This document summarizes a study on maternal transmission of Hepatitis B Virus (HBV) in Tripoli, Libya. The study tested 1500 pregnant women and their neonates for HBV markers. It found that 1.5% of pregnant women and 0.9% of neonates were HBsAg positive. 60.9% of HBsAg positive neonates were born to HBsAg positive mothers, indicating a high rate of maternal transmission. Due to the high risk of chronic infection in infants born to HBsAg positive mothers, the study concludes that administering hepatitis B immunoglobulin and vaccine is important to prevent transmission and reduce chronic carriers in the country.

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. Introduction
• Family
– Hepadnaviridae
• Genus
– Orthohepadnavirus
• Transmission
– Blood, and Blood products.
– Sexual contact.
– Vertical transmission.

3. Perinatal transmission of HBV
• Time of transmission.
• Factors determining perinatal
transmission.

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. 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. 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. 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. 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. 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. 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. 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. 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.