Prevention of mother to child transmission of hepatitis B virus infection in Nigeria: A call to action

Abstract

Abstract:Background: Sub-Sahara Africa including Nigeria has the second largest global burden of chronic carriers of hepatitis B virus (HBV) infection after Asia. Mother-to-child transmission (MTCT) of HBV is the most commonroute of transmission in high endemic areas .MTCT of hepatitis B virus infection continues to occur despite the interventions of hepatitis B vaccinations and immunoglobulins in settings where it is practiced. Infants most at risk are those whose mothers have high HBV DNA viral loads and produce the protein HBeAg. Various Nigerian studies have reported high HBV infection rates as well as HBeAg positivity among pregnant women. These HBV infections usually occur intrapartum and rarely inutero. Mothers with HBeAg positivity known to be associated with higher HBV DNA viral loads have been linked with higher chances of MTCT as HBeAg is the only structural HBV protein that can cross into the placental circulation. In the absence of post exposure prophylaxis about 40 percent of infants delivered by HBV infected mothers could develop HBV infections, and about 25% of them may come down with chronic hepatitis and resulting possible complications including liver cirrhosis and hepatocellular cancer later in life. The prevention of transmission of retroviral infection from motherto-child has been a success story of the 21 st century and such feat could be replicated for HBV infection. The standard PMTCT of HBV currently will comprise: timely prenatal screening, starting anti-viral therapy for pregnant women with HBeAg positivity and high viral load, infant postexposure prophylaxis and followup of infants of HBsAg positive mothers. There is no co-ordinated PMTCT of HBV programme in place in our setting despite the huge burden of the disease in Nigeria. Hence the need therefore to develop a home grown PMTCT programme of HBV to help tackle the burden of the disease in our country. An evidence based review of current best practice guidelines for the prevention of mother-to-child transmission of HBV for use in low and medium resource income settings with hepatitis B hyperendemicity will be quiet apt in this circumstance. This document therefore will be useful as a quick guide to Paediatricians, Obstetricians, Family Physicians, General Practice Doctors and other allied health workers charged with the care of pregnant mothers and their young children. Methods: Relevant literatures published in English language or translated into English were searched manually and electronically in PUBMED and SCOPUS for the period between 1990 and 2016 on the subject. Keywords searched included: epidemiology of HBV infection, MTCT of HBV, and its preventive strategies including prenatal screening, antiviral agents in pregnancy, infant post exposure prophylaxis and follow-up of infected children. Results: Over 35 scholarly articles on HBV epidemiology, MTCT, and preventive measures as well as follow -up models were retrieved and analyzed. Conclusion: Universal screening of all pregnant women for HBV infection is the most effective...

An appraisal of the prevention of mother-to-child transmission of hepatitis B virus health system in Nigeria

“…There are also Research Institutes and training institutions supporting learning and dissemination of research products, yet research is still underfunded in most of these institutions (FMoH, 2016a). Research on advances in HBV is currently carried out by some societies such as the Society for Gastroenterology and Hepatology in Nigeria (SOGHIN) and the Nigerian Society for Paediatric Gastroenterology Hepatology and Nutrition (NISPGHAN) (Eke et al, 2016). A Hepatitis cancer registry is maintained by the National Cancer Control Programme, an arm of the FMoH, yet, routine HBV infection surveillance are not conducted in Nigeria (Howell et al, 2014).…”

Mother-to-child transmission of human immunodeficiency virus, hepatitis B virus and hepatitis C virus among pregnant women with single, dual or triplex infections of human immunodeficiency virus, hepatitis B virus and hepatitis C virus in Nigeria: A systematic review and meta-analysis

“…8 In Nigeria, MTCT rates of HBV vary from 8.3% to 12.8%. 6 There are limited reports on MTCT rates of HCV in Nigeria as it is often not routinely screened. However, the burden of HIV/HCV MTCT may also be significant given the reported rate of 5.2% of pediatric HIV/HCV co-infections.…”

“…[2][3][4][5] In a Nigerian pediatric HIV program, 7.7% and 5.2% of the HIV-infected children were co-infected with HBV and HCV, respectively. 6 Fortunately, the MTCT of these infections of public health importance can be prevented or eliminated through simple interventions involved in prevention of mother-to-child transmission (PMTCT) programs. 7 However, these programs are poorly coordinated.…”

Prevalence of hepatitis B virus infection among pregnant women in Jos, Nigeria

“…Although a higher prevalence of HBV infection is reported among surgeons (25.7%), voluntary blood donors (23.4%), and infants (25.7%), Hepatitis B surface antigenemia (HBsAg) studies of pregnant women in Nigeria have revealed HBV prevalence of between 2% and 15.2%. [ 11 12 ] In Zaria and Ilorin both in Northern-central Nigeria, studies showed HBV prevalence in pregnancy to be 8.2% and 5.7%, respectively. [ 13 14 ] Previous studies on risk factors for HBV infection in pregnancy have shown that high parity, history of blood transfusion, HBV infection in family members, tattooing, and previous surgeries are known risk factors for HBV infection in pregnancy.…”