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Hepatitis B dalam Kehamilan
Fetomaternal Division
Department of Obstetrics & Gynecology
Faculty of Medicine University of Indonesia
Dr. Cipto Mangunkusumo General Hospital
Jakarta
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Viral Hepatitis
-
Overview
Type of Hepatitis
A B C D ESource of
virus
feces blood/
blood-derivedbody fluids
blood/
blood-derivedbody fluids
blood/
blood-derivedbody fluids
feces
Route of
transmission
fecal-oral percutaneous
permucosal
percutaneous
permucosal
percutaneous
permucosal
fecal-oral
Chronic
infection
no yes yes yes no
Prevention pre/post-
exposure
immunization
pre/post-
exposure
immunization
blood donor
screening;
risk behavior
modification
pre/post-
exposure
immunization;
risk behavior
modification
ensure safe
drinking
water
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Estimates of Acute and Chronic Disease
Burden for Viral Hepatitis, United States
HAV HBV HCV HDV
Acute infections(x 1000)/year* 125-200 140-320 35-180 6-13
Fulminantdeaths/year 100 150 ? 35
Chronicinfections
0 1-1.25million
3.5million 70,000
Chronic liver diseasedeaths/year 0 5,000 8-10,000 1,000
* Range based on estimated annual incidence, 1984-1994.
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Outcome of Hepatitis B Virus I nfection
by Age at I nfection
Symptomatic Infection
Chronic Infection
Age at Infection
ChronicInf
ection(%)
Symptomatic
Infection(%
)
Birth 1-6 months 7-12 months 1-4 years Older Children
and Adults
0
20
40
60
80
100100
80
60
40
20
0
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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 agehigh-risk adolescents at all ages
Vaccination of adults in high-risk groups
Elimination of Hepatitis B Virus
Transmission in the United States
Strategy
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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
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Definitions
Hepatitis B Surface Antigen (HBsAg): A serologicmarker on the surface of HBV. It can be detected inhigh levels in serum during acute or chronic hepatitis.
The presence of HBsAg indicates that the person isinfectious. The body normally produces antibodies toHBsAg as part of the normal immune response toinfection.
Hepatitis B Surface Antibody (anti-HBs): The presence
of anti-HBs is generally interpreted as indicatingrecovery and immunity from HBV infection. Anti-HBsalso develops in a person who has been successfullyvaccinated against hepatitis B.
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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 orongoing 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.
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Transmissibility 100 times greater than HIV1
Vertical Infected mother-to-infant during first year of life
Earlier age at exposure increases the risk ofdeveloping chronic HBV infection2
Transmission of HBV
1. WHO-CSR
2. WHO and CDC fact sheets, available at www.who.int and www.cdc.gov
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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
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Lamivudine Therapy During Pregnancy toPrevent 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 theirInfants 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 Hepatit is 2003; 10: 294-7)
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Lamivudine Treatment During Pregnancyto 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)