Chronic HBV infection among pregnant women and their infants in Shenyang, China

Abstract

BackgroundThe main transmission route of the hepatitis B virus (HBV) is mother to child transmission and contributes significantly to chronic HBV infection. Even though immunoprophylaxis with hepatitis B immunoglobulin (HBIG) and hepatitis B vaccine is administrated to neonates whose mothers are hepatitis B surface antigen (HBsAg) positive, about 10% of the neonates suffer from HBV infection in their early life.ObjectivesTo survey chronic HBV infection among pregnant women and their infants and analyze the reason for immunoprophylaxis failure.MethodsSerum HBsAg was tested in all pregnant women. HBVDNA and other serum HBV markers including hepatitis B e antigen (HBeAg), hepatitis B core antibody (anti-HBc) and hepatitis B surface antibody (anti-HBs) were tested among HBsAg positive pregnant women. All infants whose mothers were HBsAg positive were vaccinated with a standard immunoprophylaxis. Serum HBV markers and HBVDNA were tested among these infants at 7 months of age. HBV genotypes were analyzed among the infants and pregnant women who were HBVDNA positive.ResultsThe prevalence of HBsAg, anti-HBc and anti-HBs among 4,536 pregnant women was 5.49%, 29.65% and 58.55%, respectively. The prevalence of HBsAg, anti-HBc and anti-HBs among pregnant women older than 20 years of age was significantly different compared to pregnant women younger than 20 years of age (4.54, 5.69 and 0.61 times, prevalence older vs. younger, respectively. P<0.05, 0.01, 0.05, respectively). Among 249 HBsAg positive pregnant women, 167 (67.07%) were HBeAg positive, 204 (81.93%) were HBVDNA positive and only 37 (14.86%) had HBVDNA >107 IU/ml. Among the infants whose mothers were HBsAg positive, 214 (85.94%) infants were anti-HBs positive. There were 12 (4.82%) infants who were HBsAg and HBVDNA positive, and all 12 of these infants mothers were HBeAg positive and had HBVDNA >107 IU/ml. Genotypes B and C were present among 165 pregnant women and genotype C was present in 85 pregnant women. There were 12 infants who were HBsAg positive and had the same HBV genotypes as their mothers. There was a significant difference in genotypes between the pregnant women whose infants were infected with HBV compared to those without HBV infection (P < 0.05).ConclusionsThere was a significant decline in HBsAg prevalence among pregnant women and their infants in Shenyang. Genotype C might be a risk factor for mother to child transmission of HBV.

Prevalence of Serologic Markers and Risk Factors for Hepatitis B Virus among Pregnant Women in Brazzaville, Congo

“…Many studies confirm the high rate of infection at birth or during early childhood especially in high prevalence areas [9,11].…”

“…In our series, 3.4% of women positive for HBeAg, low prevalences were also detected in HBsAg positive pregnant women in some countries, in Ethiopia (<1%) [23], Nigeria (1.39%) [24] and by against the highest prevalences were found in other parts of South and Southeast Asia, where prevalence of HBeAg varies 15% -88% is reported in young women [11,25,26]. This difference was largely due to the natural history of HBV infection in Southeast Asia where infected individuals carry HBeAg and high viral load in the age groups that include most of the gestational age women [7,27].…”

“…A chronic HBV carrier have an increased risk of life to die from hepatocellular carcinoma and liver cirrhosis (25% risk) and continues to remain the main reservoir of HBV transmission [11]. Some of them eventually become mothers themselves, perpetuating the cycle [12].…”

The Follow-up of HBsAg Carrier Pregnant Women and Their Infants: Evaluation of the Clinical Results of a “Patient follow-up and Treatment Algorithm”

“…Perinatal bulaşta en önemli faktörlerden biri de gebedeki yük-sek viremi olarak bilinmektedir. Birçok çalışmada özellikle son trimesterdeki HBV DNA düzeyinin 10 6 kopya/ml'nin üzerinde olduğu gebeliklerde bulaş oranının viremiyle doğru orantılı olarak arttığı saptanmıştır (9,18,29,35) . Wiseman ve ark.…”

24 year outcomes of hepatitis B vaccination in Hangzhou, China

“…[48][49][50] Based on some studies, genotype C might be a risk factor for HBV mother to child transmission. 51 It should be recommended that pregnant women who are HBeAg positive and have a high viral load be tested for HBV genotypes. However, there are still a large number of persons un-avoided from hepatitis B infection in spite of the high HepB vaccination coverage.…”