Perinatal transmission of hepatitis B virus: an Australian experience

Wiseman, Elke; Fraser, Melissa A.; Holden, S; Glass, Änne; Kidson, Bronwynne L; Heron, Leon; Maley, Michael; Ayres, Anna; Locarnini, Stephen; Levy, Miriam

doi:10.5694/j.1326-5377.2009.tb02524.x

Cited by 347 publications

(284 citation statements)

References 20 publications

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“…In terms of a target viral load threshold, initial studies have suggested 2×10 7 IU/mL, although transmission of HBV at viral loads above 2×10 5 IU/mL has been observed 64. Others have suggested lower thresholds for transmission 65.…”

Section: Hbv Treatment Considerations In Women Of Childbearing Agementioning

confidence: 99%

“…Risk factors for immunoprophylaxis failure include high maternal HBV viral load, HBeAg positivity, incomplete HBV vaccination and a small risk of vaccine-escape mutants in the ‘a’ determinant region 64. The American Association for the Study of Liver Diseases recommends that all children born to HBsAg-positive mothers should be tested at ages 9–15 months for seroconversion 91.…”

Section: Postpartum Considerations In Hbv-infected Womenmentioning

confidence: 99%

See 1 more Smart Citation

Managing HBV in pregnancy. Prevention, prophylaxis, treatment and follow-up: position paper produced by Australian, UK and New Zealand key opinion leaders

Visvanathan

Dusheiko

Giles

et al. 2015

Gut

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Hepatitis B during pregnancy presents unique management issues for both the mother and fetus. These include the lack of a current cohesive strategy for treatment and follow-up of mothers and their babies; the uncertain risk of postpartum HBV flares; the lack of randomised trial data on the safety and efficacy of antiviral treatment in pregnancy; the lack of head-to-head studies comparing different antivirals in pregnancy; and the lack of epidemiologic information regarding infection across different populations globally. This position paper provides a comprehensive review of the management of women with HBV infection prior to conception, throughout each stage of pregnancy and postpartum, as well as recommendations and clinical approaches for the follow-up of children born to infected mothers, based on available evidence in the literature and recommendations from international experts. Prevention of perinatal transmission is an important component of global efforts to reduce the burden of chronic HBV since vertical transmission is responsible for most of the chronic infection worldwide.

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Section: Hbv Treatment Considerations In Women Of Childbearing Agementioning

confidence: 99%

Section: Postpartum Considerations In Hbv-infected Womenmentioning

confidence: 99%

Managing HBV in pregnancy. Prevention, prophylaxis, treatment and follow-up: position paper produced by Australian, UK and New Zealand key opinion leaders

Visvanathan

Dusheiko

Giles

et al. 2015

Gut

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“…There are numerous studies highlighting that even after the institution of active and passive immunoprophylaxis, higher maternal viral load is associated with a higher rate of MTCT 23–27. Immunoprophylaxis failure rates of between 8% and 32%28 29 have been reported in various prospective trials around the world and the most important factors associated with MTCT were maternal HBeAg positivity and high HBV DNA levels23 24 (table 1). Significant viremia predisposing to immunoprophylaxis failure had been considered to be serum HBV DNA levels of >8 log 10 copies/ml.…”

Section: Risk Factors For Mtctmentioning

confidence: 99%

“…Two additional doses of the hepatitis B vaccine are given at 1 and 6 months 46. This protocol has been shown to dramatically reduce the risk of MTCT to under 10% 23 25…”

Section: Management Of Hepatitis B In Pregnant Womenmentioning

confidence: 99%

A pregnant patient with a positive hepatitis B surface antigen

Mufti

Reau

2012

Frontline Gastroenterol

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Hepatitis B is a major cause of liver disease worldwide. The highest rates of chronic infection occur in subjects who are infected early in life and these patients are also at the greatest risk of developing complications such as hepatocellular carcinoma and cirrhosis from the disease. There has been a concerted worldwide effort to immunise newborns that are at the highest risk of acquiring infection. In 1992, when WHO recommended global vaccination against hepatitis B, only 31 countries elected to participate in the programme. By 2009, 177 countries were part of WHO national infant immunisation programme. Consequently, maternal screening and infant immunoprophylaxis have significantly reduced vertical transmission of hepatitis B. In this paper, we will review the management of hepatitis B in the pregnant population and identify some of the challenges that are encountered in this specialised population.

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“…If they test positive for the HBV surface antigen, further management should be initiated. Testing of the hepatitis B e antigen (HBeAg) and quantitative HBV DNA should be considered, as HBeAg positive mothers with high-maternal viraemia (>10 8 log copies/ml) appear to have a higher risk of MTCT, even with vaccination 3. Antiviral therapy in the third trimester has been advocated in these women, although data are limited.…”

Section: Commentarymentioning

confidence: 99%

Breastfeeding by mothers infected with hepatitis B carries no increased risk of transmission to infants who receive proper immunoprophylaxis: a meta-analysis

Tran

2011

Evid Based Med

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Breastfeeding by mothers infected with hepatitis B carries no increased risk of transmission to infants who receive proper immunoprophylaxis: a meta-analysis Tram T Tran Commentary on: Shi Z, Yang Y, Wang H, et al. Breastfeeding of newborns by mothers carrying hepatitis B virus: a meta-analysis and systematic review. Arch Pediatr Adolesc Med 2011;165:837-46. ContextHepatitis B (HBV) remains a global health concern with 350 million people chronically infected, and transmission still occurs despite the widely available and efficacious vaccine. Mother-to-child transmission (MTCT) is an ongoing problem in many countries, and in countries with high prevalence of HBV (>8%), only 44% have birth dose vaccine implemented into the infant vaccine schedule. 1 Currently, the Centers for Disease Control and Prevention recommends the use of hepatitis B immune globulin (HBIG) and HBV vaccine given at the time of birth with two additional doses of the vaccine in the first 6 months of life to prevent perinatal transmission. 2 With the successful implementation of this immunoprophylaxis strategy, MTCT of HBV has been reduced to less than 10%, with highest risk being in mothers with high viraemia. 3 Breastfeeding the newborn of an infected HBV mother has been controversial as it has been shown that HBV is present in breast milk. Given the lack of data showing increased transmission risk, is it now recommended to allow HBV infected mothers to breastfeed. 4 MethodsShi et al undertook a meta-analysis of all the relevant studies done on HBV infection specifically regarding breastfeeding in the English and Chinese peer-reviewed literature from 1990 to 2010. They only included studies that had extensive data on intrauterine infection (ie, infant data collected at the time of birth), appropriate immunoprophylaxis administration, breastfeeding at least 1 month and follow-up through 6-12 months. The primary outcome of this analysis looked at the rate of MTCT and hepatitis B antibody production in the infant at age of 6-12 months. Other secondary analyses were performed on rates of newborn infection at the time of birth and HBV in breastmilk and maternal blood. FindingsTen studies with all Chinese participants were included; eight in which HBIG was administered to the newborn and three in which only HBV vaccine was given. The studies included a total of 1624 subjects. There was no significant difference in the transmission of HBV in mothers who breastfed their babies compared with nonbreastfed babies (OR 0.86, 95% CI 0.51 to 1.45), even when vertical transmission risks were taken into account. The authors conclude that this meta-analysis provides strong evidence that breastfeeding does not contribute to MTCT of hepatitis B virus in the setting of appropriate immunoprophylaxis. CommentaryIn current practice, all pregnant women should be screened for HBV in the first trimester. If they test positive for the HBV surface antigen, further management should be initiated. Testing of the hepatitis B e antigen (HBeAg) and quantitative HBV DNA should b...

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Perinatal transmission of hepatitis B virus: an Australian experience

Cited by 347 publications

References 20 publications

Managing HBV in pregnancy. Prevention, prophylaxis, treatment and follow-up: position paper produced by Australian, UK and New Zealand key opinion leaders

Managing HBV in pregnancy. Prevention, prophylaxis, treatment and follow-up: position paper produced by Australian, UK and New Zealand key opinion leaders

A pregnant patient with a positive hepatitis B surface antigen

Breastfeeding by mothers infected with hepatitis B carries no increased risk of transmission to infants who receive proper immunoprophylaxis: a meta-analysis

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