Transcript Hepatitis B in pregnancy

Hepatitis B dan C dalam
Kehamilan
Viral Hepatitis - Overview
Type of Hepatitis
A
Source of
virus
Route of
transmission
Chronic
infection
Prevention
B
C
D
E
feces
blood/
blood/
blood/
blood-derived blood-derived blood-derived
body fluids body fluids
body fluids
feces
fecal-oral
percutaneous percutaneous percutaneous
permucosal permucosal permucosal
fecal-oral
no
yes
yes
yes
no
pre/postpre/postblood donor
pre/postensure safe
exposure
exposure
screening;
exposure
drinking
immunization immunization risk behavior immunization;
water
modification risk behavior
modification
Estimates of Acute and Chronic Disease
Burden for Viral Hepatitis, United States
Acute infections
(x 1000)/year*
HAV
HBV
HCV
HDV
125-200
140-320
35-180
6-13
100
150
?
35
0
1-1.25
million
3.5
million
70,000
5,000
8-10,000
1,000
Fulminant
deaths/year
Chronic
infections
Chronic liver disease
deaths/year
0
* Range based on estimated annual incidence, 1984-1994.
100
100
80
80
60
60
Chronic Infection
40
40
20
20
Symptomatic Infection (%)
Chronic Infection (%)
Outcome of Hepatitis B Virus Infection
by Age at Infection
Symptomatic Infection
0
Birth
1-6 months
7-12 months
1-4 years
Age at Infection
0
Older Children
and Adults
Elimination of Hepatitis B Virus
Transmission in the United States
Strategy
•
•
•
•
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
Interpretation of the Hepatitis B Panel
Tests
Results
Interpretation
HBsAg
anti-HBc
anti-HBs
negative
negative
negative
Susceptible
HBsAg
anti-HBc
anti-HBs
negative
positive
positive
Immune due to natural infection
HBsAg
anti-HBc
anti-HBs
negative
negative
positive
Immune due to hepatitis B vaccination
HBsAg
anti-HBc
IgM anti-HBc
anti-HBs
positive
positive
positive
negative
Acutely
infected
HBsAg
anti-HBc
IgM anti-HBc
anti-HBs
positive
positive
negative
negative
Chronically
infected
HBsAg
anti-HBc
anti-HBs
negative
positive
negative
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.
Transmission of HBV
• 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
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)