serological testing is crucial to detect positive cases and immunize susceptible infants.