Hepatitis B dalam Kehamilan

Fetomaternal Division
Department of Obstetrics & Gynecology
Faculty of Medicine University of Indonesia
Dr. Cipto Mangunkusumo General Hospital
Jakarta

Viral Hepatitis - Overview

Type of Hepatitis

A
Source of
virus

Route of
transmission
Chronic
infection
Prevention

feces

blood/
blood/
blood/
blood-derived blood-derived blood-derived
body fluids body fluids
body fluids

feces

fecal-oral

percutaneous percutaneous percutaneous

permucosal permucosal permucosal

fecal-oral

no

yes

yes

yes

no

pre/postpre/postblood donor
pre/postensure 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

Acute infections
(x 1000)/year*

HAV

HBV

HCV

HDV

125-200

140-320

35-180

6-13

100

150

35

1-1.25
million

3.5
million

70,000

5,000

8-10,000

1,000

Fulminant
deaths/year
Chronic
infections
Chronic liver disease
deaths/year

* Range based on estimated annual incidence, 1984-1994.

100

100

80

80

60

60

Chronic Infection

40

40

20

20

Symptomatic Infection (%)

Chronic Infection (%)

Outcome of Hepatitis B Virus Infection

by Age at Infection

Symptomatic Infection
0

Birth

1-6 months

7-12 months

1-4 years

Age at Infection

0
Older Children
and Adults

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
anti-HBc
anti-HBs

negative
negative
negative

Susceptible

HBsAg
anti-HBc
anti-HBs

negative
positive
positive

Immune due to natural infection

HBsAg
anti-HBc
anti-HBs

negative
negative
positive

Immune due to hepatitis B vaccination

HBsAg
anti-HBc
IgM anti-HBc
anti-HBs

positive
positive
positive
negative

Acutely
infected

HBsAg
anti-HBc
IgM anti-HBc
anti-HBs

positive
positive
negative
negative

Chronically
infected

HBsAg
anti-HBc
anti-HBs

negative
positive
negative

1. Might be recovering from acute HBV infection.

2. Might be distantly immune and test not sensitive enough to detect very low level of anti-HBs in serum.
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)