An Algorithm for Risk Assessment and Intervention of Mother to Child Transmission of Hepatitis B Virus
ABSTRACT Despite immunoprophylaxis, mother to child transmission (MTCT) of hepatitis B virus (HBV) still occurs in infants born to hepatitis B surface antigen (HBsAg)-positive mothers. We analyzed methods of risk assessment and interventions for MTCT.
We reviewed 63 articles and abstracts published from 1975-2011 that were relevant to MTCT; articles were identified using the PubMed bibliographic database.
Administration of HB immunoglobulin and HB vaccine to infants at birth (within 12 hours), followed by 2 additional doses of vaccines within 6-12 months, prevented approximately 95% of HBV transmission from HBsAg-positive mothers to their infants. However, HBV was still transmitted from 8%-30% of mothers with high levels of viremia. It is important to assess the risk for MTCT and identify mothers who are the best candidates for intervention. The most important risk factor is maternal level of HBV DNA >200,000 IU (10(6) copies)/mL; other factors include a positive test result for the HB e antigen, pregnancy complications such as threatened preterm labor or prolonged labor, and failure of immunoprophylaxis in prior children. Antiviral therapy during late stages of pregnancy is the most effective method to reduce transmission from mothers with high levels of viremia, but elective cesarean section might also be effective. Antepartum administration of HB immunoglobulin, giving infants a double dose of HB vaccine, or avoiding breastfeeding had no impact on MTCT.
HBsAg-positive mothers should be assessed for risk of MTCT, and infants should receive immunoprophylaxis. Pregnant women with levels of HBV DNA >200,000 IU/mL should be considered for strategies to reduce the risk for MTCT. We propose an algorithm for risk assessment and patient management that is based on a review of the literature and the opinion of a panel of physicians with expertise in preventing MTCT.
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ABSTRACT: To avoid the cirrhosis and liver cancer, antiviral treatment for chronic hepatitis is necessary. In the literature, several mathematical models have been used to describe the dynamics of viral infections. In addition, several control strategies have been reported in the literature to deal with optimal antiviral therapy problem of infectious diseases. In this paper, three controller structures with optimized parameters using covariance matrix adaptation–evolution strategy algorithm are proposed for optimal control of basic hepatitis B virus (HBV) infection dynamical system. The first structure is an optimized neural-type sigmoid-based closed-loop controller, which is a nonlinear feedback controller. The second structure is an optimized open-loop time-based fuzzy controller in which the control input is approximated using the mixture of Gaussian membership functions. Finally, an optimized closed-loop fuzzy controller is used as the third control structure. After designing the controllers, some parameters of the HBV infection model are considered to be unknown and the robustness of the controllers is studied. Experimental results show that the optimized neural-type sigmoid-based closed-loop controller has the best performance in terms of healthy hepatocytes and free HBVs concentration among the investigated controllers and the optimized closed-loop fuzzy controller is the best in terms of minimum mean control input signal that is the drug usage. Concerning the robustness, the optimized neural-type sigmoid-based closed-loop controller has the best performance.Neural Computing and Applications 09/2012; DOI:10.1007/s00521-012-1013-3 · 1.76 Impact Factor
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ABSTRACT: We aimed to evaluate the present situation and possible risk factors of HBV transmission after the implementation of the routine immunization among children exposed to HBV infected mothers in a developing area in northwest China. Two hundred and twenty one HBsAg carrier mothers and 247 children born to them were finally recruited in Wuwei city, Gangsu province, China in 2010. Serum samples were taken from those HBsAg carrier mothers and their children. Children who had detectable HBsAg or HBV DNA were considered to be HBV infection. Conditional logistic regression model was used to identify potential risk factors of HBV mother-to-child transmission. Of the 247 children born to HBsAg carrier mothers, 8 (3.24%) were HBsAg positive, 15 (6.07%) were HBV DNA positive. The rate of HBV mother-to-child transmission was 7.29% (18/247). The univariate analysis and multivariate analysis showed that maternal HBV DNA positive (OR=4.83, 95% CI: 1.38-16.98, p=0.0140), the delayed injection of the first dose of HBV vaccine after premature birth (OR=9.73, 95% CI: 1.78-53.21, p=0.0087) and the missing use of HBV vaccine (OR=8.29, 95% CI: 1.42-48.23, p=0.0186) were significantly associated with an increased risk for HBV mother-to-child transmission. The rate of HBV infection of the children received HBV vaccine and HBIG together after birth (2.56%, 4/156) was lower than those children received HBV vaccine alone (11.39%, 9/79) (χ(2)=7.83, p=0.0052). In conclusion, the rate of mother-to-child transmission of HBV was still high in the northwest of China. Besides the positivity of maternal HBV DNA and the missing of HBV vaccination after birth, the delayed injection of the first dose of HBV vaccine after premature birth was also a possible independent risk factor for HBV mother-to-child transmission. The HBV prevention and treatment guidelines should make it clear that all of the new born infants need to receive HBV vaccine injection after birth in 24h, including the premature infants.Vaccine 09/2012; 30(49). DOI:10.1016/j.vaccine.2012.09.031 · 3.49 Impact Factor
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ABSTRACT: Chronic hepatitis B virus (HBV) infection in pregnancy presents a unique and important challenge. Over 50% of chronic HBV carriers in endemic areas acquire infection vertically from their mothers. More importantly, over 90% of perinatally acquired infections progress to chronic HBV infection. Thus, management of chronic HBV during pregnancy and strategies to prevent mother-to-child transmission is an important step in eradicating or reducing the global burden of chronic hepatitis B. In addition, chronic HBV infection in pregnancy presents a unique clinical challenge because of the complex relationship between the physiological changes of pregnancy and the pathophysiological response to HBV. This review will present the current knowledge and a practical approach to management of HBV in pregnancy.Liver international: official journal of the International Association for the Study of the Liver 02/2013; 33(s1). DOI:10.1111/liv.12060 · 4.41 Impact Factor