HBV common in pregnant Haitians, vaccination at birth suggested

SAN DIEGO — Hepatitis B virus infection was prevalent among pregnant Haitian women, but hepatitis C virus infection was not, according to a poster at IDWeek 2015.

“The objective of the study was to look at what the risk of mother-to-child-transmission of hepatitis B in Haiti is because Haiti does not have a hepatitis B birth dose of the vaccine,” Rania A. Tohme, MD, MPH, medical epidemiologist at the CDC, told Healio.com/Hepatology. “Hepatitis B vaccine is given at 6, 10 and 14 weeks of age in Haiti and this would be too late to prevent mother-to-child-transmission.”

Rania A. Tohme

Tohme and colleagues evaluated serum of 164 pregnant women with HIV and 1,200 HIV-negative serum from 6,241 pregnant women enrolled in one of 18 antenatal care clinics during a 2012 HIV sentinel serosurvey. All serum was tested for total antibody to HBV core antigen (total anti-HBc); hepatitis B surface antigen (HBsAg); HBV DNA; antibodies to HCV (anti-HCV); and HCV RNA.

“We tested them for these markers of hepatitis B and hepatitis C because information on the burden of hepatitis B and C among pregnant women in Haiti is not available,” Tohme said.

The researchers stratified Haiti into two regions for the analysis: the Western region and all nine other regions (non-West) to better evaluate the “demographic and socioeconomic factors associated with HBV infection,” the researchers wrote.

Overall, 1,307 serum samples were available for testing and included. Of these, 32.7% tested positive for total anti-HBc (38.2% in West vs. 27% in non-West; P < .001) and 33 were HBsAg- positive (2.1% in West vs. 3% in non-West). Of the HBsAg-positive samples, 79% had detectable HBV DNA (n = 26) and 46% had HBV DNA levels at least 5,000 IU/mL (n = 15).

“The percentage of women who had chronic infection of hepatitis B, which leads to liver cirrhosis and liver cancer, was 2.5%,” Tohme said.

Among the women who showed chronic HBV seropositivity, almost half had high HBV viral loads, which can be an indicator of risk for mother-to-child-transmission of infection, according to Tohme.

“This high viral load is concerning and it is justifiable for Haiti to introduce a hepatitis B vaccine birth dose to prevent mother-to-child-transmission,” Tohme said.

Further analyses showed that women aged older than 30 years had more than double the odds of positive total anti-HBc compared with women aged between 15 and 19 years (P < .001). In addition, women with secondary (adjusted odds ratio [aOR] = 0.54; 95% CI, 0.36-0.81) and post-secondary education (aOR = 0.40, 95% CI, 0.19-0.79) had reduced odds of being positive for total anti-HBc compared with women with no education.

Six women tested positive for anti-HCV (0.5%). However, none of them were HCV RNA-positive. HCV was not found to have a significant a burden among this population in Haiti.

“HCV does not have a big burden in this population, as there was a 0.5% seroprevalence, which is quite low,” Tohme said.

The researchers also found that HIV status was not associated with HBV infection.

Tohme concluded: “We are concerned for mother-to-child-transmission because of the risk for progression to liver disease,” Tohme said. “If a baby is infected by mother-to-child-transmission, they have an 80 to 90% chance of progression to chronic hepatitis B infection and later on develop liver cirrhosis and cancer. If it is an older child, adolescent or adult, the risk for progression to chronic infection is lower.

“This is why it is important. The big risk lies in terms of mother-to-child-transmission.” – by Melinda Stevens

Reference:

Tohme RA, et al. Abstract 1630. Presented at: IDWeek; Oct. 7-11, 2015; San Diego.

Disclosures: Tohme reports no relevant financial disclosures. The findings and conclusions of the study are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.