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The Incidence of Mother-to-Child Transmission of Hepatitis B Virus Under Different Prophylaxes: A Systematic Review and Meta-Analysis
30 Pages Posted: 18 Jan 2021
More...Abstract
Background: The incidence of mother-to-child transmission (MTCT) of hepatitis B virus (HBV) in previous study varies significantly, mainly due to different diagnostic criteria. This leads to incorrect assessment of MTCT risk, the efficacy of preventive strategies and disease burden. Aiming to provide critical information for stakeholds to develop control policies, we estimated the incidence of MTCT across preventive strategies nationally, regionally, and globally, as well identified the HBV DNA threshold for peripartum antiviral prophylaxis.
Methods: We searched databases (including PubMed, Embase, and the Cochrane Library) for both original study on MTCT of HBV and corresponding prophylaxis. The incidence of MTCT was estimated by pooling the data when employing DerSimonian-Laird random effects model.
Findings: Among 109 studies, 1544 of 32357 infants infected with HBV from chronic hepatitis B (CHB) mothers in 19 countries. Without any prophylaxes, the pooled incidence of MTCT was 30·7%, ranging from 0·0% (95% CI 0·0-6·0; European Region) to 47·3% (95% CI 28·2-66·9; Western Pacific Region). When infants received hepatitis B vaccine (HepB) after birth, the MTCT incidence decreased significantly to 5·7% (95% CI 3·4-8·4) in total, 7·7% (95%CI 4·9-11·1) for Western Pacific Region. Superiority of hepatitis B immune globulin (HBIG) was showed, and the incidence further descended when combining HBIG and HepB (4·8% (95% CI 4·0-5·7)). Most noticeably, when providing antivirals for pregnant women in combination with combined immunoprophylaxis for infants, the occurrence of MTCT almost reached to 0·0%, regardless of HBeAg status and geographical regions. Moreover, the analysis of maternal HBV DNA level in narrow range demonstrated that MTCT risk were 0·0%, 0·6%,1·0%, 4·3%, and 10·4% in infants from mothers with HBV DNA levels of < 4·29, 4·00-5·29, 5·00-6·29, 6·00-7·29 and ≥ 7·00 Log IU/mL, respectively.
Interpretation: Though severe burden of HBV MTCT existed in the Western Pacific Region, huge success on blocking MTCT has been achieved by HepB and peripartum antiviral prophylaxis. African can borrow the experiences of MTCT prevention from Western Pacific Region. Then, expansion the coverage of HepB is the most important step. HBIG-free prophylaxis, namely, maternal antiviral therapy plus neonatal vaccination, are also advocated to provide an alternative for cold-chains lacking regions. keeping optimal threshold in mind, antivirals could be proposed for pregnant women with HBV DNA level of ≥ 4·00 Log IU/mL, according to patients will, economic situation, HBV burden or availability of prophylaxes.
Funding Statement: This work is funded by the Natural Science Foundation of China (81670537, 81770594), and Key R&D Program of Shaanxi (2018ZDXM-SF-037).
Declaration of Interests: Naijuan Yao, Shan Fu, Yuchao Wu, Zhen Tian, Yali Feng, Juan Li, Xufei Luo, Jing Wang, Taotao Yan, Yuan Yang, Yaolong Chen declare no competing interests. Fanpu Ji, Yingren Zhao, Tianyan Chen, Jinfeng Liu: Speaker of Gilead Sciences and GSK.
Keywords: hepatitis B virus; mother-to-child transmission; incidence; preventive strategy; meta-analysis, systematic review
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