Hepatitis B dan C dalam Kehamilan

1. Hepatitis B dan C dalam Kehamilan

2. A B C D E Source of feces blood/ blood/ blood/ feces virus blood-derived blood-derived blood-derived body fluids body fluids body fluids Route of fecal-oral percutaneous percutaneous percutaneous fecal-oral transmission permucosal permucosal permucosal Chronic no yes yes yes no infection Prevention pre/post- pre/post- blood donor pre/post- ensure safe exposure exposure screening; exposure drinking immunization immunization risk behavior immunization; water modification risk behavior modification Viral Hepatitis - Overview Type of Hepatitis

3. Estimates of Acute and Chronic DiseaseBurden for Viral Hepatitis, United States HAV HBV HCV HDV Acute infections (x 1000)/year* 125-200 140-320 35-180 6-13 Fulminant deaths/year 100 150 ? 35 Chronic 0 1-1.25 3.5 infections million million 70,000 Chronic liver disease deaths/year 0 5,000 8-10,000 1,000 * Range based on estimated annual incidence, 1984-1994.

4. Outcome of Hepatitis B Virus Infection by Age at Infection 100 100 80 80 60 60 Chronic Infection Symptomatic Infection (%) Chronic Infection (%) 40 40 20 20 Symptomatic Infection 0 0 1-6 months 7-12 months Older Children and Adults Birth 1-4 years Age at Infection

5. 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

6. Interpretation of the Hepatitis B Panel

7. 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.

8. 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.

11. 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

13. 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

14. 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)

15. 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)