Prevention of mother to child transmission of hepatitis B: A global challenge

Abstract

Globally, mother to child transmission (MTCT) of hepatitis B virus (HBV) is the major route of transmission, while horizontal transmission, between adults, dominates in countries such as Norway. 2 billion people worldwide have serologic evidence of past or present infection with hepatitis, emphasizing that this infectious disease should be acknowledged as a global health problem in line with HIV, tuberculosis and malaria. MTCT of hepatitis B is the most important factor for developing a persistent infection, thus the risk of chronicity is inversely proportional with age, and most of the newborns (90%), to hepatitis B positive mothers, will get the virus without any prevention strategies. This is leading us to the focus of this assignment upon the prevention of mother to child transmission of hepatitis B. Despite an existing and effective vaccine and immunoprophylaxis regime, the implementation of immunoprophylaxis in developing countries has been challenging. The infections burden of the disease is well established in highly endemic East Asia where the prevalence is estimated to be above 5% and the virus is one of the major infectious causes of death. Vietnam and Cambodia are two high endemic countries facing great challenges concerning the combat against MTCT of the virus. The main focus on prevention strategies should be to obtain better coverage of the monovalent HBV vaccine and HBV immunoglobulin, timely after birth. Additionally, antiviral therapies to decrease the hepatitis B viral concentrations in the mother before delivery will be important in future. This assignment is a literature study and gives an introduction to the virus and the major routes of MTCT. Moreover, it looks into current guidelines by WHO and Centres for Disease Control and Prevention (CDC) and discusses prevention strategies, and also gives an overview on the situation in Norway today. It will point out research gaps and the need for policy changes, including better national plans for serosurveys. However, the question of how to prevent MTCT of HBV is more intricate than it seemingly looks like, there are many challenges and factor to take into consideration, factor that are not so evident for decision makers living in our part of the world.

Finally, without better control of the transmission between mother and child of the virus in high endemic East Asia, control at a global level will be difficult to obtain. Hopefully this assignment can contribute to put focus on the infections disease of the virus.