Prevention of Mother-to-Child Transmission of HBV

Abstract

The World Health Organization estimates that 2 billion people worldwide have been exposed to hepatitis B virus (HBV). Among them, 370 million people have chronic infection. Chronic HBV infection remains a significant health issue and a leading cause of cirrhosis and hepatocellular carcinoma worldwide. Transmission of the HBV, despite the availability of the vaccine, still occurs, particularly in the perinatal setting. Up to 50% of new cases of HBV infection are due to mother-to-child transmission (MTCT). Perinatal (vertical) transmission of HBV is defined as positivity at 6–12 months of the hepatitis B surface antigen (HBsAg) or of HBV-DNA in an infant born to an infected mother. In the absence of standard active-passive immunoprophylaxis treatment, approximately 70–80% of infants born to HBsAg- and hepatitis B e-antigen (HBeAg)-positive mothers became chronically infected with HBV, and about 90% of these children who are exposed remain chronically infected. HBeAg-negative mothers carry a 10–40% transmission risk, and of those infants who are infected, 40–70% may remain chronically infected. The transmission rate was reduced to 5–10% when newborn received appropriate active-passive immunoprophylaxis at birth. Mothers with highest transmission risk should be assessed for relatively new and safe oral antiviral treatments. Recent prospective studies with oral antivirals in late pregnancy showed promising results in reducing the MTCT rate and the safety profiles of these oral antiviral agents.