Prenatal screening and postnatal prophylaxis may prevent vertical Hep B transmission

Image: PD 

1. From an observational study of mothers infected with hepatitis B virus (HBV), prenatal screening with postnatal prophylaxis was associated with a reduced risk of transmission of HBV to the infant. 

2. Mothers with a negative e-antigen and viral load <5×10⁷ IU/mL were unlikely to transmit HBV to the infant. 

Evidence Rating Level: 2 (Good) 

Study Rundown: Between 35-50% of hepatitis B virus (HBV) carriers contracted the virus perinatally. Thus, the prevention of vertical mother-infant transmission is an important target in reducing disease prevalence. Although screening and prophylaxis are recommended, their implementation and limitations are not well understood. This observational study aimed to determine the effectiveness of current HBV preventative techniques. Overall, the increase in HBV testing rates since 1997 correlated well with a decrease in the incidence of infant HBV infection. Similarly, the rates of prophylactic hepatitis B immune globulin (HBIg) and complete vaccinations increased. From further analysis of HBV testing within the study population, no mothers with a negative E-antigen or low viral load transmitted HBV to their infant. The major limitation is the observation nature of the analysis.  Thus, the direct value of prophylaxis and screening cannot be determined beyond a correlation. However, these data do support the efficacy of current measures to screen and treat mothers at high risk for transmitting HBV.

Click to read the study, published today in the Annals of Internal Medicine

Click to read an accompanying editorial in the Annals of Internal Medicine

Relevant Reading: A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States

In-Depth [observational study]: The patient population was collected from the Kaiser Permanente Northern California organization, with a total of 3253 HBV positive mothers with 4446 children with data from 1997-2010. Only 0.75% of children became HBsAg-positive, with a nearly significant decrease in Poisson incidence rate ratio over this time period of 0.90 (CI=0.82-1.0). Among children with viral load less than 5×10⁷ IU/mL, there were no cases of HBV transmission, which was 90.9% of the total population. Of those with viral loads greater than 5×10⁷ IU/mL, 3.95 per 100 births (CI=0.81-11.53) tested positive for HBsAg, and they also were from e-antigen positive mothers. Similarly, from all e-antigen positive mothers, 3.37 per 100 births (CI=2.08-5.14) became infected. In a multivariate analysis of other potential factors, only e-antigen was a significant predictor of HBV transmission. Together, immunization and screening may decrease vertical transmission, and demonstrating a high viral load and positive e-antigen may be useful in predicting transmission.

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