Nigerian Journal of Paediatrics

Prevention of mother to child transmission of hepatitis B virus infection in Nigeria A call to action

Niger J Paediatr 2016; 43 (3): 201 – 208

ORIGINAL

Eke CB

Prevention of mother to child

Onyire NB

Amadi OF

transmission of hepatitis B virus

infection in Nigeria: A call to action

DOI:http://dx.doi.org/10.4314/njp.v43i3.9

Accepted: 2nd June 2016

Abstract : Background: Sub- Sa-

women with HBeAg positivity and

hara Africa including Nigeria has

high viral load, infant post-

Eke CB

(

)

the second largest global burden

exposure prophylaxis and follow-

Department of Paediatrics,

of chronic carriers of hepatitis B

up of infants of HBsAg positive

College of Medicine, University of

Nigeria, Enugu Campus, Nigeria.

virus (HBV) infection after Asia.

mothers.

Email: christopher.eke@unn.edu.ng

Mother-to-child

transmission

There is no co-ordinated PMTCT

(MTCT) of HBV is the most com-

of HBV programme in place in our

Onyire NB

mon route of transmission in high

setting despite the huge burden of

Department of Paediatrics,

endemic areas .MTCT of hepatitis

the disease in Nigeria. Hence the

College of Medicine, Ebonyi State

B virus infection continues to

need therefore to develop a home

University, Abakaliki/Federal Teaching

occur despite the interventions of

grown PMTCT programme of

Hospital Abakaliki, Nigeria.

hepatitis B vaccinations and im-

HBV to help tackle the burden of

munoglobulins in settings where it

the disease in our country. An evi-

Amadi OF

Department of Paediatrics,

is practiced. Infants most at risk

dence based review of current best

College of Medicine, Enugu State

are those whose mothers have

practice guidelines for the preven-

University of Science and Technology

high HBV DNA viral loads and

tion of mother-to-child transmis-

(ESUT)/ESUT Teaching Hospital Park

produce the protein HBeAg. Vari-

sion of HBV for use in low and

Lane Enugu, Nigeria.

ous Nigerian studies have re-

medium resource income settings

ported high HBV infection rates

with hepatitis B hyperendemicity

as well as HBeAg positivity

will be quiet apt in this circum-

among pregnant women.

stance.

These HBV infections usually

This document therefore will be

occur intrapartum and rarely in-

useful as a quick guide to Paedia-

utero. Mothers with HBeAg posi-

tricians, Obstetricians, Family

tivity known to be associated with

Physicians, General Practice Doc-

higher HBV DNA viral loads

tors and other allied health workers

have been linked with higher

charged with the care of pregnant

chances of MTCT as HBeAg is

mothers and their young children.

the only structural HBV protein

Methods: Relevant literatures pub-

that can cross into the placental

lished in English language or

circulation.

translated

into

English were

In the absence of post exposure

searched manually and electroni-

prophylaxis about 40 percent of

cally in PUBMED and SCOPUS

infants delivered by HBV infected

for the period between 1990 and

mothers could develop HBV in-

2016 on the subject. Keywords

fections, and about 25% of them

searched included: epidemiology

may come down with chronic

of HBV infection, MTCT of HBV,

hepatitis and resulting possible

and its preventive strategies in-

complications including liver cir-

cluding prenatal screening, anti-

rhosis and hepatocellular cancer

viral agents in pregnancy, infant

later in life.

post exposure prophylaxis and

The prevention of transmission of

follow-up of infected children.

retroviral infection from mother-

Results: Over 35 scholarly articles

to-child has been a success story

on HBV epidemiology, MTCT,

of the 21 century and such feat

and preventive measures as well as

could be replicated for HBV in-

follow – up models were retrieved

fection. The standard PMTCT of

and analyzed.

HBV currently will comprise:

Conclusion: Universal screening

timely prenatal screening, starting

of all pregnant women for HBV

anti-viral therapy for pregnant

infection is the most effective

202

strategy for the prevention of

tive mothers should receive timely

Key words : Prevention of mother

MTCT of HBV, as effective pre-

post exposure prophylaxis and

to child transmission; Hepatitis B

ventive measures could be applied

followed up for possible develop-

virus infection; Resource limited

starting from pregnancy to deliv-

ment of chronic hepatitis B infec-

settings.

ery while infants of HBsAg posi-

tion.

Introduction

prophylaxis (PEP) using the administration of hepatitis

B vaccine within 24 hours of birth followed by comple-

Hepatitis B virus (HBV) infection is a potentially life

tion of the HBV vaccine series; are recognized strategies

threatening liver infection. It is a major global public

for reducing MTCT transmission rates and the global

burden of a new chronic HBV infection.

10,22

health problem and known to cause chronic hepatitis

with high risk of mortality resulting from hepatic cirrho-

sis and cancer. Sub-Sahara Africa has the second largest

The World Health Organization has actively initiated

global burden of chronic carriers of HBV infection after

responses to the control of HBV pandemic through pro-

moting the prevention of its transmission.

Asian continent. Estimates of hepatitis B antiginaemia

seroprevalence of 6-20% have been reported, making

Sub-Sahara Africa a hyper-endemic region. Nigeria

3,4

Of note also is that even where women have access to

also is a hyper-endemic country for HBV infection, with

birth dose vaccine of HBV and hepatitis B immu-

varying reported rates ranging from 0.5 to 44.7 percent

noglobulin there remains a 5-10 percent failure rate.

in children.

5-9

This occurs in women with high HBV viral loads. In this

group of mothers, antiviral therapy during pregnancy

In highly endemic regions HBV infection is commonly

has been shown to significantly reduce the risk of

MTCT.

spread from mother to child prenatally, during the pe-

In circumstances where mothers do not need

riod of delivery (perinatal transmission), or through

the anti-viral therapy for their own (HBV infection)

horizontal transmission (exposure to infected blood/

health; the antiviral therapy could be used during preg-

body or other fluids) particularly from an infected child

nancy with the aim of reducing the risk of MTCT of

to an uninfected child during the first five years of

HBV.

life

1,10

In Nigeria varying reports of horizontal as well as

vertical transmission as the most common route of HBV

Considering that the prevention of transmission of retro-

transmission in children exist.

11,12

viral infection from mother-to-child has been a success

story in this 21 Century. Such feat could be replicated

MTCT has also been shown to occur during pregnancy

for HBV infection particularly in hyperendemic settings

and/or delivery. Mother-to-child transmission (MTCT)

like ours.

of HBV infection has been reported to be responsible for

However gaps still exist on the current recommenda-

over a third of cases of chronic HBV infections world-

tions for managing HBV infected mothers as well as

wide. Hepatitis B infection in pregnancy poses a seri-

their exposed infants particularly in our setting. Also

ous threat to the infant at birth.

failure in follow-up of HBV exposed infants abound

In the absence of post exposure prophylaxis, about 40

despite the potential complications associated with

percent of infants delivered by HBV infected mothers

chronic HBV infections particularly liver cirrhosis and

could develop HBV infections, and about 25% of whom

hepatoma.

will die resulting from complications of chronic liver

disease.

Several Nigerian studies in pregnant women

It therefore becomes pertinent to review the literature on

have reported HBV rates between 8.3 to 12.8 per-

the current best practice guidelines on prevention of

cent.

11,15,16,17

mother-to-child transmission (PMTCT) of HBV infec-

tion in other to further empower our clinicians particu-

MTCT of hepatitis B virus infection continues to occur

larly Obstetricians and Paediatricians alike as well as

despite the interventions of hepatitis B vaccinations and

other allied health professionals in addressing this prob-

immunoglobulins in settings where it is practiced. It is

lem adequately in other to reduce the burden of HBV

pertinent to understand that the most significant risk

through vertical transmissions in high endemic settings

factor in transmission of HBV is high maternal viral

like ours.

load.

Nigeria has introduced the birth dose of hepatitis B vac-

Nigerian studies have shown high levels of HBeAg posi-

cine as well other primary series hepatitis B vaccination

since 2004. The birth dose of HBV vaccine has been

tivity in pregnant women.

19, 20

Despite presence of hepatitis B surface antigen positiv-

shown to be strategic towards PMTCT of HBV, how-

ity, mothers who are HBeAg with HBV DNA levels

ever ensuring universal HBsAg screening in pregnancy,

greater than or equal to 10 copies per mililitre (greater

starting anti-viral therapy for pregnant women with

than 200,000 in/ml) are at greatest risk of transmitting

HBeAg positivity and high viral load, timely administra-

HBV to their infants.

tion of the birth dose of HBV vaccination and follow-up

of exposed infants will remarkably help to realize this

Screening pregnant women for HBsAg (HBV infection),

objective of PMTCT of HBV. Also efforts should be

starting anti-viral therapy for those with HBeAg positiv-

made to educate carrier mothers (after testing) and their

ity and high viral load, providing infant post-exposure

families on the prevalent risk factors and essence of pre-

203

ventive measures.

particularly in third trimester of pregnancy or intrapar-

tum carries the highest risk of transmission of HBV in-

fection.

Current implications are that there is urgent need for

Nigeria and other countries in the Sub- Sahara Africa as

well as Asia where hyper-endemicity of HBV exist to

The risk of maternal transmission of HBV infection in

articulate evidence – based, home adaptable and sustain-

pregnancy and peri-natal period is dependent on mater-

able programmes on prevention of mother-to-child-

nal HBeAg positivity. Mothers with positive HBeAg

transmission of HBV geared towards the eradication of

have a transmission rate of 70-90 percent whereas those

the HBV infection.

with a negative HBeAg have a rate probably less than

10%.

26,27

In Nigeria the current national programme on the

PMTCT of human immune deficiency virus (HIV) in-

However the precise mechanism of HBV transmission

fection could be leveraged upon in the realization of

remains largely uncertain but it appears that infection

HBV prevention. All that is needed is the political will,

may occur intrapartum, or rarely, in-utero.

which basically implies political strategic financial in-

Hepatitis B viral DNA and HBsAg have been detected

vestment in the programmes to make the PMTCT of

in amniotic fluid, placental cells and virginal secretions

HBV in Nigeria - a dream come true.

of HBsAg positive women during pregnancy and in cord

blood of their neonates.

Hepatitis B Virus Pathology

Prenatal transmission

The HBV is a member of the hepadnaviridae family (a

hepatotropic group of DNA viruses).

9,24

The possibility of prenatal transmission of HBV has

The mature HBV virion is a spherical double layered

been speculated to be low.However, mothers with

“Dane particle” that has 4 different genes including the

HBeAg positivity known to be associated with higher

outer surface envelop of glycoprotein (hepatitis B sur-

HBV DNA viral loads have been linked with higher

face antigen; HBsAg); an inner portion of the virion

chances of MTCT as HBeAg is the only structural HBV

protein that can cross into the placental circulation.

22,29

designated as hepatitis B core antigen (HBcAg), the

nucleocapsid which encodes the viral DNA and a non-

structural antigen known as hepatitis B epsilon (e) anti-

Intra-partum transmission

gen (HBeAg). The HBeAg is a non-particulate soluble

antigen from HBeAg by proteolytic self clearage.

The intra-partum period has been shown to be associated

with higher chances of MTCT of HBV.

The HBeAg is a marker of active viral replication and

This exposure occurs via micro-transfusion or haema-

correlates favourably with HBV DNA levels. The HBV

tologic leaks of maternal blood to the fetus during con-

virion also contains a DNA polymerase which exhibits

tractions or through inoculations of mucosal membranes

reverse transcriptase activity and genomic replication

or breaks in the skin (e.g. during some obstetric proce-

occurs through an intermediate RNA template as well as

dures including insertion of fetal scalp electrodes in set-

tings where it is practised.

protein from the x-region (HBX) which is needed for the

viral replication and acts as a transcriptional transactiva-

tor of the viral genes and a wide range of host gene pa-

The mode of delivery (vaginal or caesarean section)

rameters.

24,25

does not seem to increase or decrease the risk of perina-

tal HBV infection. Most studies found no difference in

The replication of HBV occurs usually in the liver; how-

MTCT among babies delivered by caesarean or sponta-

ever it could occur in the lymphocytes, spleen, kidneys,

neous versus operative vaginal deliveries among infants

and pancreas.

24,25

who received post exposure prophylaxis (PEP).

However there is no consensus recommendation as per

Mother-to-child transmission of hepatitis B virus infec-

the preferred mode of delivery in high risk mothers.

tion

Breastfeeding

Prior to the era of the introduction of universal hepatitis

B vaccinations the possible risk of a child becoming a

Though possible markers of HBV have been demon-

chronic carrier of hepatitis B virus infection was

strated in breast milk and colostrum from HBsAg –

positive women; transmission of HBV through breast

about10 – 30percent if born to mother who is HBsAg

positive but HBeAg negative; and up to 90% if mother

milk is not a significant source of infection, as reported

is also HBeAg positive.

6,22,26

in some pre- HBV routine neonatal prophylaxis stud-

ies.

31,32

The most important risk factor for the transmission of

hepatitis B in pregnancy is the maternal HBV DNA lev-

Reported prevalence of HBV infection in breastfed and

els. It has also been proven that failures in MTCT infant

non-breastfed infants appear same, however, some of the

post exposure prophylaxis (PEP) usually occur in moth-

studies did not take maternal HBV DNA viral load into

ers with HBV DNA viral threshold of ≥10 to ≥10 cop-

cognizance. Also, mothers with cracked or bleeding

ies per mililitre. Maternal acquisition of HBV infection

nipples may momentarily stop breastfeeding as meta-

204

analysis of studies among mothers with absence of such

PMTCT programme as the maternal status is obtained

early enough and appropriate measures applied.

symptoms did not identify an increase in MTCT rates of

HBV when breastfed babies received post exposure pro-

phylaxis (PEP).

Rapid immunochromatographic hepatitis B surface anti-

gen tests with acceptable performance are available to

It is recommended that HBV positive mothers should

identify HBV infected pregnant women.

breastfeed their infants provided that the infants receive

timely and adequate PEP at birth.

Cost-effective point-of-care tests for combined HBsAg

and HBeAg detection and determination of HBV viral

load are currently being developed and further re-

Clinical features

sources should be channeled towards making it a suc-

Most cases of acute HBV infection usually manifest

cess story.

with non-specific presentations including nausea, vomit-

ing, loss or poor appetite, fever, myalgia and weak-

Prenatal prevention for mothers

ness.

The maternal HBeAg positivity as well as elevated HBV

One percent of cases of acute hepatitis including those

DNA viral load are directly related to rate of intrauterine

transmission. Therefore reduction of maternal DNA

occurring in neonatal period may develop fulminant

hepatitis. Course of cases of acute, fulminant hepatitis B

viral load of HBV is an effective method of decreasing

virus infection could be irreversible and result in liver

the rate of HBV infection in infants particularly in en-

demic areas.

39,40

failure with possible mortality.

Majority of cases of HBV infections including acute and

Use of anti-viral agents in pregnancy

chronic hepatitis are asymptomatic. Chronic HBV infec-

tion however has three immunologic phases: immune

The probable reasons for use of anti- viral (anti-

tolerant (absent or minimal liver inflammation, high

retroviral) therapy in chronic hepatitis B in pregnancy

viraemia); immune active (alanine amino-transferase

are based on maternal viral load, liver enzyme levels

rises, high viraemia, liver inflammation rises; high vi-

(liver function test), HBeAg status, liver histology, and

HIV co-infection status.

raemia, liver inflammation, and fibrosis improve, anti-

HBe is present); and the inactive chronic hepatitis (the

non-replicative or inactive immune-control phase) which

The benefits of anti- retroviral (ARV) prophylaxis dur-

follows successful sero-conversion from an HBeAg –

ing pregnancy is to decrease viraemia so as to limit

breakthrough HBV infection. The administration of

positive to anti-HBe state.

The immune tolerant phase usually appears in individu-

anti- retroviral therapy (ART) starting from late preg-

als who had perinatal infection from HBeAg positive

nancy will reduce maternal HBV viral load and poten-

tially reduce the possible risk of MTCT.

mothers.

The use of antiviral agents during pregnancy mainly for

Preventive measures

prophylaxis of perinatal HBV transmission would entail

Prenatal hepatitis b virus infection screening

diligent evaluation of potential risks and benefits among

infants and their pregnant mothers alike. Some studies

Chronic HBV infection is characterized by the presence

in animal specimens have shown severe growth restric-

of HBsAg for at least 6 months (with or without concur-

tion and reduced bone mineral density in exposed fe-

rent HBeAg positivity). The persistence of HBsAg is the

tuses to ART.

principal marker of risk of developing chronic liver dis-

ease and hepatocellular carcinoma later in life.

However, recent efficacy data on prophylaxis of

PMTCT of HBV have shown acceptable safety profile

It is recommended that all pregnant women should be

in pregnant women. Equally commencement of the ART

tested routinely for HBsAg during an early prenatal visit

in the third trimester of pregnancy among mothers with

(preferably in the first trimester) in every pregnancy

high viral load (e.g. ≥10iU/mL) to prevent breakthrough

irrespective of if they had been previously vaccinated

perinatal HBV transmission has also been successful

for HBV or tested.

without concerns. Tenofovir, lamivudine and telbi-

Un-booked pregnant mothers or women who were not

vudine are nucleos(t)ide inhibitors which act as chain

screened prenatally particularly those who engage in

termination in DNA elongation and can be administered

from 28 weeks of pregnancy.

behaviours that put them at high risk for infection espe-

cially intravenous drug users, those with more than one

sexual partners in the previous six months or an HBsAg-

Initially lamivudine (3TC) was commonly used with

positive sex partner, evaluation or treatment for a sexu-

benefit of reduction in transmission of HBV transmis-

ally transmitted disease and those with clinical hepatitis

sion; however, it was shown to be associated with devel-

should be tested at the time of admission to the hospital

opment of resistance owing to its low genetic barrier. On

for delivery.

the other hand, tenofovir, has a high barrier to resistance

and has been used extensively in the setting of HIV in

The prenatal HBsAg screening is key to successful HBV

pregnancy. Use of tenofovir in pregnancy has resulted in

205

significant reductions among mothers, without any re-

serves as a safety net as non-testing, errors in testing,

markable adverse effects.

44,45

reporting and documentation of maternal HBsAg status

could occur.

Based on safety data from the ARV in Pregnancy Regis-

try in pregnant HIV positive women who have received

In the United States, the CDC in 2005 recommended

tenofovir and/or lamivudine or emtricitabine; tenofovir

that the Advisory Committee on Immunization Practices

appears to be the preferred ARV, owing to its better

(ACIP) and all health professionals should administer

resistance profile, and more extensive safety data in

the HBV vaccine to all newborns before hospital dis-

pregnant HBV positive mothers.

23,43

charge in order to protect them against the HBV ifneci-

ton.

As ongoing caution is being advised on the use of ART

in pregnancy; the absence of adverse drug events in

However, in Nigeria it has been noted that many babies

mothers and their infant pairs who received ART in

whom were delivered in health facilities do not receive

pregnancy up to date offers promise in their use. Some

the birth dose of recommended vaccinations before the

hospital discharge. Nigeria recommends that the birth

guidelines recommend treatment for non-cirrhotic pa-

tients (including pregnant woman) with serum HBV

dose of HBV should be given preferably within the first

DNA levels greater than 20,000 iu/mL (> 10 copies/

24hours of birth but up to first 2 weeks of life. This birth

mL) and evidence of liver disaes.

dose is usually given as a monovalent vaccine. It is of

note that giving the birth dose after the neonatal period

Intra-partum/Neonatal transmission

reduces the efficacy of PEP which decreases with in-

creasing time as exposure.

Use of monitors should be avoided as much as possible.

In centres where it is obtainable the use of fetal scalp

Nigerian HBV Vaccination Schedule

electrode monitoring as well as fetal blood sampling

should be avoided particularly if mother is HBeAg posi-

The birth dose of HBV vaccine followed by two more

tive. Also standard precautions should be implemented

doses to complete the primary series is the conventional.

for care of all women in labour. Appropriate cleaning of

However, WHO recommends that four doses may be

the newborn should equally be practiced- upon delivery

given in line with the programmatic protocol of National

Schedules.

the neonate’s eyes as well as the non - intact skin should

be cleaned properly using water as soon as possible after

birth.

The pentavalent vaccine which replaced the trivalent

DPT was introduced in Nigeria in 2012, and contains

Immunoprophylaxis

HBV vaccine among others as a combination vaccine to

be commenced at age 6 weeks through ten and 14 weeks

The double usage of active and passive immuneprophy-

respectively. However, Nigeria currently gives the birth

laxis is the ideal measure to prevent MTCT of HBV

dose in addition to three combined doses in form of pen-

infection.

tavalent vaccine doses.

PEP with hepatitis B vaccine and hepatitis B immune-

globulin (HBIG) administered within 12 to 24 hours

The complete vaccine series induces protective antibody

after birth followed by completion of a three dose vacci-

levels in more than 95% of infants, children and young

nation series, has been shown to protect 85 to 95% of

adults. Protection lasts at least 20 years and is probably

life long. The vaccine has excellent record of safety and

infants whose mothers were positive for both HBsAg

and HBeAg.

effectiveness and the immunogenicity of the combined

hepatitis vaccines is equivalent to that of their individual

Birth dose hepatitis B vaccine

antigens administered separately.

The recombinant DNA – derived hepatitis B vaccines

Immunization escape mutants in the S – gene of HBV

have been available and licensed for use since 1982. The

have been detected, and concerns have been expressed

World Health Organization (WHO) as well as the Cen-

that these variants could replicate in the presence of vac-

ters for Disease Control (CDC) recommends universal

cine induced anti-HBS or anti-HBS contained in HBIG.

HBV vaccination for all infants, and that the first dose

However no evidence exist that s-gene immunization

should be given as soon as possible after birth preferably

escape mutants posing a risk to currently existing pro-

grammes using hepatitis B vaccine.

within the first 12 hours of birth.

Further studies including surveillance are needed to

In Nigeria the universal HBV vaccination was initiated

track any possible emergence of these variants in future.

by the Federal Government in 2004; despite that huge

gap still exists in meeting the targets as majority of the

Vaccinations in preterm/Low Birth Weights

children receive the birth dose vaccine outside the rec-

ommended time owing to maternal as well as pro-

Previously, the American Academy of Pediatrics (AAP)

gramme – related factors.

49,50

routinely recommended that the birth dose of HBV vac-

cine for preterm and low birth weight infants born to

The birth dose of HBV vaccine is very important as that

HBsAg negative mothers be delayed up till the infant

206

weighed 2 kilograms or is two months of chronological

Follow – up

age, owing to reduced immunogenicity in preterm less

than two kilograms (<2kg). However recent guidelines

MTCT of hepatitis B virus continues to occur despite

by the AAP recommends that such children should re-

the use of adequate preventive measures including vac-

cinations and HBIG administration. The ACIP recom-

ceive the first dose of hepatitis B vaccine by 30 days of

chronological age irrespective of the gestation age. Also

mends post-HBV vaccination testing for all infants born

if such preterm/LBW shows consistent weight gain ne-

to HBsAg positive women. The testing consists of

cessitating hospital discharge before 30 days of age, the

HBsAg for infection and anti-HBS for response to vac-

first dose of hepatitis B vaccine should be given at the

cination. The optimal timing for detecting protective

time of hospital discharge. The remaining three doses of

antibodies is one to 2 months after the final Hepatitis B

hepatitis B vaccine series should be completed on the

vaccine dose at ≥ 9 months of age. The testing for fol-

same schedule as applicable to full term infants, ensur-

low-up should commence at 9 to 18months of age, at

least 1month after the last dose of vaccine.

ing that the second dose is given at least 30 days after

the initial dose.

The anti-HBS levels done earlier than 9 months of age

may reflect passive immunization with HBIG.

Also of note is that currently the ACIP does not recom-

Anti –

mend routine booster doses of hepatitis B vaccine for

HBS levels of more than 10m/u/L indicate adequate

persons who completed the primary HBV immunization

protection whereas babies with anti-HBs levels of less

series in childhood.

than 10m/u/L need to be re-vaccinated with the entire 3

dose schedule.

The immunogenicity of hepatitis B vaccine is low in

individuals with severe immunosuppressive states in-

Babies who are HBsAg positive are infected and need

cluding AIDS, and timely administration of the HBV

further evaluation and follow-up by a paediatric gastro-

vaccine commencing at birth should be the rule rather

enterologist.

than the exception as the HIV immunosuppression wors-

ens overtime among infected children.

Currently Nigerian Society for Paediatric Gastroenterol-

Hepatitis B vaccination is recommended in HBsAg

ogy Hepatology and Nutrition (NISPGHAN) and Soci-

negative women in pregnancy with high likelihood of

ety for Gastroenterology and Hepatology in Nigeria

acquisition of the infection particularly in those having

(SOGHIN) are in the forefront of spreading the good

multiple sexual partners or intravenous drug abusers.

news of HBV prevention in Nigeria and should be en-

couraged by the authorities by doing the needful.

Passive immunization

It provides passively acquired anti-HBS and temporary

Conclusion

protection when administered in standard doses. Hepati-

tis B immuneglobulin (HBIG) is typically used as an

Universal screening of all pregnant women for HBV

adjuvant to the hepatitis B vaccine in the PMTCT of

infection is the most effective strategy for the prevention

hepatitis B infection in exposed infants, providing tem-

of MTCT of HBV, as effective preventive measures

porarily protection for 3 to 6 months.

could be applied starting from pregnancy to delivery

while infants of HBsAg positive mothers should receive

Administration of hepatitis B immuneglobulin and hepa-

timely and adequate PEP as well as follow up for possi-

titis B vaccine within 24 hours of birth, followed by the

ble development of chronic hepatitis B infection.

completion of the vaccine series is 85 – 95% efficacious

in PMTCT of HBV.

Author’s contributions

HIBG administered alone is the primary means of pro-

CBE: Study conceptualization, literature search,

tection after an HBV exposure for non-responders to

manuscript draft, critical editing of the manuscript for

hepatitis B vaccination.

important intellectual content.

NBO, OFA: Critical editing of the manuscript for im-

portant intellectual content.

Conflict of Interests: None

Funding: None

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