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

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majority (28 out of 34) of these non-responder newborns but never in the other newborns whoresponded to the HBsAg vaccine. HBV genome was detected in serum, only in some cases (nineout of 34) and never in the absence of HBV DNA in PBMC. For nine out of 14 followednewborns, the absence of response was transitory since anti-HBs Abs appeared after 15 months,without booster, while the HBV genome had disappeared. Unresponsiveness was specific to theHBV envelope protein since all late responders and 15-months-non-responders to the HBsAgvaccine produced normal levels of Abs to the three poliovirus serotypes, to tetanus toxoid and tothe pneumococcus polysaccharides. An in utero induced immune tolerance to low doses of HBsAgappears as the most plausible hypothesis to explain this unresponsiveness to HBV vaccine.Lee C, Gong Y, Brok J, Boxall EH, Gluud C. Effect of hepatitis B immunisation in newborninfants of mothers positive for hepatitis B surface antigen: systematic review and meta-analysis.BMJ 2006; 332:328-336.Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Copenhagen University Hospital,Denmark.The objective was to evaluate the effects of hepatitis B vaccine and immunoglobulin in newborninfants of mothers positive for hepatitis B surface antigen. Design: Systematic review and metaanalysisof randomised clinical trials. Data sources: electronic databases and hand searches.Randomised clinical trials were assessed for methodological quality. Meta-analysis wasundertaken on three outcomes: the relative risks of hepatitis B occurrence, antibody levels tohepatitis B surface antigen, and adverse events. 29 randomised clinical trials were identified, fiveof which were considered high quality. Only three trials reported inclusion of mothers negative forhepatitis B e antigen. Compared with placebo or no intervention, vaccination reduced theoccurrence of hepatitis B (relative risk 0.28, 95% confidence interval 0.20 to 0.40; four trials). Nosignificant difference in hepatitis B occurrence was found between recombinant vaccine andplasma derived vaccine (1.00, 0.71 to 1.42; four trials) and between high dose versus low dosevaccine (plasma derived vaccine 0.97, 0.55 to 1.68, three trials; recombinant vaccine 0.78, 0.31 to1.94, one trial). Compared with placebo or no intervention, hepatitis B immunoglobulin or thecombination of plasma derived vaccine and hepatitis B immunoglobulin reduced hepatitis Boccurrence (immunoglobulin 0.50, 0.41 to 0.60, one trial; vaccine and immunoglobulin 0.08, 0.03to 0.17, three trials). Compared with vaccine alone, vaccine plus hepatitis B immunoglobulinreduced hepatitis B occurrence (0.54, 0.41 to 0.73; 10 trials). Hepatitis B vaccine and hepatitis Bimmunoglobulin seem safe, but few trials reported adverse events. Hepatitis B vaccine, hepatitis Bimmunoglobulin, and vaccine plus immunoglobulin prevent hepatitis B occurrence in newborninfants of mothers positive for hepatitis B surface antigen.Lee SS, Young BW, Wong KH, Lim WL. The implication of a reduced-dose hepatitis Bvaccination schedule in low risk newborns. Vaccine 2002; 20:3752-3754.Department of Health, Hong Kong SAR Government, Hong Kong, China. ss_lee@dh.gov.hkFive hundred and seventy-four babies born to HBsAg negative mothers in Hong Kong receivedeither a regular (5 µg) or reduced (2.5 µg) three-dose regimen of recombinant hepatitis B vaccine.A significantly higher anti-HBs positivity rate (> or = 10 mIU/ml), geometric mean titer (GMT)and the maintenance of a high anti-HBs level (> or = 100 mIU/ml) were observed with the regulardoseregimen. The differences persisted, however, only up to 1 year post-vaccination. Over an 8-year period, only 1% of the vaccinees demonstrated anti-HBc seroconversion and none hadbecome HBsAg positive. The long-term efficacy of the reduced-dose regimen was confirmed,even in an HBV endemic population.24
Levin CE, Nelson CM, Widjaya A, Moniaga V, Anwar C. The costs of home delivery of a birthdose of hepatitis B vaccine in a prefilled syringe in Indonesia. Bull World Health Organ 2005;83:456-461.Program for Appropriate Technology in Health, Seattle, WA 98107, USA. clevin@path.orgThe objective was to provide global policy-makers with decision-making information fordeveloping strategies for immunization of infants with a birth dose of hepatitis B vaccine, thispaper presents a retrospective cost analysis, conducted in Indonesia, of delivering this vaccine atbirth using the Uniject prefill injection device. Incremental costs or cost savings associated withchanges in the hepatitis B immunization programme were calculated using sensitivity analysis tovary the estimates of vaccine wastage rates and prices for vaccines and injection devices, for thebirth dose of hepatitis B vaccine. The introduction of hepatitis B vaccine prefilled in Uniject (HB-Uniject) single-dose injection devices for use by midwives for delivering the birth dose is costsavingwhen the wastage rate for multidose vials is greater than 33% (Uniject is a trademark ofBD, Franklin Lakes, NJ, USA). The introduction of HB-Uniject for birth-dose delivery iseconomically worthwhile and can increase coverage of the critical birth dose, improve resourceutilization, reduce transmission of hepatitis B and promote injection safety.Li XM, Shi MF, Yang YB, Shi ZJ, Hou HY, Shen HM, Teng BQ. Effect of hepatitis Bimmunoglobulin on interruption of HBV intrauterine infection. World J Gastroenterol 2004;10:3215-3217.Department of Obstetrics and Gynecology, Third Affiliated Hospital, Sun Yat-Sen University,Guangzhou 510630, Guangdong Province, China. tigerlee777@163.netThe aim was to evaluate the efficacy of hepatitis B immunoglobulin (HBIg) in interruptinghepatitis B virus (HBV) intrauterine infection during late pregnancy. We allocated 112 HBsAgpositive pregnant women into 2 groups randomly. Fifty seven cases in the HBIG group received200 IU (unit) HBIg intramuscularly every 4 wk from the 28 wk of gestation to the time of delivery,while 55 cases in the control group received no special treatment. HBsAg, HBeAg, HBcAb,HBeAb, HBsAb and HBV DNA levels were tested in the peripheral blood specimens from all ofthe mothers at 28 wk of gestation, just before delivery, and in blood from their newborns within 24h before administration of immune prophylaxis. The intrauterine infection rate in HBIg group andcontrol group were 10.5% and 27.3%, respectively, with significant difference (P < 0.05). Itshowed ascendant trend as HBV DNA levels in the peripheral blood increased before delivery.HBIg is potent to cut down HBV intrauterine infection rate significantly when administered topregnant women regularly during late pregnancy. The possibility of HBV intrauterine infectionincreases if maternal blood HBV DNA > or = 10 8 copies/ml.Li XM, Yang YB, Hou HY, Shi ZJ, Shen HM, Teng BQ, Li AM, Shi MF, Zou L. Interruptionof HBV intrauterine transmission: a clinical study. World J Gastroenterol 2003; 9:1501-1503.Department of Obstetrics and Gynecology, The Third Affiliated Hospital, Sun Yat-Sen University,Guangzhou 510630, Guangdong Province, China. tigerli777@163.comThe aim was to investigate the effect of hepatitis B virus (HBV) specific immunoglobin (HBIg)and lamivudine on HBV intrauterine transmission in HBsAg positive pregnant women. Eachsubject in the HBIG group (56 cases) was given 200 IU HBIg intramuscularly (i.m.) every 4 weeksfrom 28-week (wk) of gestation, while each subject in the lamivudine group (43 cases) received100 mg lamivudine orally (po.) every day from 28-wk of gestation until the 30 th day after labor.Subjects in the control group (52 cases) received no specific treatment. Blood specimens weretested for HBsAg, HBeAg, and HBV-DNA in all maternities at 28-wk of gestation, beforedelivery, and in their newborns 24 hours before the administration of immune prophylaxis.25
Page 1 and 2: Pre-meeting documentPrevention and
Page 3 and 4: Part I Prevention and control of pe
Page 5 and 6: prevalence was significantly higher
Page 7 and 8: clusters (obstetrics wards/hospital
Page 9 and 10: Boxall E. Screening of pregnant wom
Page 11 and 12: Chang MH, Hsu HY, Huang LM, Lee PI,
Page 13 and 14: of infection in infants and childre
Page 15 and 16: Eriksen EM, Perlman JA, Miller A, M
Page 17 and 18: liver enzyme abnormalities than wer
Page 19 and 20: health care, is feasible and achiev
Page 21 and 22: HBsAg and anti-HBs in 4.5%. In the
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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
Page 35 and 36: Ranger-Rogez S, Alain S, Denis F. H
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 49 and 50: at birth and 2 weeks after birth, f
Page 51 and 52: Chubinishvili OV, Mikhailov MI, Sak
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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