Prevention of mother-to-infant transmission of hepatitis B virus: pointers on antiviral prophylaxis in pregnancy
Overview
WHO estimates that during 2015, 257 million human beings had been dwelling with continual hepatitis B virus (HBV) contamination worldwide and that 900 000 died from HBV contamination, on the whole thru the improvement of cirrhosis and hepatocellular carcinoma. Worldwide, the bulk of humans with continual hepatitis B contamination and related deaths in maturity received their contamination at the start thru mother-to-infant perinatal transmission or in early childhood.
These pointers offer evidence-primarily based steerage on using peripartum antiviral prophylaxis in HBsAg-nice pregnant ladies for the prevention of mother-to-infant transmission of HBV
Hepatitis B virus (HBV) contamination in a pregnant girl poses an extreme threat to her little one at birth. Without postexposure immunoprophylaxis, about 40% of toddlers born to HBV-inflamed moms withinside the United States will broaden persistent HBV contamination, about one-fourth of whom will sooner or later die from persistent liver disease.
Perinatal HBV transmission may be avoided with the aid of using figuring out HBV-inflamed (i.e., hepatitis B floor antigen [HBsAg]-high quality) pregnant girls and imparting hepatitis B immune globulin and hepatitis B vaccine to their toddlers within 12 hours of birth.
Preventing perinatal HBV transmission is an imperative part of the country-wide approach to get rid of hepatitis B withinside the United States. National tips name for the following:
Universal screening of pregnant girls for HBsAg for the duration of every pregnancy
Screening all HBsAg-high quality pregnant girls for HBV DNA to manual the usage of maternal antiviral remedy for the duration of pregnancy. AASLD shows maternal antiviral remedy whilst HBV DNA is >200,000 IU/mL
Case-control of HBsAg-high quality moms and their toddlers
Provision of immunoprophylaxis for toddlers born to inflamed moms, which includes hepatitis B vaccine and hepatitis B immune globulin inside 12 hours of birth
Routine vaccination of all toddlers with the hepatitis B vaccine series, with the primary dose administered within 24 hours of birth
Testing and Treatment During Pregnancy
A hepatitis B virus infection should not cause any problems for you or your unborn baby during your pregnancy if you take the correct precautions. It is important for your doctor to be aware of your hepatitis B infection so that he or she can run appropriate tests and evaluate and monitor the health of your liver, and so your baby can be protected from infection with hepatitis B when it is born. The U.S. CDC and WHO recommend that ALL pregnant people are tested for hepatitis B. Please ask your doctor to test you for hepatitis B early in your pregnancy!
The birth dose of the hepatitis B vaccine and hepatitis B immune globulin (HBIG, if recommended and available) can sometimes fail to prevent transmission to newborns. This typically occurs in pregnant people who are HBeAg positive and have a very high viral load, allowing for the transmission of hepatitis B to your baby. Fortunately, there is a way to prevent transmission even if you are a person with a high viral load.
All people who are diagnosed with hepatitis B in pregnancy should be referred for follow up care with a physician skilled at managing hepatitis B infection. Your physician should perform additional laboratory testing, including HBV DNA level (viral load), and should be checked to see if there is evidence of cirrhosis (extensive liver damage). (click here for a detailed description of these tests).
An HBV DNA level greater than 200,000 IU/mL or 1 million cp/ml indicates a level where the combination of the birth dose of the hepatitis B vaccine (and HBIG) will fail. First-line, antiviral therapy with tenofovir (TDF/viread) is recommended starting from week 28 of pregnancy until delivery but may continue 3 months postpartum. Please talk to your doctor about your own test results.
If the HBV DNA (viral load) blood test is not available or is cost prohibitive, then pregnant people should be tested for HBeAg (a blood test). A “positive” HBeAg test result can indicate a high virus level. Antiviral treatment with tenofovir (TDF) during the last trimester would be recommended for women who test HBeAg positive. TDF Treatment may be discontinued after delivery or 3-months postpartum.
All babies born to people with hepatitis B should receive a birth dose of the hepatitis B vaccine within 24 hours of delivery whether they receive treatment with an antiviral or not.
All people who are diagnosed with hepatitis B should be referred to care with a knowledgeable doctor. Some may require continued treatment with an antiviral, many will not. All people need regular monitoring throughout their life since hepatitis B infection and the health of the liver can change over time.
WHO estimates that in 2015, 257 million people were living with chronic hepatitis B virus (HBV) infection worldwide, and that 900 000 had died from HBV infection, mostly as a result of cirrhosis or hepatocellular carcinoma. Most HBV-associated deaths among adults are secondary to infections acquired at birth or in the first five years of life. In May 2016, the World Health Assembly endorsed the Global Health Sector Strategy on viral hepatitis, which calls for the elimination of viral hepatitis as a public health threat by 2030 (defined as a 90% reduction in incidence of new infections and a 65% reduction in mortality). Elimination of HBV infection as a public health threat requires a reduction in the prevalence of hepatitis B surface antigen (HBsAg) to below 0.1% in children 5 years of age. This can be achieved through universal immunization of newborns against hepatitis B and other interventions to prevent mother-to-child transmission of HBV.
Rationale for updating the recommendations on prevention of mother-to-child transmission of HBV to address peripartum prophylaxis with antivirals
The WHO position papers on immunization recommend that all infants receive their first dose of hepatitis B vaccine as soon as possible after birth, preferably within 24 hours, and that the birth dose be followed by two or three doses of hepatitis B vaccine at least four weeks apart to complete the primary series. Immunization against hepatitis B starting at birth is the foundation of the prevention of perinatal and horizontal transmission of HBV. In 2015, in the WHO Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection, no recommendation was made for the additional use of antiviral therapy to prevent mother-to-child HBV transmission. This was because of the still limited and low quality evidence base with several ongoing trials, and the lack of consensus as to the programmatic implications of a policy for more widespread use of antivirals in pregnancy. Three key developments prompted the consideration to now include the use of antiviral prophylaxis for pregnant women with HBV infection as an additional measure to prevent mother-to-child transmission of HBV. First, further evidence has become available on the efficacy and safety of antiviral prophylaxis in pregnant women and their children. Second, WHO has received requests from countries and regions with already high birth dose and infant vaccination coverage for updated guidance on the use of peripartum prophylaxis. Third, data from epidemiological studies and modelling suggest that infant vaccination alone would be insufficient to reach the 0.1% HBsAg prevalence goal in children by 2030, and that peripartum prophylaxis may also be needed.
https://apps.who.int/iris/rest/bitstreams/1288815/retrieve
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