A friend is a carrier of hepatitis B virus (HBV). He is preparing for pregnancy recently. I called me yesterday, will hepatitis B virus be passed on to the baby?In response to this issue, I will talk to you about some knowledge about the spread of hepatitis B virus maternal and baby spread and breast milk. I hope it can help everyone.
Everyone should also know that my country is a great country B, and nearly 100 million Chinese are carriers of hepatitis B virus.Nearly 100 million Chinese people carry hepatitis B virus to let me protect you?There are many ways to spread the hepatitis B virus. One of the main ways of communication is the spread of maternal and infants.Will chronic HBV infection mothers spread hepatitis B virus to babies?Let’s talk with evidence of evidence.
A study carried out in China, 112 newborns of chronic HBV infected with mother delivery. When the mother’s serum HBV DNA level <20,000IU/ml (<105 copy/ml), the newborn infection rate is 0, and the mother HBV DNA level is about aboutWhen 109IU/ML (9-10log10 copy/ml), the newborn infection rate increased to 50%.
A study of Australia showed that 138 babies of HBV DNA -positive mothers had similar trends.Four cases of infants were detected, and HBV dissemination occurred, although 3 of them accepted hepatitis B immunoglobulin (HBIG) and hepatitis B vaccine, and 1 case was vaccinated.And these four infants’ mothers HBV DNA levels are relatively high (> 108 copy/ml).
Another series of cases of cases show that in the absence of preventive measures, the mother and child communication rate of HBEAG-positive mothers is 85%-90%, and the mother-to-child communication rate of HBEAG negative mothers is 32%.Even if the hepatitis B vaccine and HBIG are given, the children of HBEAG -positive mothers still have the risk of HBV infection, which is about 9%.
The above clinical trials prove that not all chronic HBV infected mothers will spread hepatitis B virus to babies.The spread of HBV is closely related to the level of HBV DNA replication.
The cesarean section cannot prevent HBV spread.Therefore, for the mother carrying HBV, the cesarean section should not be recommended to reduce HBV transmission.
Breastfeeding and maternal and infant dissemination -HBV is unlikely to spread through breastfeeding. It is especially true of infants with hepatitis B immunoglobulin and hepatitis B vaccine at birth.Although HBV DNA has been detected in the colostrum of HBSAG -positive mothers, there is no evidence that breastfeeding is associated with the baby’s subsequent chronic HBV infection.However, infants must complete the vaccination of hepatitis B vaccine.Chronic hepatitis B mothers who are fed in breast milk should also pay attention to prevent nipples from rupture and bleeding.
Parenting — Analysis of genotypes and species, HBV may be transmitted to the baby by his father.A study in Taiwan in China shows that in the mother who is negative for HBSAG and her father is a positive HBSAG, HBV infection rate is 65%.Most of these transmission are considered to be caused by the infectious blood and body fluids that their father’s infectious blood and body fluids are closely exposed to the unprotected newborns.Although some studies have been detected in sperm, no clinical evidence supports the infected sperm will cause HBV infection to spread to the fetus.Therefore, it is particularly important to protect the blood and body fluids of newborns who do not contact HBSAG’s positive father; do not kiss the baby to prevent the spread of saliva; do not share the thresholds such as nail shear with babies.
All women should detect HBSAG during the first prenatal inspection.This blood testing will determine whether women have HBV infections and whether they face the risk of HBV to babies.
Mother who has no HBV infection should vaccinate.In addition, these women should review HBSAG in the second trimester (about 28 weeks).For patients with anti-HBC single-positive, you can also take a dose of hepatitis B vaccine to strengthen the needle to determine whether the anti-HBS titer can increase to> 10miu/ml.Women who are not tested before production should be tested when preparing for production.
So how to prevent maternal and infant transmission for mothers infected with HBV.Measures to prevent maternal and infant transmission include screening women, antiviral treatment for women with higher HBV DNA levels, and newborns who have a newborn of HBSAG-positive mothers-active immunogenic vaccination (hepatitis B immunoglobulin and hepatitis B vaccine).
For women with low levels of HBV DNA in early pregnancy, the HBV virus load should be reviewed at 26-28 weeks of pregnancy.If this level is rising, antiviral treatment should be considered.Recommended HBV DNA> 2x105IU/ML or> 106 copies/ml, starting with antiviral treatment.On the basis of infant standard passive-active immunization vaccination, mothers should also be given antiviral treatment to further reduce the risk of maternal and baby transmission.
For patients who need to be treated, we prefer omolic acid to norofovir two pyrarododrax (TDF) instead of other antiviral drugs, because TDF rarely has drug resistance.The importance is that many young mothers may need to receive antiviral treatment against liver disease in the future.In addition, TDF seems to be safe for pregnancy.If the cost of antiviral treatment cannot be affected and the short -term treatment (that is, ≤3 months), Lamifid can be selected.Neither the existing animals and human data are confirmed to be tdf teratogenic
Newborn immunization-newborns for HBSAG-positive mothers should be passive-active immunochemical vaccination should be given. Choose the first part of the injection of the first agent B vaccination and a hepatitis B immunoglobulin within 12 hours after delivery.The remaining hepatitis B vaccination.
in conclusion:
1. For babies who give birth to HBSAG -positive mothers, the HBV infection rate is as high as 90%if no newborns prevention measures are taken.Give the infant B immunohistocytes (HBIG) and hepatitis B vaccine during childbirth, which can reduce the HBV transmission rate by at least 95%.
2. In addition to the passive-active immunization of the newborn, the use of antiviral treatment with antiviral treatment can also reduce the risk of maternal and baby transmission.The higher the virus load, the more important the antiviral treatment.Starting antiviral treatment at 28-30 weeks of pregnancy, the preferred texolinolinolinol (TDF) is preferred because it can be safe for pregnancy and low risk of drug resistance.If antiviral treatment is stopped after childbirth, patients should be monitored to have liver disease.
references:
1. In May 2018, the clinical management consensus in the childcare female infection with hepatitis B virus
2. GILES M, Visvanathan K, LEWIN S, Et Al. Clinical and Virology Predictors of Hepatic Flares in Pregnant WORONIC Hepatitis B. Gut 2015; 64: 1810.
3. Waitt C, Olagunju a, Nakalema S, et al. Plasma and Breast Milk Pharmacokinetics of Emtricitabine, Tenofovir and Lamivudine USing Drid and Breast Mi. LK Spots in Nursing African Mother-INFANT PAIRS. J Antimicrob Chemother 2018; 73: 1013.
4. Ganne-Carrie N, Causse X, Zarski JP et al. Effical and Safety Results of Tenofovir DF (TDF) Treatment from the First Trimester in HBV Pregnant Women In Real-Li Fe Clinical Practice. Hepatology. 2013; 58 (SUPPL 1): 664A-5A
