Hepatitis B dalam Kehamilan

Department of Obstetrics & Gynecology

Faculty of Medicine University of Indonesia
Dr. Cipto Mangunkusumo General Hospital
Jakarta
Viral Hepatitis - Overview

Type of Hepatitis
A B C D E
Source of feces blood/ blood/ blood/ feces
virus blood-derived blood-derived blood-derived
body fluids body fluids body fluids

Route of fecal-oral percutaneous percutaneous percutaneous fecal-oral

transmission permucosal permucosal permucosal

Chronic no yes yes yes no

infection

Prevention pre/post- pre/post- blood donor pre/post- ensure safe

exposure exposure screening; exposure drinking
immunization immunization risk behavior immunization; water
modification risk behavior
modification
 Estimates of Acute and Chronic Disease
Burden for Viral Hepatitis, United States

HAV HBV HCV HDV

Acute infections
(x 1000)/year* 125-200 140-320 35-180 6-13

Fulminant
deaths/year 100 150 ? 35
Chronic 0 1-1.25 3.5
infections million million 70,000

Chronic liver disease

deaths/year 0 5,000 8-10,000 1,000
* Range based on estimated annual incidence, 1984-1994.
 Outcome of Hepatitis B Virus Infection
by Age at Infection
100 100

Symptomatic Infection (%)

Chronic Infection (%)

80 80

60 60
Chronic Infection

40 40

20 20

Symptomatic Infection
0 0
Birth 1-6 months 7-12 months 1-4 years Older Children
and Adults
Age at Infection
 Elimination of Hepatitis B Virus
Transmission in the United States

Strategy
Prevent perinatal HBV transmission
Routine vaccination of all infants
Vaccination of children in high-risk groups
Vaccination of adolescents
all unvaccinated children at 11-12 years of age
high-risk adolescents at all ages
Vaccination of adults in high-risk groups
 Interpretation of the Hepatitis B Panel
Tests Results Interpretation
HBsAg negative Susceptible
anti-HBc negative
anti-HBs negative
HBsAg negative Immune due to natural infection
anti-HBc positive
anti-HBs positive
HBsAg negative Immune due to hepatitis B vaccination
anti-HBc negative
anti-HBs positive
HBsAg positive Acutely
anti-HBc positive infected
IgM anti-HBc positive
anti-HBs negative
HBsAg positive Chronically
anti-HBc positive infected
IgM anti-HBc negative
anti-HBs negative
HBsAg negative 1. Might be recovering from acute HBV infection.
anti-HBc positive 2. Might be distantly immune and test not sensitive enough to detect very low level of anti-HBs in serum.
anti-HBs negative 3. Might be susceptible with a false positive anti-HBc.
4. Might be undetectable level of HBsAg present in the serum and the person is actually chronically infected
 Definitions
Hepatitis B Surface Antigen (HBsAg): A serologic
marker on the surface of HBV. It can be detected in
high levels in serum during acute or chronic hepatitis.
The presence of HBsAg indicates that the person is
infectious. The body normally produces antibodies to
HBsAg as part of the normal immune response to
infection.
Hepatitis B Surface Antibody (anti-HBs): The presence
of anti-HBs is generally interpreted as indicating
recovery and immunity from HBV infection. Anti-HBs
also develops in a person who has been successfully
vaccinated against hepatitis B.
 Definitions
Total Hepatitis B Core Antibody (anti-HBc):
Appears at the onset of symptoms in acute
hepatitis B and persists for life. The
presence of anti-HBc indicates previous or
ongoing infection with hepatitis B virus
(HBV) in an undefined time frame.
IgM Antibody to Hepatits B Core Antigen
(IgM anti-HBc): This antibody appears during
acute or recent HBV infection and is present
for about 6 months.
 Transmission of HBV
Transmissibility 100 times greater than HIV1
Vertical
Infected mother-to-infant during first year of life
Earlier age at exposure increases the risk of
developing chronic HBV infection2

1. WHO-CSR
2. WHO and CDC fact sheets, available at www.who.int and www.cdc.gov
 INTRAUTERINE INFECTION OF HBV

HBsAg Seropositive Rate at Birth :

2.4% (16/665) Among Neonates of HBeAg
Positive, HBsAg Positive Mothers

Chronicity : 100%
Tang JR et al. J Pediatr 1998 ; 133: 374
 Lamivudine Therapy During Pregnancy to
Prevent Perinatal Transmission of HBV Infection

8 Highly Viraemic (HBV-DNA>1.2 x 109 geq/mL)

Mothers Treated With 150 mg of lamivudine Daily
Since 34 Wks of Gestation.
HBV-DNA, HBsAg, Anti-HBs, Anti-HBc of their
Infants were Measured at 0, 3, 6, 12 Months.
Historical Control : 24 Children , born to untreated
HBsAg-positive mothers with HBV-DNA levels >1.2
x 109 geq/mL
All children received passive-active immunization at
birth .

van Zonneveld M, et al. ( J Viral Hepatitis 2003; 10: 294-7)

 Lamivudine Treatment During Pregnancy
to Prevent Perinatal Transmission of HBV Infection

Lamivudine Group : 1/8 Children (12.5%) was

HBsAg and HBV-DNA positive at age 12
months.
Untreated Historical Control Group, Perinatal
Transmission Occurred in 7/25 children (28%).

M. van Zonneveld M, et al. ( J Viral Hepatitis 2003; 10: 294-7)