MATERNAL TRANSMISSION OF
HEPATITIS B VIRUS (HBV)
IN TRIPOLI-LIBYA

Hamida El-Magrahe, Abdul Rahaman
Furarah, Kheiria El-Fi...
Introduction
• Family
– Hepadnaviridae

• Genus
– Orthohepadnavirus

• Transmission
– Blood, and Blood products.
– Sexual ...
Perinatal transmission of HBV
• Time of transmission.
• Factors determining perinatal
transmission.
Table 1. Serological markers of HBV infection
Phase

AntiAntiHBsAg HBs HBeAg HBe

AntiHBc

HBV
DNA

Acute

+

-

+

-

IgM...
Factors determining transmission of
HBV
• Acute hepatitis B infection during
pregnancy.
– Women having acute hepatitis B i...
Factors determining transmission of
HBV
• Chronic hepatitis B infection during
pregnancy.
– HBsAg+ve and HBeAg+ve
• risk o...
Objectives of the Study
• Pregnant women with HBV are a major
reservoir of the virus in the community.
– To estimate the p...
Materials and Methods
• Blood samples from 1500 pregnant
women (aged <21 to >35 years
[mean=28yr]) and 1500 cord blood of
...
Results
• HBsAg was detected in 23 (1.5%) pregnant women
and in 14 (0.9%) neonates.
• Although HBsAg was detected at highe...
Table 2. Prevalence of HBV serological markers
in pregnant women and their neonates
No. (%) positive
Serological
marker

P...
Table 3. Hepatitis B status of 1500 Libyan pregnant women
Hepatitis B Virus serological markers

Group

Maternal status

I...
Conclusions
• This study showed high rate (>60%) of
maternal transmission of HBV among
HBsAg+ve mothers in Tripoli.
• Beca...
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Maternal transmission of HBV-Libya

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Maternal transmission of HBV-Libya

  1. 1. MATERNAL TRANSMISSION OF HEPATITIS B VIRUS (HBV) IN TRIPOLI-LIBYA Hamida El-Magrahe, Abdul Rahaman Furarah, Kheiria El-Figih, Suad El Urshfany and Khalifa Sifaw Ghenghesh Faculty of Sciences, Tripoli University; Faculty of Medicine, Tripoli University; and Tripoli Medical Center; Tripoli-Libya
  2. 2. Introduction • Family – Hepadnaviridae • Genus – Orthohepadnavirus • Transmission – Blood, and Blood products. – Sexual contact. – Vertical transmission.
  3. 3. Perinatal transmission of HBV • Time of transmission. • Factors determining perinatal transmission.
  4. 4. Table 1. Serological markers of HBV infection Phase AntiAntiHBsAg HBs HBeAg HBe AntiHBc HBV DNA Acute + - + - IgM + Chronic active + - + - IgG + Chronic carrier + - - + IgG - Recovery - + - + IgG - Vaccine - + - - - -
  5. 5. Factors determining transmission of HBV • Acute hepatitis B infection during pregnancy. – Women having acute hepatitis B in the first or second trimester rarely transmit HBV to their neonates • risk of transmission is low 3%. – Women having acute hepatitis B in the last trimester of pregnancy • risk of transmission is about 70-78%.
  6. 6. Factors determining transmission of HBV • Chronic hepatitis B infection during pregnancy. – HBsAg+ve and HBeAg+ve • risk of transmitting HBV to their neonates is 80-90 % • 85-90 % of infected infants become chronic carriers. – HBsAg+ve, HBeAg-ve, and anti-HBe-ve • risk of transmitting HBV to their neonates is 31%. – HBsAg-ve, HBeAg-ve, and anti-HBe+ve • risk of transmitting HBV to their neonates is 10-20 %.
  7. 7. Objectives of the Study • Pregnant women with HBV are a major reservoir of the virus in the community. – To estimate the prevalence of HBV infection among pregnant women. – To assess the importance of maternal transmission of HBV. – To define the importance of different HBV markers in the transmission of the virus from mother to the fetus.
  8. 8. Materials and Methods • Blood samples from 1500 pregnant women (aged <21 to >35 years [mean=28yr]) and 1500 cord blood of their neonates at Tripoli Medical Center, Tripoli were tested for the different markers of HBV using ELISA techniques. • The study was carried out between April 2001 and March 2002.
  9. 9. Results • HBsAg was detected in 23 (1.5%) pregnant women and in 14 (0.9%) neonates. • Although HBsAg was detected at higher rate in pregnant women aged >25 years (1.8% [22/1235]) than in pregnant women aged <25 years (0.4% [1/265]), the difference was not statistically significant (P>0.05, Chi-squares test). • All HBsAg+ve neonates were born to HBsAg+ve mothers with a rate of maternal transmission at 60.9% [14/23]. • HBeAg was detected in 21.7% (5/23) and 7.1 (1/14) of HBsAg+ve pregnant women and HBsAg+ve neonates, respectively. • HBV markers detected in pregnant women and neonates are shown Table 2.
  10. 10. Table 2. Prevalence of HBV serological markers in pregnant women and their neonates No. (%) positive Serological marker Pregnant women (n=1500) Neonates (n=1500) HBsAg 23 (1.5) 14 (0.9) HBeAg 5 (0.3) 1 (<0.1) Anti-HBe 11 (0.7) 8 (0.5) Total-antiHBc 16 (1.1) 9 (0.6) Anti-HBcIgM 4 (0.3) 7 (0.5)
  11. 11. Table 3. Hepatitis B status of 1500 Libyan pregnant women Hepatitis B Virus serological markers Group Maternal status I II No. (%) Positive HBeAg Anti-HBe Susceptible - - - - - 1477 (98.5) Early infection, asymptomatic + - - - - 2 (0.12) + - + - - 1 (0.06) Acute infection, replicating + + + + - 3 (0.2) Recovery or convalescence? + + - - + 7 (0.5) + - - - + 4 (0.25) Chronic infection V Anti-HBcIgM Recovery or convalescence? VI Anti-HBcTotal Acute infection III HBsAg + + - - - 4 (0.25) Chronic Infection, replicating + + - + - 2 (0.12)
  12. 12. Conclusions • This study showed high rate (>60%) of maternal transmission of HBV among HBsAg+ve mothers in Tripoli. • Because of the high risk of developing chronic HBV infection at birth among infants born to HBsAg+ve mothers, administration of HBIG in combination with hepatitis B vaccine as post-exposure prophylaxis for such infants is of paramount importance. • In addition, universal HBsAg screening of all pregnant women will greatly assist in reducing the maternal transmission of HBV in the country.

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