Hepatitis B, infected mothers have a very high probability of infecting the foetus during pregnancy. Infection can be prevented with vaccine and immunoglobulins immediately after birth

Hepatitis B is an infection caused by the Hepatitis B virus (HBV)

Hepatitis B virus infection can be acute or chronic.

It is defined as chronic when it lasts more than 6 months. The hepatitis B virus is mainly transmitted by contact with infected blood and, in adults, by sexual transmission.

The World Health Organisation (WHO) estimates that there are approximately 257 million people in the world with chronic hepatitis B virus infection.

In children, hepatitis B usually has a benign evolution

In some cases, however, it can be particularly severe.

The most common transmission is between the hepatitis B virus-infected mother and the child she is carrying (vertical transmission).

More than 90% of children who become infected at birth become chronic carriers of the hepatitis B virus.

If the infection occurs later, at pre-school age, the risk of becoming a chronic carrier drops to 25-60%.

If the infection occurs at a later age, the risk drops further to 5%, as in adulthood.

The infection can be diagnosed by looking in the blood for a substance called HBsAg.

This substance, called surface antigen, is part of the hepatitis B virus

Its presence in the blood indicates that there is an ongoing hepatitis B infection.

The most effective measure to prevent infection is vaccination. In Italy, hepatitis B vaccination has been mandatory since 1991.

Vaccination has reduced the risk of liver cancer by 70%.

There are 3 possible ways of transmitting the infection from mother to child, which can occur before or immediately after birth (perinatal transmission):

• Transplacental in utero (intrauterine transmission): the infection passes from the mother’s blood to the child’s blood via the placenta;
• During childbirth (intra-partum transmission);
• Postnatal (rare) e.g. during breastfeeding, if there are rhagades or other bleeding nipple lesions (postnatal transmission).

In the absence of appropriate treatment, the chronic carrier status of the virus shows no sign of being a carrier.

However, over time, chronic carriers of the virus can develop severe liver damage.

30-40 years after infection, cirrhosis and tumours (hepatocarcinoma) can occur.

The risk is therefore all the greater the earlier the infection occurred.

In other words, the risk of cirrhosis and tumours is greatest in adults who became infected as infants.

Children born to a mother chronically infected with the hepatitis B virus should be given a first dose of hepatitis B vaccine within 12 to 24 hours after birth.

At the same time as the vaccine, these infants should be given specific hepatitis B virus immunoglobulin (HBIG)

The vaccination cycle should then be completed with 3 further doses at 4 weeks, at 8 weeks and at 11-12 months.

Preferably, 1-3 months after the last dose, the immune response to the vaccine should be checked (search for antibodies directed against the hepatitis B virus) to verify that the child is protected against infection.

A small number of infants born to mothers who are chronic carriers of the hepatitis B virus become infected despite proper prophylaxis with vaccine and immunoglobulins performed at birth.

This may depend on the number of copies of the virus present in the mother’s blood (viraemia).

In infected pregnant women, if the viremia is high (HBV DNA >200,000 IU/mL), it is indicated to start prophylaxis with antiviral drugs (tenofovir) between the 24th and 28th week of gestation to reduce the number of viruses in the blood and thus ensure that the immunoglobulin and vaccination prophylaxis carried out at birth on the newborn can be effective.

This is why screening for the hepatitis B virus (HBsAg) in the first trimester of pregnancy is recommended for pregnant women.

As for the mode of delivery, there is no evidence that delivery by caesarean section is better than vaginal delivery for avoiding the risk of transmission of hepatitis B virus infection from mother to newborn.

Infants who have received the vaccine and immunoglobulins can be breastfed by the mother

Breast-feeding should therefore be encouraged, as long as neither rhagades nor nipple bleeding are present.

The main aim of antiviral therapy, both in adult and paediatric age, is to decrease the risk of cirrhosis and liver cancer (hepatocarcinoma).

Interferons and antivirals (lamivudine, tenofovir and entecavir) have proven effective in the treatment of chronic hepatitis.

Antiviral therapy should only be carried out on prescription by specialist centres.

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Source

Bambino Gesù