29 May Hepatitis B: Preventing Transmission from Mother to Baby
MedicalResearch: What are the main findings of the study?
Dr. Kubo: The main findings of the study are three folds:
1) The CDC guideline works for the majority of infants in preventing vertical transmission, if the immunizations are done according to the recommended schedule.
2) It takes an organized effort to case-manage each mother-infant pairs in order to achieve almost complete immunization rates and very low transmission rates.
3) Highest risk group was mothers with extremely high viral load and e-antigen positivity. This group of women may benefit from additional therapy to prevent the vertical transmission. However, for others, the risk of transmission is extremely low as long as the infants are immunized according to the guideline.
MedicalResearch: Were any of the findings unexpected?
Dr. Kubo: What was unexpected was how high the viral load had to be for women to be in the high risk group, along with e-antigen positivity (another risk factor that we had known). It used to be unclear from the previous research who would benefit most from additional therapy, but this study gave us better idea.
MedicalResearch: What should clinicians and patients take away from your report?
Dr. Kubo: If you are a mother with HBV, it is important to get your baby immunized on time. This study also let clinicians know about who are at highest risk. If a doctor sees a pregnant woman with very high viral load and also e-antigen, they may recommend additional therapy to further reduce the risk of transmission. But if a woman is e-antigen negative, and the viral load was not too high, regular immunization program actually work really well. It is important to remember that it does take an organized effort to adhere to the CDC guideline by case managing mother-infant pairs.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Dr. Kubo: If another organization has similar programs to track infants, it would be great to replicate a similar study to better understand the high risk group. In addition, the next step might be to study what types of therapies can prevent the transmission among the women who are at high risk, so we can minimize the transmission rate.
Prevention of Vertical Transmission of Hepatitis B
An Observational Study:
Kubo A, Shlager L, Marks AR, Lakritz D, Beaumont C, Gabellini K, et al. Prevention of Vertical Transmission of Hepatitis B: An Observational Study. Ann Intern Med. [Epub ahead of print 27 May 2014]