Document Detail


Perinatal transmission of hepatitis B virus: an Australian experience.
MedLine Citation:
PMID:  19413519     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine the rate of perinatal hepatitis B virus (HBV) transmission in an Australian setting and to identify maternal virological factors associated with highest risk of transmission. DESIGN, PARTICIPANTS AND SETTING: A prospective, observational study of perinatal transmission of HBV. Participants were pregnant women attending Sydney South West Area Health Service antenatal clinics who tested positive for hepatitis B surface antigen (HBsAg), and their babies. All babies were routinely offered hepatitis B immunoglobulin (HBIG) and HBV vaccination. Babies positive for HBsAg at 9-month follow-up underwent further virological testing, including HBV DNA sequencing. The study was conducted between August 2002 and May 2008. MAIN OUTCOME MEASURES: HBV DNA levels and demographic characteristics of HBsAg-positive pregnant women; proportion of their infants with active HBV infection at 9-month follow-up; maternal characteristics affecting transmission rate; HBV DNA sequencing of infected infants and their mothers. RESULTS: Of 313 HBsAg-positive pregnant women, 213 (68%) were HBV DNA-positive and 92 (29%) were positive for hepatitis B "e" antigen (HBeAg); 138 babies born to HBV DNA-positive mothers were tested for HBV infection (HBsAg positivity) at about 9 months of age. Four cases of transmission were identified. All four mothers had very high HBV DNA levels (> 10(8) copies/mL) and were HBeAg-positive. Three of the four infants were infected with wild-type HBV strains, with identical maternal/infant isolates. The fourth mother-infant pair had an S gene variant, HBV D144E, which has been previously reported in association with vaccine/HBIG escape. (Unfortunately, HBIG was inadvertently omitted from the immunisation schedule of this infant.) Transmission rates were 4/138 (3%) from HBV DNA-positive mothers overall, 4/61 (7%) from HBeAg-positive mothers, and 4/47 (9%) from mothers with very high HBV DNA levels. No transmission was seen in 91 babies of mothers with HBV DNA levels < 10(8) copies/mL. CONCLUSION: In this cohort, HBV perinatal transmission was restricted to HBeAg-positive mothers with very high viral loads.
Authors:
Elke Wiseman; Melissa A Fraser; Sally Holden; Anne Glass; Bronwynne L Kidson; Leon G Heron; Michael W Maley; Anna Ayres; Stephen A Locarnini; Miriam T Levy
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Medical journal of Australia     Volume:  190     ISSN:  0025-729X     ISO Abbreviation:  Med. J. Aust.     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-05-05     Completed Date:  2009-06-25     Revised Date:  2009-10-22    
Medline Journal Info:
Nlm Unique ID:  0400714     Medline TA:  Med J Aust     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  489-92     Citation Subset:  IM    
Affiliation:
Liverpool Hospital, Sydney South West Area Health Service, Sydney, NSW, Australia.
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MeSH Terms
Descriptor/Qualifier:
Adult
Australia / epidemiology
DNA, Viral / blood
Female
Hepatitis B / blood,  epidemiology,  transmission*
Hepatitis B Surface Antigens / blood
Hepatitis B e Antigens / blood
Hepatitis B virus / genetics
Humans
Infant, Newborn
Infectious Disease Transmission, Vertical / statistics & numerical data*
Pregnancy
Pregnancy Complications, Infectious / blood,  epidemiology*
Viral Load
Chemical
Reg. No./Substance:
0/DNA, Viral; 0/Hepatitis B Surface Antigens; 0/Hepatitis B e Antigens
Comments/Corrections
Comment In:
Med J Aust. 2009 Sep 21;191(6):357; author reply 357   [PMID:  19769564 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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