Management of hepatitis B in pregnant women and infants: a multicentre audit from four London hospitals
Gauri Godbole,Dianne Irish,Marina Basarab,Tabitha Mahungu,Andrew Fox-Lewis,Claire Thorne,Michael Jacobs,Geoffrey Dusheiko,William Rosenberg,Deepak Suri,Andrew Millar,Eleni Nastouli +11 more
TLDR
In certain sectors of London, implementation of the pathway for management of women with hepatitis B and their infants is suboptimal and improved intersectorial sharing of information is needed to reduce the risk of women of high infectivity being lost to follow up.Abstract:
Pregnant women with hepatitis B virus (HBV) infection can transmit the infection to their infants, screening of patients and appropriate interventions reduce vertical transmission. This audit was conducted to assess adherence to the national guidelines for management of HBV infection in pregnancy. A retrospective audit was conducted on pregnant women diagnosed with hepatitis B on screening in antenatal clinics, across four hospitals in London over 2 years (2009–2010). Data was collected from antenatal records and discharge summaries using a standard audit form. The outcomes measured included HBV serological markers, HBV DNA, detection of other blood borne viruses and referral to hepatology services, administration of active and passive prophylaxis to infants at birth. Descriptive statistics are presented. Proportions were compared using the χ
2 test and 95% confidence intervals (CI) were calculated for prevalence estimates. Analyses were conducted using STATA 12. HBsAg was detected in 1.05% (n = 401, 95% CI 0.95-1.16) of women attending an antenatal appointment, 12% (n = 48) of the women were at a high risk of vertical transmission (HBe Ag positive or antiHBe and HBeAg negative or HBV DNA >106 IU/ml). Only 62% (n = 248) women were referred to hepatology or specialist clinics and 29% (n = 13) of women of high infectivity were on antiviral agents. Testing for hepatitis C and delta virus was suboptimal. 75% (n = 36) of the infants at a high risk of acquisition of HBV received both active and passive prophylaxis. In certain sectors of London, implementation of the pathway for management of women with hepatitis B and their infants is suboptimal. National guidelines should be followed and improved intersectorial sharing of information is needed to reduce the risk of women of high infectivity being lost to follow up.read more
Citations
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Addressing liver disease in the UK: A blueprint for attaining excellence in health care and reducing premature mortality from lifestyle issues of excess consumption of alcohol, obesity, and viral hepatitis
Roger Williams,Richard Aspinall,Mark A Bellis,Ginette Camps-Walsh,Matthew E. Cramp,Anil Dhawan,James Ferguson,Daniel M. Forton,Graham R. Foster,Sir Ian Gilmore,Matthew Hickman,Mark Hudson,Deirdre Kelly,Andrew Langford,Martin Lombard,Louise Longworth,Natasha K. Martin,Kieran Moriarty,Philip N. Newsome,John O'Grady,Rachel Pryke,Harry Rutter,Stephen D. Ryder,Nick Sheron,Thomas J. Smith +24 more
TL;DR: The aim of this Commission is to provide the strongest evidence base through involvement of experts from a wide cross-section of disciplines, making firm recommendations to reduce the unacceptable premature mortality and disease burden from avoidable causes and to improve the standard of care for patients with liver disease in hospital.
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Prophylactic vaccination against hepatitis B: achievements, challenges and perspectives.
TL;DR: Third-generation HBV vaccines produced in mammalian cells contain correctly folded HBsAg and neutralizing epitopes of the preS antigens, induce more rapid protection, overcome nonresponse to second-generation vaccines and, most importantly, may provide better protection for newborns of HBV-positive mothers.
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Vertical transmission of hepatitis B virus: challenges and solutions.
Ivan Gentile,Guglielmo Borgia +1 more
TL;DR: Universal screening of all pregnant women, at-birth prophylaxis with specific anti-HBV immune globulin, as well as HBV vaccination for newborns of infected mothers are effective in reducing the risk of vertical transmission, however, in cases of a high viral load and hepatitis B antigen positivity, there is a residual risk of HBV transmission to the newborn despite proprylaxis.
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Accuracy of HBeAg to identify pregnant women at risk of transmitting hepatitis B virus to their neonates: a systematic review and meta-analysis
Pauline Boucheron,Ying Lu,Kyoko Yoshida,Tianshuo Zhao,Anna L Funk,Anna L Funk,Françoise Lunel-Fabiani,Alice Nanelin Guingané,Edouard Tuaillon,Judith van Holten,Roger Chou,Marc Bulterys,Marc Bulterys,Yusuke Shimakawa +13 more
TL;DR: The HBV DNA threshold for MTCT is identified, the sensitivity and specificity of hepatitis B e antigen (HBeAg) testing is assessed, and pregnant women with chronic HBV infection without concurrent antiviral therapy are predicted on the basis of HBeAg testing.
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Immune Tolerant Chronic Hepatitis B: The Unrecognized Risks.
TL;DR: The notion that the immune tolerant phase is truly benign is challenged and the possibility that events during this phase may contribute significantly to cirrhosis, hepatocellular carcinoma (HCC), and the premature death of 25% of HBV carriers worldwide is considered.
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BMC Pregnancy and Childbirth
Joy E Lawn,Mohammad Yawar Yakoob,Rachel A Haws,Tanya Soomro,Gary L. Darmstadt,Zulfiqar A Bhutta,Afsah Zulfiqar Bhutta,L Darmstadt +7 more
TL;DR: This first paper in the series outlines issues in stillbirth data availability and quality, the global epidemiology of stillbirths, and describes the methodology and framework used for the review of interventions and strategies.
Journal ArticleDOI
THE e ANTIGEN AND VERTICAL TRANSMISSION OF HEPATITIS B SURFACE ANTIGEN
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