New WHO guidance on preventing mother-to-child transmission of hepatitis B

28 Jul 2020 Keith Alcorn
Originally published on www.infohep.org

Pregnant women who test positive for hepatitis B infection and have a high level of HBV in the blood should receive preventive antiviral therapy with tenofovir from the 28th week of pregnancy until birth, the World Health Organization recommends in new guidelines on the prevention of mother-to-child hepatitis B transmission released this week.

Infants can be protected against hepatitis B infection through a safe and effective vaccine.

WHO recommends that all infants receive a first dose of the hepatitis B vaccine as soon as possible after birth – preferably within 24 hours – followed by at least two additional doses.

The proportion of children under five years of age chronically infected with hepatitis B (HBV) dropped to just under 1% in 2019 down from around 5% in the pre-vaccine era (the period between the 1980s and the early 2000s), according to new estimates from the World Health Organization (WHO).

On World Hepatitis Day 2020, WHO is calling for intensified efforts to prevent mother-to-child transmission of HBV through testing pregnant women and provision of antiviral prophylaxis to those who need it and maintaining and expanding access to hepatitis B immunisation and birth dose vaccine.

The scale-up of hepatitis B vaccine worldwide over the last two decades, which has been in large part due to the support provided by Gavi, the Vaccine Alliance, has been a great public health success story and contributed to the decrease in HBV infections among children. In 2019, coverage of 3 doses of the hepatitis B vaccine during childhood reached 85% worldwide, up from around 30% in 2000. However, access to the first critical dose within 24 hours of birth remains uneven. Global coverage of this birth dose is 43%, but this drops to 34% in the WHO Eastern Mediterranean Region and only 6% in the WHO African Region.

“Expanding access to a timely birth dose of the hepatitis B vaccine is the cornerstone of efforts to prevent mother-to-children transmission of HBV. For countries especially in regions such as sub-Saharan Africa, where the birth dose of hepatitis B vaccine has not yet been introduced, it is a priority to assure that protection as early as possible,” said Dr Meg Doherty, Director of Global HIV, Hepatitis and STI Programmes.

An additional way to protect children is to provide pregnant women with antiviral treatment to reduce mother-to-child transmission of HBV. WHO already recommends routine testing of all pregnant women for HBV, as well as HIV and syphilis as early as possible in their pregnancy. In view of new evidence on the safety and efficacy of antiviral prophylaxis in pregnant women and their children, WHO is issuing today 2 new recommendations:

  • Pregnant women who test positive for hepatitis B infection and have a high level of HBV in the blood (known as HBV viral load) should receive preventive antiviral therapy with tenofovir from the 28th week of pregnancy until birth. The antiviral drug, tenofovir is available at low cost in many countries of the world for less than US$3 per month.
  • In settings where HBV viral load testing is not available, WHO recommends the use of an alternative low cost test (HBeAg) to determine whether a woman is eligible for preventive antiviral therapy.

In countries that have already achieved high coverage of hepatitis B immunization, including timely birth dose, routine testing for HBV infection among pregnant women and antiviral prophylaxis for those in need is an additional opportunity to prevent onward transmission from mother to child.