Seroprevalence of
Download
Report
Transcript Seroprevalence of
Hepatitis-2015
Orlando, USA
July 20 - 22 2015
Vani Malhotra
HEPATITIS B INFECTION DURING
PREGNANCY –EXPERIENCE AT TERTIARY
CARE CENTRE OF NORTH INDIA
Dr Vani Malhotra
MD MICOG
Professor
Department of Obstetrics and
Gynecology
PGIMS, Rohtak, India
Hepatitis B Virus (HBV) infection is a global
problem with nearly 350 million carriers at
risk for cirrhosis and hepatocellular
carcinoma
50% carriers have acquired their infection
vertically from mothers (MTCT)
90% of vertically acquired infection become
chronic
AASLD
All pregnant women be screened for HBsAg
during the first trimester, even if previously
vaccinated or tested
Lok ASF, McMahon BJ. Chronic Hepatitis B:
update 2009. Hepatology 2009; 50: 661-2
AASLD & ACOG– POSITIVE
MOTHERS
Medical evaluation immediately
-duration of disease
-extent of liver disease
-risk factors for MTCT(HBeAg status & viral
load)
VERTICAL TRANSMISSION (MTCT)
Transmission of pathogen from mother to child
during pregnancy or childbirth or by
breastfeeding
ROUTE OF TRANSMISSION
• Transplacental transmission of HBV in utero
• Natal transmission during delivery
• Postnatal transmission during care of infant or
through breast milk
IN UTERO-TRANSMISSION
Main risk factors
Maternal HbeAg positivity
High maternal viral load
History of threatened abortion or preterm
labor
NATAL TRANSMISSION
Transfusion of mothers blood to fetus during
labor contractions(microtransfusions)
Infection after rupture of membranes
Direct contact of the infants mucosal
membranes
POSTNATAL TRANSMISSION
Ingestion of virus or by contact with skin
lesions on mothers breast
RISK FACTORS FOR MTCT
High maternal viral load
Positive HBeAg status
ANTIVIRAL DRUGS
Potent antiviral suppression
Safe & well tolerated
Reduces perinatal HBV transmission
problems
Viral drug resistance
Contraindication to breast feeding
Hepatitis flares upon discontinuation
Drug
FDA Category
Remarks
Lamivudine
C
Recommended
Telbivudine
B
Recommended
Tenofovir
B
May be recommended
Entecavir
C
Not Recommended
Adefovir
C
Not Recommended
IMMUNOPROPHYLAXIS
Infants born to HBsAg –positive mothers
should receive both HBIG and HBV within 12
hours of birth
Next two doses should be given within six
months of birth
90-95% protection
Follow up of infants
HBsAg and anti HBs at 9 months of age
HBsAg negative + anti-HBs>10mIU/ml are
disease free
Anti-HBs <10mIU/mlrevaccinated(Immunoprophylaxis failure)
RECOMMENDATIONS FOR BREAST
FEEDING
With appropriate immunoprophylaxis,
breastfeeding of infants of chronic HBV
carriers posos no additional risk of
transmission of HBV, however antiviral drugs
should be stopped
PRESENT STUDY
Prospective study carried at PGIMS, Rohtak
from Jan 2014-Dec 2014
Women in any trimester of pregnancy were
tested for HBsAg using ELISA
Women who tested positive were enrolled for
the study & liver function tests, HBeAg,
HbeAb, IgM Anti HbC& HBV DNA analysis
was done using PCR
contd
Women with abnormal liver function tests,
positive HBeAg & HBV DNA more than 1lakh
copies/ml were given tablet lamivudine 100
mg to reduce the transmission
AIMS & OBJECTIVES
To investigate the Seroprevalence of hepatitis
B surface antigen in pregnant women
Management of chronic HBV infection in
pregnant mothers
To prevent Mother to child transmission
(MTCT) of HBV
OBSERVATIONS
Total cases included in the present study are
15,000
Out of these , 52 cases were found to be
HBsAg positive
Seroprevalence 0.34 (52/15,000)
AGE GROUP(YEARS)
N=52
<20
4
7.6%
20-25
26
50%
25-30
18
34.6%
>30
4
7.6%
PARITY
(n=52)
P0
9
17.3%
P1
8
15.3%
P2
18
34.6%
P3
10
19.23%
P4
7
13.4%
RISK FACTORS
(n=52)
Tattoing
22
42.3%
Blood
transfusion
Previous
surgical
procedures
No risk
7
13.4%
12
23.07%
11
21.1%
AREA DISTRIBUTION
N=52
Urban
20
38.4%
Rural
32
61.53%
SOCIOECONOMIC STATUS
N=52
Lower
28
53.8%
Middle
20
38.46%
Higher
4
7.6%
HUSBAND HBsAg Status
N=52
Positive
5
9.6%
Negative
20
38.9%
Declined
27
51.9%
ACTIVITY OF DISEASE
ACUTE
HEPATITIS
8
15.38%
CHRONIC
HEPATITIS
44
84.6%
RISK FACTORS FOR MTCT
12 (23.07%) patients out of 52 patients were
HBsAg positive & their DNA titres were more
than 1 lac copies/ml, so tab lamivudine was
started
MODE OF DELIEVERY
N=52
FTVD
31
59.6%
PTVD
14
26.9%
LSCS
6
11.5%
FT ASSISTED
DELIEVERY
1
1.9%
INDICATION OF LSCS
N=6
Fetal Distress
3
50%
Previous 2 LSCS
2
33.30%
Breech
1
13.3%
MATURITY
N=52
Term
37
71.15%
Preterm
15
28.8%
BIRTH WEIGHT(KG)
N=52
<2.5
10
19.2%
2.5-3.0
27
51.9%
>3.0
15
28.8%
All the babies received HBIG & HBV vaccine
within 12 hrs of birth
Breast feeding was recommended in all
MORTALITY & MORBIDITY
MATERNAL
MORTALITY
MORBIDITY
FETAL
MORTALITY
MORBIDITY
1(HEPATIC
ENCEPHALOPAT
HY)
SEPSIS-1
DIC-2
1
5 (ADMISSION
TO NICU)
SUMMARY
50% patients belong to 20-25 year age group
34.6% were Para 2
Tattoing was the risk factor in 42.3% patients
53.8% patients belong to lower S/E status
SUMMARY
In 23.3% patients, HBeAg positivity & high
DNA assay was found and were given Tab
Lamivudine
88.4% delivered vaginally
51.9% were having birth weight in the range
of 2.5-3.0kg
All the babies received HBV vaccine & HBIG
within 12 hrs of birth
COMPARISON
NO OF PREGNANT
WOMEN
SCREENED
PREVALENCE OF
HBsAg(%)
20,104
1.11
Sandesh et al(2006) 70,659
0.25
Abbas et al(2001)
6,910
1.01
Present
Study(2014)
15,000
0.34
Pande et al(2011)
CONCLUSION
Universal screening of all pregnant women
for HBV infection
Pregnant women found to be HBsAg positive
should be investigated for risk factors for
MTCT
Maternal high HBV DNA & HBeAg positivity
are important risk factors for MTCT
CONCLUSION
In women with these risk factors, use of
antiviral drugs should be considered for
preventing antenatal transmission
All the babies should receive both HBV
vaccine and HBIG within 12 h of birth
Breast feeding of infants is recommended,
however , mothers should stop these antiviral
drugs to limit the exposure of infants to these
drugs
TAKE HOME MESSAGE
Appropriate treatment &
follow-up to HBV infected
mothers and their newborns
is critical in preventing HBV
MTCT & eradicating HBV
infection
THANK YOU
Meet the eminent gathering once again at
Hepatitis-2016
Dubai, UAE
October 17 - 19, 2016
Hepatitis– 2016 Website:
hepatitis.omicsgroup.com