Mei-Hwei Chang1, Bjorn Fischler2, Barri Blauvelt3, Mirta Ciocca4, Anil Dhawan5, Udeme Ekong6, Yen-Hsuan Ni1, Gilda Porta7, Anupam Sibal8, Daniel DAgostino9, Stefan Wirth10, Neelam Morhan11, Kathleen B Schwarz12. 1. Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan. 2. Department of Pediatrics, Karolinska University Hospital, CLINTEC, Stockholm, Sweden. 3. Institute for Global Health, University of Massachusetts, Amherst, MA. 4. Pediatric Hepatology and Liver Transplant Section of German Hospital, Buenos Aires, Argentina. 5. Paediatric Liver GI and Nutrition Center, King's College Hospital, London, UK. 6. Section of Pediatric Gastroenterology and Hepatology, Yale University School of Medicine, New Haven, CT. 7. Department of Pediatrics, University of São Paulo, São Paulo, Brazil. 8. Department of Paediatrics, Indraprastha Apollo Hospitals, New Delhi, India. 9. Pediatric Hepatology and Liver Transplant Section, Hospital Italiano, Buenos Aires, Argentina. 10. Department of Pediatrics, Helios Medical Center, Witten/Herdecke University, Witten, Germany. 11. Department of Pediatric Gastroenterology, Hepatology and Liver Transplantation, The Medicity Hospital, Gurgaon, Haryana, India. 12. Department of Pediatrics, Johns Hopkins Medical Institutions, Baltimore, MD.
Abstract
OBJECTIVE: Mother-to-infant transmission (MIT) is the leading cause of hepatitis B virus (HBV) infections globally. The aim of this international study was to assess the impediments to prevention of (MIT) of HBV. METHODS: A cross-sectional survey was developed by the Federation of the International Societies for Pediatric Gastroenterology, Hepatology and Nutrition. (FISPGHAN) The survey was sent to HBV experts of the 5-member societies of FISPGHAN, and 63 of 91 countries/regions responded. Main outcome measures include percentage of countries having vaccine programs, timing of the first dose of HBV vaccine, availability of HBV vaccine for outborn neonates, payment of HBV vaccine and hepatitis B immune globulin, screening HBV markers during pregnancy, and antivirals to highly infectious pregnant mothers. RESULTS: Among the participating countries/regions, 11% did not implement infant HBV immunization programs. The first dose of vaccine was given >24 hours in 36% of the total countries and 100% of African countries. The recommended birth dose was unavailable for outborn neonates in 45% of the total countries, including 92% of African and 50% of Latin American countries/regions. During pregnancy, 44% countries do not screen maternal viral markers, and 46% do not provide third trimester antiviral therapy for highly viremic pregnant mothers. CONCLUSIONS: Our study demonstrated multiple obstacles to achieving the goal of preventing MIT of HBV. Comprehensive public health programs to enhance vaccine coverage rate, supply HBV vaccine for out-born neonates, screening maternal HBV markers, treating highly viremic pregnant mothers are proposed to overcome these obstacles and achieve the goal of preventing MIT of HBV.
OBJECTIVE: Mother-to-infant transmission (MIT) is the leading cause of hepatitis B virus (HBV) infections globally. The aim of this international study was to assess the impediments to prevention of (MIT) of HBV. METHODS: A cross-sectional survey was developed by the Federation of the International Societies for Pediatric Gastroenterology, Hepatology and Nutrition. (FISPGHAN) The survey was sent to HBV experts of the 5-member societies of FISPGHAN, and 63 of 91 countries/regions responded. Main outcome measures include percentage of countries having vaccine programs, timing of the first dose of HBV vaccine, availability of HBV vaccine for outborn neonates, payment of HBV vaccine and hepatitis B immune globulin, screening HBV markers during pregnancy, and antivirals to highly infectious pregnant mothers. RESULTS: Among the participating countries/regions, 11% did not implement infantHBV immunization programs. The first dose of vaccine was given >24 hours in 36% of the total countries and 100% of African countries. The recommended birth dose was unavailable for outborn neonates in 45% of the total countries, including 92% of African and 50% of Latin American countries/regions. During pregnancy, 44% countries do not screen maternal viral markers, and 46% do not provide third trimester antiviral therapy for highly viremic pregnant mothers. CONCLUSIONS: Our study demonstrated multiple obstacles to achieving the goal of preventing MIT of HBV. Comprehensive public health programs to enhance vaccine coverage rate, supply HBV vaccine for out-born neonates, screening maternal HBV markers, treating highly viremic pregnant mothers are proposed to overcome these obstacles and achieve the goal of preventing MIT of HBV.