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

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Ahn YO. Strategy for vaccination against hepatitis B in areas with high endemicity: focus onKorea. Gut 1996; 38(Suppl 2):S63-S66.Department of Preventive Medicine, Seoul National University College of Medicine, Korea.Hepatitis B vaccination strategies may vary from country to country depending on hepatitis Bvirus (HBV) endemicity, predominant modes of infection, age of infection, and health careresources. In areas with high endemicity like Korea, transmission of virus from carrier mothers toinfants during the perinatal period, and from other horizontal sources to infants and children,account for most cases of HBV infection. The consequences of HBV infection at an early age areserious, as more than 70% remain chronic carriers of the virus. These chronic carriers are theprincipal source of infection for other susceptible people, and are themselves at high risk ofdeveloping other serious diseases, such as chronic hepatitis, liver cirrhosis, and hepatocellularcarcinoma. Theoretically, therefore, routine infant immunisation supplemented with prenatalscreening of pregnant women for HBsAg or HBeAg and mass immunisation of children is theappropriate strategy for control of hepatitis B in these countries. To prevent primary liver cancerassociated with HBV infection, however, immunisation of adults at high risk would also beprudent. Mandatory vaccination of all neonates is recommended in highly endemic areas, togetherwith hepatitis B immune globulin in babies born to HBsAg carrier mothers.Aiken KD, Clark SJ, Cabana MD. Reasons hospitals give for not offering hepatitis B vaccine tolow-risk newborns. Clin Pediatr (Phila) 2002; 41:681-686.Child Health Evaluation and Research Unit, Division of General Pediatrics, University ofMichigan Health System, Ann Arbor, Michigan 48109-0718, USAAfter a temporary suspension of hepatitis B vaccination (HBV) for low-risk newborns in July1999, some hospitals still do not offer HBV to these infants. A semi-structured telephone survey ofmedical directors from a national random sample of 296 hospital nurseries was completed fromAugust 2000 to April 2001 and analyzed using qualitative techniques. Directors of 201 of 290eligible nurseries (71%) participated. Twenty-ight nurseries have never offered HBV to low-risknewborns (‘Never Offered HBV’) and 37 nurseries had offered HBV to low-risk newborns beforeJuly 1999, but discontinued this practice after the temporary suspension (‘Discontinued HBV’).Common reasons for not offering HBV to low-risk newborns were difficulty with reimbursementand convenience of outpatient administration. In addition, directors of ‘Never Offered HBV’nurseries cited low disease incidence in their patient population, whereas directors of‘Discontinued HBV’ cited preference for the combination hepatitis B - Haemophilus influenzatype b vaccine as important factors. Multi-faceted interventions may be necessary to increase HBVuse in the nursery.Alvarez-Muñoz MT, Vázquez-Rosales JG, Torres-López FJ, Arredondo-García JL,Bustamante-Calvillo ME, Del Rey-Pineda G, Garduno-Espinosa J, Muñoz-Hernandez O.Infection of pregnant women with hepatitis B and C viruses and risks for vertical transmission.Arch Med Res 1997; 28:415-419.Unidad de Investigacion Medica en Enfermedades Infecciosas y Parasitarias, Coordinacion deInvestigacion Medica, IMSS, Mexico, D.F.Pregnant women infected with hepatitis B and C viruses pose a risk for infecting their newborninfants by vertical transmission. We studied 6,253 pregnant women aged 12-49 years for infectionwith hepatitis B (HBV) and C (HCV) viruses. Infection was diagnosed by measuring IgGantibodies against HBc, HBs, HBe, as well as IgM-HBc and HCV viral antigens withcommercially available immunoassay kits. HBV infection was detected in 113 cases (1.8%), and4
prevalence was significantly higher (2.4%) in a group of women with a high-risk pregnancy whowere attending a perinatology hospital than in healthy pregnant women (1.67%, p < 0.05).Infection with HBV was significantly higher in women older than 30 years old (p < 0.05). HBsAgwas found in blood, colostrum and vaginal exudate of two pregnant women; HBsAg was detectedin the gastric aspirate but not in the blood of the two newborn infants. HBeAg and IgM-HBc werenot detected in any of the samples. DNA-HBV was detected in serum of seven women, and DNA-HBV was detected in the gastric aspirate of only one of the newborns. HCV infection wasdiagnosed in three out of 111 women with markers for HBV infection (2.7%), and in 6 out of1,000 women without these markers (0.6%). Anti-HCV antibodies were found in the serum of sixof their infants during up to six months of age. Infants were monitored for one year and none ofthem developed any sign of hepatic disease. These results suggest that special attention should bepaid to women older than 30 years and with a high-risk pregnancy, as they are at a higher risk ofHBV and HCV infections.André FE, Zuckerman AJ. Review: protective efficacy of hepatitis B vaccines in neonates. JMed Virol 1994; 44:144-151. Enclosed in Annex.SmithKline Beecham Biologicals, Rixensart, Belgium.A literature search was carried out to investigate the factors that influence the protective efficacy(PE) of hepatitis B vaccines when given to neonates of hepatitis B surface antigen and e antigenpositive mothers. Hepatitis B vaccines with either high or low antigen doses are very effective inpreventing chronic hepatitis B infection in neonates at risk, but there is evidence that with lowerdosages simultaneous use of hepatitis B immune globulin (HBIg) administration is more importantthan with higher dosages to elicit good protection (PE > or = 90%). There is also a tendency forlower dosages to confer high PE less consistently, with noticeably greater numbers of chronicsurface antigen carriers in neonates who received a complete vaccination course. Furthermorevaccination courses with higher vaccine dosages give high PEs, without concomitant HBIgadministration at birth, provided that the first vaccine dose is given at birth and that the seconddose follows within 2 months.Arora NK, Ganguly S, Agadi SN, Irshad M, Kohli R, Deo M, Paul VK, Deorari AK, ChellaniH, Prasad MS, Sharma D. Hepatitis B immunization in low birthweight infants: do they need anadditional dose? Acta Paediatr 2002; 1:995-1001.Department of Pediatrics, All India Institute of Medical Sciences, New Delhi.nkmanan@hotmail.comThe aim was to determine the influence of gestation and weight on the development of protectiveanti-HB levels and geometric mean titres after three doses of HBV vaccine and to ascertain theneed for a fourth dose in low birthweight infants. Hepatitis B vaccine (Enivac HB, Panacea BiotecLtd., India) was given to 82 preterm (PT) and 60 term intrauterine growth-retarded (T-IUGR)infants at birth and at 6, 10 and 14wk of life. Protective anti-HB levels (> 10 mIU/ml) werereached in 86.6% (71/82) of PT infants and 96.7% (58/60) of T-IUGR infants after three doses ofHBV vaccine (p = 0.044). The odds of having a protective response after the third dose of HBVvaccine was 1.25 (95% CI 1.02-1.53) with every one-week increase in gestation (p = 0.032).Birthweight was not associated with the development of a protective immune response. After thethird dose, only 66.7% (8/12) of the PT infants whose mothers had anti-HB antibodies, developedprotective anti-HB levels compared with 90% (63/70) of those with no maternal antibodies (p =0.028). In PT infants after the fourth dose, there was a significant increase in the proportion ofinfants with protective antibody levels (8.6%, 95% CI 0.6-16.6%) among those with no maternalantibodies and 12.2% overall (95% CI 6.0-21.3) (p = 0.031 to 0.002) over that reached with thethird dose. Administration of the fourth dose to T-IUGR infants did not confer such a benefit. In5
Page 1 and 2: Pre-meeting documentPrevention and
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Page 9 and 10: Boxall E. Screening of pregnant wom
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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 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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Onishchenko GG. Incidence of infect
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Zanetti A, Tanzi E, Semprini AE. He
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