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Mechanisms and Prevention of Vertical Transmission in Chronic Viral Hepatitis
Marianna G Mavilia1, George Y Wu1
1Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, USA.
Insights
Vertical transmission of hepatitis B virus (HBV) and hepatitis C virus (HCV) to infants is a significant concern. While HBV has preventative measures, HCV lacks them, highlighting the need for universal maternal screening.
Area of Science:
- Hepatology and Virology
- Maternal-Fetal Medicine
- Infectious Disease Epidemiology
Background:
- Vertical transmission (VT) is the main pathway for transmitting viral hepatitis to children.
- Hepatitis B virus (HBV) VT rates are 1-28%, and hepatitis C virus (HCV) rates are 3-15%.
- Transmission can occur in utero or during delivery, with maternal viral load and HIV co-infection as risk factors.
Purpose of the Study:
- To compare vertical transmission routes and prevention strategies for HBV and HCV.
- To emphasize the importance of screening pregnant women for viral hepatitis.
Main Methods:
- Review of existing literature on HBV and HCV vertical transmission.
- Analysis of transmission mechanisms, risk factors, and current prevention protocols.
- Comparison of preventative interventions for HBV versus HCV.
Main Results:
- HBV VT primarily occurs via intrauterine transmission, with several preventative options available post-partum.
- HCV VT also occurs intrauterine or peripartum, but no specific preventative interventions exist.
- Common risk factors for VT include high maternal viral load, HIV co-infection, and neonatal sex.
Conclusions:
- Effective prevention of HBV VT involves antiviral therapy, vaccination, and immunoglobulin administration.
- Lack of specific preventative measures for HCV VT underscores the critical need for maternal screening.
- Universal screening of women before and during pregnancy is essential for managing both HBV and HCV VT.
Abstract:
Vertical transmission (VT) is the primary route of transmission of viral hepatitis in children. The rate of VT ranges from 1-28% with hepatitis B virus (HBV) and 3-15% with hepatitis C virus (HCV). VT for both viruses can occur during the intrauterine or peripartum period. VT of HBV primarily occurs by intrauterine transmission (IUT). Hepatitis B surface antigen is unable to cross the placenta and, therefore, relies on processes like transplacental leakage, placental infection, cellular transmission by peripheral blood mononuclear cells, and germline transmission. HCV can also infect the fetus by IUT. Both viruses also have the potential for transmission during delivery, when there is increase chance of maternal-fetal blood exposure. HBV and HCV share some common risk factors for VT, including maternal viral load, human immunodeficiency virus co-infection and neonatal sex. Prevention of VT differs greatly between HBV and HCV. There are several alternatives for prevention of HBV VT, including antiviral medications during the third trimester of pregnancy and HBV vaccine, as well as hepatitis B immunoglobulin administration to infants post-partum. In contrast, there are no preventative interventions available for HCV. Despite these differences, the key to prevention with both viruses is screening women prior to and during pregnancy.
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