Prevention and control of perinatal hepatitis B virus transmission in ...

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logistic regression analysis identified maternal HBV DNA to be a stronger independent predictorof persistent infection than HBeAg status. Thus, perinatal exposure to high levels of maternalHBV DNA is the most important determinant of infection outcome in the infant.Cacciola I, Cerenzia G, Pollicino T, Squadrito G, Castellaneta S, Zanetti AR, Mieli-VerganiG, Raimondo G. Genomic heterogeneity of hepatitis B virus (HBV) and outcome of perinatalHBV infection. J Hepatol 2002; 36:426-432.Department of Internal Medicine, University of Messina, Messina, Italy.Data regarding hepatitis B virus (HBV) genomic heterogeneity in perinatal infection areincomplete, although HBV variants might be involved in neonatal fulminant hepatitis (ALF). Weinvestigated HBV variability in infected babies showing different clinical courses. We analyzedHBV genomes isolated from nine vertically infected babies and the mothers of four of them. Twoinfants born to HBe-antigen (HBeAg)-positive women developed a chronic infection; seven babies(six born to anti-HBe mothers) developed acute hepatitis that had a fulminant course in four casesand a benign course in three. Two babies developing ALF received anti-HBV immunoprophylaxisat birth. Viruses carrying no significant mutation infected infants born to HBeAg-positive women.HBeAg-defective viruses were detected both in children with benign and fulminant hepatitis andtheir mothers. A double nucleotide mutation at positions 1762 and 1764 of the HBV core-promoterwas found in two of the four infants with ALF, although it was not detected in isolates from themother of one of them. No significant S gene mutation was found in HBV from any of the babies.This study indicates that HBV genomic heterogeneity is not primarily involved either in theevolution of the infection or the failure of neonatal HBV immunoprophylaxis.Chakravarti A, Rawat D, Jain M. A study on the perinatal transmission of the hepatitis B virus.Indian J Med Microbiol 2005; 23:128-130.Department of Microbiology, Maulana Azad Medical College and Associated Lok NayakHospital, New Delhi - 110 019, India. anita_chakravarti@yahoo.comThe purpose of this study was to determine the age wise prevalence of Hepatitis B virus (HBV) inchildren under five years and to analyze the relative importance of horizontal or verticaltransmission. This study included 400 children in the age group of less than five years attendingthe outpatient department of pediatrics with minor complaints. History of HBV immunization wastaken as the exclusion criteria. All the samples were tested for Hepatitis B surface antigen(HBsAg) and anti HBs using commercial ELISA kits. Liver function tests were performed on allthe HBsAg positive patients. Hepatits B nucleocapsid antigen (HBeAg) was detected in fewHBsAg positive mothers. Overall HBsAg positivity in children below five years was 2.25%. Therewas no statistically significant difference in HBsAg positivity in the different age groups by chisquare test. HBsAg positivity in mothers was 4.25%. However only in three cases the pair ofmother and child were both positive for HBsAg. The mean anti HBs positivity in children was23.75%. There was no statistically significant difference in the anti HBs positivity in different agegroups of children. The observation that there is no statistically significant difference in theprevalence of HBV infection (HBsAg and HBs) amongst different age groups of children belowfive years signifies that a large proportion of HBV infection in children of this age is acquired viavertical transmission. It is also indicated that this mode of disease transmission is responsible forthe majority of chronic carriers. Universal immunization of all infants is desirable to decrease thecarrier pool and it is inferred from the present study that Hepatitis B immunization should begin atbirth to have greater impact.10
Chang MH, Hsu HY, Huang LM, Lee PI, Lin HH, Lee CY. The role of transplacental hepatitisB core antibody in the mother-to-infant transmission of hepatitis B virus. J Hepatol 1996; 24:674-679.Department of Pediatrics and Obstetrics, College of Medicine, National Taiwan University, Taipei,Taiwan.The aim was to investigate the influence of transplacental hepatitis B core antibody (anti-HBc) onperinatal hepatitis B virus (HBV) transmission, we studied the anti-HBc titers in 294 motherneonatepairs. The anti-HBc titer was highest (10(5.13 +/- 0.80) to 10(4.36 +/- 0.97) in mothers,10(5.13 +/- 0.76) to 10(5.52 +/- 0.98) in infants) in the 200 hepatitis B e antigen (HBeAg) positivehepatitis B surface antigen (HBsAg) carrier mothers and their infants, second highest (10(4.51 +/-0.76) and 10(4.68 +/- 0.76)) in the 60 HBeAg-negative HBsAg carrier mothers and their infants,and lowest (10(3.11 +/- 0.76) and 10(3.24 +/- 0.83)) in the 34 non-carrier mothers and their infants(p < 0.05). One hundred and ninety-two infants of HBeAg-positive carrier mothers receivedhepatitis B immunoglobulin as well as hepatitis B vaccines, and were followed prospectively frombirth. Ten infants became HBsAg carriers, and their mothers had significantly lower anti-HBctiters than those of the mothers of 182 infants who did not become carriers (p = 0.003), whilematernal serum hepatitis B virus DNA levels (29.9 +/- 23.6 versus 39.9 +/- 58.1 pg/10 ml) did notdiffer in those two groups (p > 0.25). The same trend was observed in the infants' anti-HBc titersin those two groups (p = 0.0006). The association of lower anti-HBc titers in HBeAg-positivecarrier mother-infant pairs and the development of carrier status in the infants suggests a positiverole of anti-HBc in the modulation of mother-to-infant transmission of HBV. A high maternal anti-HBc level in serum may be a negative predictor of immunoprophylaxis failure in high-risk infants.Chen HL, Chang MH, Ni YH, Hsu HY, Lee PI, Lee CY, Chen DS. Seroepidemiology ofhepatitis B virus infection in children: Ten years of mass vaccination in Taiwan. JAMA 1996;276:906-908.Department of Pediatrics, National Taiwan University Hospital, Taipei Taiwan.The objective was to study the seroepidemiology of hepatitis B virus (HBV) infection in children10 years after a mass hepatitis B vaccination program was begun in Taiwan. Design: crosssectionalseroprevalence survey. Setting: Cheng-Chung/Chung-Cheng District, Taipei, Taiwan,1994. Serum samples from 1515 healthy children younger than 12 years were tested for HBVmarkers. The results were compared with a baseline seroepidemiologic study conducted just beforethe vaccination program was launched in 1984 and with a subsequent study in 1989 in the samearea. Eighty-seven percent of the children had received at least 3 doses of HBV vaccine. Theoverall prevalence rate of hepatitis B surface antigenemia decreased from 9.8% in 1984 to 1.3% in1994. A statistically significant decrease was observed in every age group from 1 to 10 years. Theoverall prevalence rate of hepatitis B core antibody was 26% in 1984, 15% in 1989, and 4.0% in1994. This suggests that the risk of horizontal HBV infection has decreased over time, not onlybecause of the protective effect of the vaccine but also because the infection source hasdiminished. A high prevalence rate of hepatitis B surface antibody (79%) was noted in 1994 asanticipated. The Taiwanese mass vaccination program has protected most children younger than10 years from becoming carriers, reducing both perinatal and horizontal HBV transmission. MassHBV vaccination has proved to be a successful method to control HBV infection in thishyperendemic area.11
Page 1 and 2: Pre-meeting documentPrevention and
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Page 9: Boxall E. Screening of pregnant wom
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Page 21 and 22: HBsAg and anti-HBs in 4.5%. In the
Page 23 and 24: immunoprophylaxis. Reflecting effec
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Page 27 and 28: Delaying vaccination of premature i
Page 29 and 30: diagnosis. In the past, the inciden
Page 31 and 32: shows that the prevalence of HBV in
Page 33 and 34: Niu MT, Targonski PV, Stoll BJ, Alb
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Page 37 and 38: vaccinees) and low reactogenicity o
Page 39 and 40: single ELISA test is about Rs40. At
Page 41 and 42: newborns with surface antigenemia,
Page 43 and 44: Wang Z, Zhang J, Yang H, Li X, Wen
Page 45 and 46: of hepatitis B vaccine. This study
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Page 53 and 54: Jensen L, Heilmann C, Smith E, Want
Page 55 and 56: Onishchenko GG. Incidence of infect
Page 57: Zanetti A, Tanzi E, Semprini AE. He

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