Research Report
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World J Gastroenterol. Dec 7, 2014; 20(45): 17075-17083
Published online Dec 7, 2014. doi: 10.3748/wjg.v20.i45.17075
Applicability and efficacy of a model for prevention of perinatal transmission of hepatitis B virus infection: Single center study in Egypt
Hanaa M El-Karaksy, Lamiaa M Mohsen, Doa’a A Saleh, Mona S Hamdy, Noha A Yassin, Mohamed Farouk, Mohamed E Salit, Mortada H El-Shabrawi
Hanaa M El-Karaksy, Lamiaa M Mohsen, Noha A Yassin, Mohamed Farouk, Mortada H El-Shabrawi, Department of Pediatrics, Kasr Al-Ainy School of Medicine, Cairo University, Cairo 11562, Egypt
Doa’a A Saleh, Department of Community Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo 11566, Egypt
Mona S Hamdy, Department of Clinical and Chemical Pathology, Kasr Al-Ainy School of Medicine, Cairo University, Cairo 11566, Egypt
Mohamed E Salit, Department of Obstetrics and Gynecology, Kasr Al-Ainy School of Medicine, Cairo University, Cairo 11566, Egypt
Author contributions: El-Karaksy HM, Mohsen LM, Saleh DA and El-Shabrawi MH were involved in the study concept and design; Yassin NA, Farouk M and Salit ME were involved in patient recruitment and screening of mothers; El-Karaksy HM and Yassin NA were involved in immunoprophylaxis and follow up of infants; Saleh DA did the statistical analysis; Hamdy MS did the laboratory work; El-Karaksy HM, Mohsen LM and Saleh DA shared in data interpretation and writing of results; El-Karaksy HM, Mohsen LM and Saleh DA wrote the manuscript; all authors reviewed, revised and approved the manuscript.
Supported by Partially by Cairo University
Correspondence to: Hanaa M El-Karaksy, Professor, Department of Pediatrics, Kasr Al-Ainy School of Medicine, Cairo University, 44 Mohei El-Deen Abu El-Ezz Street, Dokki, Cairo 11562, Egypt. hanaakaraksy@kasralainy.edu.eg
Telephone: +20-2-33375913 Fax: +20-2-25311616
Received: February 26, 2014
Revised: April 29, 2014
Accepted: July 24, 2014
Published online: December 7, 2014
Processing time: 284 Days and 17.6 Hours
Abstract

AIM: To identify possible maternal risk factors for hepatitis B virus (HBV) acquisition and assess the efficacy of immunoprophylaxis given to infants born to hepatitis B virus surface antigen (HBsAg) positive mothers.

METHODS: Screening of 2000 pregnant females was carried out using rapid test and confirmed by enzyme immunoassay. A questionnaire consisting of 20 questions about the possible risk factors for acquisition of HBV infection was filled for every pregnant HBsAg positive female in addition to at least 2 pregnant HBsAg negative females for each positive case. Infants of HBsAg positive women were offered passive and active immunoprophylaxis within the 1st 48 h after birth, in addition to 2nd and 3rd doses of HBV vaccine after 1 and 6 mo respectively. Infants were tested for HBsAg and hepatitis B surface antibodies (HBsAb) at six months of age.

RESULTS: HBsAg was confirmed positive in 1.2% of tested pregnant women. Risk factors significantly associated with HBV positivity were; history of injections (OR = 5.65), history of seeking medical advice in a clinic (OR = 7.02), history of hospitalization (OR = 6.82), history of surgery (OR = 4) and family history of hepatitis (OR = 3.89) (P < 0.05). Dropout rate was 28% for HBsAg women whose rapid test was not confirmed and could not be reached to provide immunoprophylaxis for thier newborns. Immunoprophylaxis failure was detected in only one newborn (3.7%) who tested positive for HBsAg at 6 mo of age; and vaccine failure (seronegative to HBsAb after 4 doses of the vaccine) was detected in another one (3.7%). The success rate of the immunoprophylaxis regimen was 92.6%.

CONCLUSION: This pilot study shows that a successful national program for prevention of perinatal transmission of HBV needs to be preceded by an awareness campaign to avoid a high dropout rate.

Keywords: Egypt; Hepatitis B virus; Hepatitis B virus surface antigen positive mothers; Immunoprophylaxis; Perinatal transmission

Core tip: Perinatal transmission of hepatitis B virus (HBV) is still a threat in Egypt despite a successful immunization program for infants. In this work we tried to assess the risk factors for maternal acquisition of HBV and study a model for prevention of perinatal transmission of HBV. To achieve our aim we screened 2000 pregnant women for hepatitis B virus surface antigen. Risk factors for HBV acquisition were mostly related to medical care. We encountered a high dropout rate of women who could not be reached to offer their newborns immunoprophylaxis. For those who received immunoprophylaxis after birth, a success rate of 92.6% was achieved. An awareness campaign has to precede implementation of a national program for prevention of perinatal transmission of HBV.