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

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demonstrated that the HBsAg rate reached the adult level before the fifth year of age, and neonatalvaccination with either plasma-derived or recombinant hepatitis B vaccines provided a similar75% protective efficacy against HBV infection. The high rate of follow-up and blood testscoverage of the cohorts provided data to show 75% protection at the tenth to eleventh years of ageagainst serum HBsAg and also against prolonged hepatic dysfunction. The strategy of controllinghepatitis B nationwide was based on the universal immunisation of newborns, beginning in citiesand then the rural areas. The large-scale vaccine source was provided by domestic plants throughtechnology transfer, first providing plasma-derived vaccine replaced completely by recombinantDNA vaccine in 1997. An official survey in 1999 using a cluster sampling of 25,878 children from31 provinces reported an average coverage rate of three dose of hepatitis B vaccination of 70.7%,being higher in urban areas. The Ministry of Public Health of China has planned to integratehepatitis B vaccination into the nationwide EPI program with Government-provided vaccinesstarting January 1, 2002.Sutanto A, Suarnawa IM, Nelson CM, Stewart T, Soewarso TI. Home delivery of heat-stablevaccines in Indonesia: outreach immunization with a prefilled, single-use injection device. BullWorld Health Organ 1999; 77:119-126.Disease Prevention and Health Promotion, NTB Province, Ministry of Health, Indonesia.Extending immunization coverage to underserved populations will require innovativeimmunization strategies. This study evaluated one such strategy: the use of a prefilled, single-useinjection device for outreach immunization by village midwives. The device, UniJect, is designedto prevent refilling or reuse. Stored at ambient temperatures for up to 1 month in midwives' homes,vaccine-filled UniJect devices were immediately available for outreach. Between July 1995 andApril 1996, 110 midwives on the Indonesia islands of Lombok and Bali visited the homes ofnewborn infants to deliver hepatitis B vaccine to the infants and tetanus toxoid to their mothers.Observations and interviews showed that the midwives used the device properly and safely toadminister approximately 10,000 sterile injections in home settings. There were no problems withexcessive heat exposure during the storage or delivery of vaccine. Injection recipients andmidwives expressed a strong preference for the UniJect device over a standard syringe. Use of theprefilled device outside the cold chain simplified the logistics and facilitated the speed andefficiency of home visits, while the single-dose format minimized vaccine wastage.Tang JR, Hsu HY, Lin HH, Ni YH, Chang MH. Hepatitis B surface antigenemia at birth: along-term follow-up study. J Pediatr 1998; 133:374-377.Department of Pediatrics, College of Medicine, National Taiwan University, Taipei, Taiwan.The objective was to investigate the prevalence and outcome of hepatitis B surface antigenemia innewborns of hepatitis B e antigen (HBeAg)-positive hepatitis B surface antigen (HBsAg) carriermothers under the current immunoprophylaxis program. From 1984 to 1993, 665 high-risknewborns born to HBeAg-positive HBsAg carrier mothers were prospectively recruited. Thenewborns were tested for HBsAg soon after birth, before hepatitis B immune globulinadministration. All newborns received hepatitis B immune globulin within 24 hours after birth plussubsequent hepatitis B vaccination. Those who were seropositive for HBsAg at birth wereregularly followed up for their hepatitis B virus (HBV) markers, liver function profiles, and alphafetoproteinlevels from 1984 to 1996. Sixteen (2.4%) of the 665 subjects were found to beseropositive for HBsAg at birth, and all remained HBsAg-positive at 6 months of age. Twelve ofthe 16 received long-term follow-up care, and all were confirmed to have chronic HBV infection.Of the 12, 2 had HBeAg seroconversion, and 1 had alanine aminotransferase flares withoutHBeAg seroconversion. Delayed appearance of hepatitis B core antibody (anti-HBc) occurred in 2without alanine aminotransferase elevation. Current immunoprophylaxis strategy does not protect40
newborns with surface antigenemia, apparently acquired in utero, from becoming HBV carriers.Immunologic attempts to eliminate HBV may occur in carrier children infected in utero, despitetheir profound immune tolerance to HBV.Van Damme P, Vorsters A. Hepatitis B control in Europe by universal vaccination programmes:the situation in 2001. J Med Virol 2002; 67:433-439.Centre for the Evaluation of Vaccination, WHO Collaborating Centre for Prevention and Controlof Viral Hepatitis, Department of Epidemiology and Social Medicine, University of Antwerpen,Antwerpen, Belgium. pierre.vandamme@ua.ac.beIn the nine years since the Global Advisory Group of the Expanded Programme on Immunisation(WHO) set 1997 as the target for integrating hepatitis B vaccination into national immunisationprogrammes worldwide, 129 countries have included hepatitis B vaccine as part of their routineinfant or adolescent immunisation programmes (June 2001). By the end of 2002, 41 out of the 51countries of the WHO European Region will be implementing universal hepatitis B immunisation.The rewards of effective implementation of the programmes in countries that started 10 years agoare becoming apparent; and their success offers an exemplary model for other countries. Someother countries, however, have difficulties to incorporate hepatitis B vaccine into universalchildhood immunisation programmes, because of major economic constrains and the inability toprocure a constant vaccine supply. The next decade will be characterised by expanded use ofhepatitis B vaccines and the increasing efforts to sustain vaccine programmes and make thevaccine available to those countries and regions that cannot afford it. In Europe, as well as in therest of the world, work still remains to be done to support and implement interventions that willbring us closer to the WHO goal and to eradicate hepatitis B.Vranckx R, Alisjahbana A, Meheus A. Hepatitis B virus vaccination and antenatal transmissionof HBV markers to neonates. J Viral Hepat 1999; 6:135-139.Institute of Public Health, Brussels, Belgium.The high prevalence of hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) inpregnant women is considered to be the most important factor contributing to the high carrier rateof HBsAg in some populations. Several factors, including the age at which infection occurs,predispose to the acquisition and frequency of the carrier state. The proportion of infected peoplewho become chronic carriers ranges from about 80 to 95% for babies born to HBsAg/HBeAgpositivemothers. In this study of Indonesian infants receiving only active immunization againstHBV, we measured the HBV markers passively acquired from their HBsAg-positive mothers. Therelationship of these markers with vaccination response and with HBV infection status was studiedlongitudinally in the infants. In the exposed neonates from the HBsAg-positive mothers (n = 61),the seroconversion rate to hepatitis B surface antibody (HBsAb) positivity was 95% after the firstbooster vaccination, with a geometric mean titre (GMT) of 2017 IU/l. After 60 months, the GMTin this group decreased to 50 IU/l. Four newborns in this group became HBsAg carriers. Of thefour vaccination failures, three newborns were HBsAg/HBeAg positive at birth, suggesting thatthey had been infected in utero. No vaccination strategy (active alone, or passive/active) canprevent this transmission from occurring. One carrier was HBsAg negative at birth and up tomonth 4 but was HBsAg positive at month 12 and subsequently, suggesting a postnatal infection.Vaccination early in life can, to a large extent, prevent perinatal transmission and hepatitis B virus(HBV) infection later in infancy and childhood. In this study, the protective efficacy of thevaccination was 85% in the subcohort of neonates from HBeAg-positive mothers and 100% in thesubcohort of neonates from HBeAg-negative mothers. Lack of maternal antibodies to hepatitis Bcore antigen (HBcAb) correlated strongly with transmission of HBV infection.41
Page 1 and 2: Pre-meeting documentPrevention and
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Page 11 and 12: Chang MH, Hsu HY, Huang LM, Lee PI,
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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
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Page 31 and 32: shows that the prevalence of HBV in
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Page 37 and 38: vaccinees) and low reactogenicity o
Page 39: single ELISA test is about Rs40. At
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Page 45 and 46: of hepatitis B vaccine. This study
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Page 55 and 56: Onishchenko GG. Incidence of infect
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