1. Hepatitis Preg

7/25/2019 1. Hepatitis Preg

1/15

Hepatitis B dalam Kehamilan

Fetomaternal Division

Department of Obstetrics & Gynecology

Faculty of Medicine University of Indonesia

Dr. Cipto Mangunkusumo General Hospital

Jakarta


2/15

Viral Hepatitis

-

Overview

Type of Hepatitis

A B C D ESource of

virus

feces blood/

blood-derivedbody fluids

blood/


blood/


feces

Route of

transmission

fecal-oral percutaneous

permucosal

percutaneous

permucosal

percutaneous

permucosal

fecal-oral

Chronic

infection

no yes yes yes no

Prevention pre/post-

exposure

immunization

pre/post-

exposure

immunization

blood donor

screening;

risk behavior

modification

pre/post-

exposure

immunization;

risk behavior

modification

ensure safe

drinking

water


3/15

Estimates of Acute and Chronic Disease

Burden for Viral Hepatitis, United States

HAV HBV HCV HDV

Acute infections(x 1000)/year* 125-200 140-320 35-180 6-13

Fulminantdeaths/year 100 150 ? 35

Chronicinfections

0 1-1.25million

3.5million 70,000

Chronic liver diseasedeaths/year 0 5,000 8-10,000 1,000

* Range based on estimated annual incidence, 1984-1994.


4/15

Outcome of Hepatitis B Virus I nfection

by Age at I nfection

Symptomatic Infection

Chronic Infection

Age at Infection

ChronicInf

ection(%)

Symptomatic

Infection(%

)

Birth 1-6 months 7-12 months 1-4 years Older Children

and Adults

0

20

40

60

80

100100

80

60

40

20

0


5/15

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 agehigh-risk adolescents at all ages

Vaccination of adults in high-risk groups

Elimination of Hepatitis B Virus

Transmission in the United States

Strategy


6/15

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


7/15

Definitions

Hepatitis B Surface Antigen (HBsAg): A serologicmarker on the surface of HBV. It can be detected inhigh levels in serum during acute or chronic hepatitis.

The presence of HBsAg indicates that the person isinfectious. The body normally produces antibodies toHBsAg as part of the normal immune response toinfection.

Hepatitis B Surface Antibody (anti-HBs): The presence

of anti-HBs is generally interpreted as indicatingrecovery and immunity from HBV infection. Anti-HBsalso develops in a person who has been successfullyvaccinated against hepatitis B.


8/15

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 orongoing 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.


9/15


10/15


11/15

Transmissibility 100 times greater than HIV1

Vertical Infected mother-to-infant during first year of life

Earlier age at exposure increases the risk ofdeveloping chronic HBV infection2

Transmission of HBV

1. WHO-CSR

2. WHO and CDC fact sheets, available at www.who.int and www.cdc.gov


12/15


13/15

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


14/15

Lamivudine Therapy During Pregnancy toPrevent 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 theirInfants 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 Hepatit is 2003; 10: 294-7)


15/15

Lamivudine Treatment During Pregnancyto 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)

Documents

1. Hepatitis Preg