Download - BAB 04d HepB Preg
Hepatitis B dalam Kehamilan
Noroyono WibowoFetomaternal Division
Department of Obstetrics & GynecologyFaculty of Medicine University of IndonesiaDr. Cipto Mangunkusumo General Hospital
Jakarta
Viral Hepatitis - OverviewViral Hepatitis - Overview
Type of HepatitisType of Hepatitis
AA BB CC DD EESource ofvirus
feces blood/blood-derived
body fluids
blood/blood-derived
body fluids
blood/blood-derived
body fluids
feces
Route oftransmission
fecal-oral percutaneouspermucosal
percutaneouspermucosal
percutaneouspermucosal
fecal-oral
Chronicinfection
no yes yes yes no
Prevention pre/post-exposure
immunization
pre/post-exposure
immunization
blood donorscreening;
risk behaviormodification
pre/post-exposure
immunization;risk behaviormodification
ensure safedrinkingwater
Estimates of Acute and Chronic DiseaseBurden for Viral Hepatitis, United States
HAV HBV HCV HDVAcute infections(x 1000)/year* 125-200 140-320 35-180 6-13
Fulminant deaths/year 100 150 ? 35
Chronicinfections
0 1-1.25 million
3.5million 70,000
Chronic liver disease deaths/year 0 5,000 8-10,000 1,000
* Range based on estimated annual incidence, 1984-1994.
Outcome of Hepatitis B Virus InfectionOutcome of Hepatitis B Virus Infectionby Age at Infectionby Age at Infection
Symptomatic Infection
Chronic Infection
Age at Infection
Chr
onic
Infe
ctio
n (%
)
Sym
ptom
atic
Infe
ctio
n (%
)
Birth 1-6 months 7-12 months 1-4 years Older Childrenand Adults
0
20
40
60
80
100100
80
60
40
20
0
• Prevent perinatal HBV transmission• Routine vaccination of all infants• Vaccination of children in high-risk groups• Vaccination of adolescents
– all unvaccinated children at 11-12 years of age– “high-risk” adolescents at all ages
• Vaccination of adults in high-risk groups
Elimination of Hepatitis B Virus Elimination of Hepatitis B Virus Transmission in the United StatesTransmission in the United States
StrategyStrategy
Interpretation of the Hepatitis B PanelTests Results InterpretationHBsAganti-HBcanti-HBs
negativenegativenegative
Susceptible
HBsAganti-HBcanti-HBs
negativepositivepositive
Immune due to natural infection
HBsAganti-HBcanti-HBs
negativenegativepositive
Immune due to hepatitis B vaccination
HBsAganti-HBcIgM anti-HBcanti-HBs
positivepositivepositivenegative
Acutelyinfected
HBsAganti-HBcIgM anti-HBcanti-HBs
positivepositivenegativenegative
Chronicallyinfected
HBsAganti-HBcanti-HBs
negativepositivenegative
1. Might be recovering from acute HBV infection.2. Might be distantly immune and test not sensitive enough to detect very low level of anti-HBs in serum.3. Might be susceptible with a false positive anti-HBc.4. Might be undetectable level of HBsAg present in the serum and the person is actually chronically infected
Definitions• Hepatitis B Surface Antigen (HBsAg): A serologic
marker on the surface of HBV. It can be detected in high levels in serum during acute or chronic hepatitis. The presence of HBsAg indicates that the person is infectious. The body normally produces antibodies to HBsAg as part of the normal immune response to infection.
• Hepatitis B Surface Antibody (anti-HBs): The presence of anti-HBs is generally interpreted as indicating recovery and immunity from HBV infection. Anti-HBs also develops in a person who has been successfully vaccinated against hepatitis B.
Definitions• Total Hepatitis B Core Antibody (anti-HBc):
Appears at the onset of symptoms in acute hepatitis B and persists for life. The presence of anti-HBc indicates previous or ongoing infection with hepatitis B virus (HBV) in an undefined time frame.
• IgM Antibody to Hepatits B Core Antigen (IgM anti-HBc): This antibody appears during acute or recent HBV infection and is present for about 6 months.
• Transmissibility 100 times greater than HIV1 • Vertical
– Infected mother-to-infant during first year of life• Earlier age at exposure increases the risk of
developing chronic HBV infection2
Transmission of HBV
1. WHO-CSR
2. WHO and CDC fact sheets, available at www.who.int and www.cdc.gov
INTRAUTERINE INFECTION OF HBV
• HBsAg Seropositive Rate at Birth : 2.4% (16/665) Among Neonates of HBeAg
Positive, HBsAg Positive Mothers
• Chronicity : 100%
Tang JR et al. J Pediatr 1998 ; 133: 374
Lamivudine Therapy During Pregnancy to Prevent Perinatal Transmission of HBV Infection
8 Highly Viraemic (HBV-DNA>1.2 x 109 geq/mL) Mothers Treated With 150 mg of lamivudine Daily Since 34 Wks of Gestation.
HBV-DNA, HBsAg, Anti-HBs, Anti-HBc of their Infants were Measured at 0, 3, 6, 12 Months.
• Historical Control : 24 Children , born to untreated HBsAg-positive mothers with HBV-DNA levels >1.2 x 109 geq/mL
• All children received passive-active immunization at birth .
van Zonneveld M, et al. ( J Viral Hepatitis 2003; 10: 294-7)
Lamivudine Treatment During Pregnancy to Prevent Perinatal Transmission of HBV Infection
• Lamivudine Group : 1/8 Children (12.5%) was HBsAg and HBV-DNA positive at age 12 months.
• Untreated Historical Control Group, Perinatal Transmission Occurred in 7/25 children (28%).
M. van Zonneveld M, et al. ( J Viral Hepatitis 2003; 10: 294-7)