Handan ALAY, Melek ŞAHİNER, Berrin GÖKTUĞ KADIOĞLU, Ragıp Afşin ALAY

Erzurum'da Hepatit B’li Annelerin Bebeklerine Verilen Pasif-Aktif İmmunoprofilaksinin Sonuçları, Türkiye

GİRİŞ ve AMAÇ: Hepatit B virüsü (HBV) ile infekte annelerden doğan bebekler pasif-aktif immünoprofilaksiye rağmen infekte olabilirler. Bu çalışmada HBV’nin bulaşmasında maternal vireminin rolünü ve HBV ile infekte annelerden doğan bebeklerin pasif-aktif immunoprofilaksi sonuçlarını değerlendirmeyi amaçladık. YÖNTEM ve GEREÇLER: Bu çalışmaya bir Kadın Hastalıkları ve Doğum hastanesinde 2014 ve 2016 yılları arasında HBV ile infekte anneler ve pasif-aktif immünoprofilaksi uygulanan bebekleri dahil edildi. Hastaların sosyodemografik verileri, hepatit belirteçleri, viral yükleri ve çocukların hepatit belirteçleri değerlendirildi. BULGULAR: 2014-2016 yılları arasında 26925 gebe kadın HBsAg için tarandı. 328 HBsAg pozitif gebe kadının 271’i hastanemizde doğum yaptı. Sadece 53 anne ve bebeğine ulaşabildik. HBsAg pozitif 53 anneden 2(% 3,72)’si HBeAg pozitif, 51(% 96,23) anne ise AntiHBe pozitifti. Beş annede(% 9,43) viral yük ≥2000 IU / ml idi. 28(% 52,83) annenin viral yüklerine ulaşılamadı. Maternal HBeAg durumu ve viral yük ile infant antikor yanıtı arasında istatistiksel olarak anlamlı ilişki vardı (p <0,05). Doğum ağırlığı, gestasyonel yaş ve HBIG yapılma zamanı ile infant antikor yanıtı arasında istatistiksel olarak anlamlı bir ilişki yoktu (p> 0,05). TARTIŞMA ve SONUÇ: HBV ile infekte annelerin bebeklerinde pasif-aktif immunoprofilaksi, perinatal bulaşmanın önlenmesinde oldukça etkilidir. HBsAg taraması tüm gebelere hamilelikleri sırasında yapılmalıdır. Hamileliklerinde HBsAg pozitif olarak saptanan annelerin bebeklerine doğumdan 6-12 saat içinde pasif-aktif immunoprofilaksi verilmelidir. Sonrasında mutlaka immünizasyon sonuçları değerlendirilmelidir. Ebeveynlere taburculuk sırasında bilgi verilmesi, toplumun farkındalığını artıracak ve hepatit B'nin ortadan kaldırılmasına katkıda bulunacaktır.

Anahtar Kelimeler:

HBsAg pozitif anneler, çocuklar, pasif-aktif immünoprofilaksi

Outcomes of Passive-Active Immunoprophylaxis Administered to Infants of Mothers Infected with Hepatitis B Virus in Erzurum, Turkey

OBJECTIVES: Infants born to mothers with hepatitis B virus (HBV) may be infected despite receiving passive-active immunoprophylaxis. The purpose of this study was to assess the role of maternal viremia in the transmission of HBV and the passive-active immunoprophylaxis outcomes of infants born to women infected by HBV. METHODS: HBV-infected mothers and infants up to 12 months of age receiving passive-active immunoprophylaxis at the Erzurum Nenehatun Obstetrics and Gynecology Hospital, Turkey, between 2014 and 2016 were included in the study. Socio-demographic data for the patients, and hepatitis markers, viral loads and hepatitis markers of children were evaluated.RESULTS: A total of 26,925 pregnant women were screened for HBsAg between 2014 and 2016. Three hundred twenty-eight HBsAg-positive pregnant women, of whom 271 delivered at our hospital, and 53 mother-infant pairs were included in the study. Of the 53 HBsAg-positive mothers, HBeAg status was positive in 2 (3.72%) and antiHBe status was positive in 51 (96.23%). Viral load was ≥2000IU/ml in 5 mothers (9.43%). The viral loads of 28 mothers (52.83%) were unavailable. Statistically significant associations were determined between maternal HBeAg status, maternal viral load and antibody response (p<0.05). No statistically significant associations were observed between birth weight, gestational age, timing of HBIG and antibody response (p>0.05). CONCLUSIONS: Passive-active immunoprophylaxis in babies of HBV-infected mothers was highly efficacious in preventing perinatal transmission. Antepartum HBsAg markers must be examined in all pregnancies, and passive-active immunoprophylaxis should be given in the first 6-12 h of life to infants of mothers who are HBsAg-positive during pregnancy. Immunization results should be evaluated subsequently. Healthy generations can be produced by treating HBsAg-positivity with high maternal viremia by means of passive-active immunoprophylaxis, thus reducing the economic impact of diseases and care, and improving quality of life. Giving information to parents during discharge training will increase community awareness and contribute to the eradication of hepatitis B.

Keywords:

HBsAg-positive mothers, children, passive-active immunoprophylaxis,

PDF

___

[1] Geographic pattern of hepatitis B prevalence, 1997. The World Health Organizations pages on vaccines and immunizations http://wwwwhoint/vaccines-surveillance/graphics /htmls/ hepbprevhtm 2007.
[2] Yao JL: Perinatal transmission of hepatitis B virus infection and vaccination in China. Gut 1996, 38(Suppl 2):37-8.
[3] Koziel MJ, Siddiqui A: Hepatitis B virus and hepatitis D virus. In: Principles and practice of infectious diseases. Edited by Mandell GL, Bennett JE, Dolin E, 6 edn. Philadelphia: Churchill Livingstone; 2005: 1864–90.
[4] Shapiro CN: Epidemiology of hepatitis B. Pediatr Infect Dis J 1993, 12(5):433-7.
[5] Ghendon Y: WHO strategy for the global elimination of new cases of hepatitis B. Vaccine 1990, 8:129-33.
[6] Centers for Disease Control (CDC) Postexposure prophylaxis of hepatitis B.MMWR Morb Mortal Wkly Rep 1984, 33:285-90.
[7] Reesink H, Reerink-Brongers E, Lafeber-Schut BT, Kalshoven-Benschop J, Brummelhuis HJ: Prevention of chronic HBsAg carrier state in infants of HBsAg-positive mothers by hepatitis B immunoglobulin. The Lancet 1979, 314(8140):436-8.
[8] Centers for Disease Control (CDC) Prevention of perinatal transmission of hepatitis B virus: prenatal screening of all pregnant women for hepatitis B surface antigen. MMWR Morb Mortal Wkly Rep 1988, 37:341-6.
[9] Hepatitis B virus: a comprehensive strategy for eliminating transmission in the United States through universal childhood vaccination. Recommendations of the Immunization Practices Advisory Committee (ACIP).MMWR Recomm Rep 1991, 40:1-25.
[10] Zhang L, Gui X, Wang B, Ji H, Yisilafu R, Li F, Zhou Y, Zhang L, Zhang H, Liu X: A study of immunoprophylaxis failure and risk factors of hepatitis B virus mother-to-infant transmission. European journal of pediatrics 2014, 173(9):1161-8.
[11] Tran TT: Hepatitis B and pregnancy. Clin Infect Dis 2016, 62(4):314-7.
[12] Lin X, Guo Y, Zhou A, Zhang Y, Cao J, Yang M, Xiao F, Zhang B, Du Y: Immunoprophylaxis failure against vertical transmission of hepatitis B virus in the Chinese population: a hospital-based study and a meta-analysis. The Pediatric infectious disease journal 2014, 33(9):897-903.
[13] Beasley RP, Lin C-C, Wang K-Y, Hsieh F-J, Hwang L-Y, Stevens C, Sun T-S, Szmuness W: Hepatitis B immune globulin (HBIG) efficacy in the interruption of perinatal transmission of hepatitis B virus carrier state: initial report of a randomised double-blind placebo-controlled trial. The Lancet 1981, 318(8243):388-93.
[14] Xu DZ, Yan YP, Choi BC, Xu JQ, Men K, Zhang JX, Liu ZH, Wang FS: Risk factors and mechanism of transplacental transmission of hepatitis B virus: A case‐control study. Journal of medical virology 2002, 67(1):20-6.
[15] Xu Z-y, Duan S-C, Margolis HS, Purcell RH, Ou-Yang P-Y, Coleman PJ, Zhuang Y-L, Xu H-F, Qian S-G, Zhu Q-R: Long-term efficacy of active postexposure immunization of infants for prevention of hepatitis B virus infection. Journal of Infectious Diseases 1995, 171(1):54-60.
[16] Weinbaum CM, Williams I, Mast EE, Wang SA, Finelli L, Wasley A, Neitzel SM, Ward JW, Control CfD, Prevention: Recommendations for identification and public health management of persons with chronic hepatitis B virus infection. MMWR Recomm Rep 2008, 57(RR-8):1-20.
[17] ACOG Practice Bulletin No. 86: Viral hepatitis in pregnancy. Obstet Gynecol 2007, 110(4):941-56.
[18] Chen HL, Lin LH, Hu FC, Lee JT, Lin WT, Yang YJ, Huang FC, Wu SF, Chen SCC, Wen WH: Effects of maternal screening and universal immunization to prevent mother-to-infant transmission of HBV. Gastroenterology 2012, 142(4):773-781. e772.
[19] Lee C, Gong Y, Brok J, Boxall EH, Gluud C: Effect of hepatitis B immunisation in newborn infants of mothers positive for hepatitis B surface antigen: systematic review and meta-analysis. Bmj 2006, 332(7537):328-36.
[20] Su HX, Xu DZ, Li D, Zhang JX, Lu J, Choi BC, Yan YP: Heterogeneity analysis of the hepatitis B virus genome in intrauterine infection. Journal of medical virology 2005, 77(2):180-7.
[21] Wei J, Xue S, Zhang J, Wang S, Wang B: Study of the relationship in pregnant women between hepatitis B markers and a placenta positive for hepatitis B surface antigen. Journal of perinatal medicine 2015, 43(2):191-9.
[22] Tosun S: Viral hepatitlerin ülkemizdeki değişen epidemiyolojisi. Ankem Derg 2013, 27(Suppl 2):128-34.
[23] Karaca Ç, Karaca N, Usta T: Gebe populasyonda Hepatit B,C,D virus infeksiyonu sıklığı ve hepatit C virusunun perinatal yolla geçiş oranı. . Akademik Gastroenteroloji Dergisi 2003, 2(122-4).
[24] Comella LT, Cunnigham MD, Eyal FG: Infection diseases. Appleton and Lange 1992(348-9).
[25] Tosun S.Y, Yücetürk M, S B: The immunization of babies born of HBsAg positive pregnant women. Ege Tıp Dergisi 2002, 41:21-3.
[26] Pan CQ, Duan ZP, Bhamidimarri KR, Zou HB, Liang XF, Li J, Tong MJ: An algorithm for risk assessment and intervention of mother to child transmission of hepatitis B virus. Clinical gastroenterology and hepatology 2012, 10(5):452-9.
[27] Sloan D, Ramsay M, Prasad L, Gelb D, Teo CG: Prevention of perinatal transmission of hepatitis B to babies at high risk: an evaluation. Vaccine 2005, 23(48-49):5500-8.
[28] Prakash C, Bhatia R, Kumari S, Verghese T, Datta KK: Response to hepatitis B vaccination in high risk population. The Journal of communicable diseases 2000, 32(1):17-21.