Vani Malhotra Hepatitis-2015 Orlando, USA July 20 - 22 2015.
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Transcript of Vani Malhotra Hepatitis-2015 Orlando, USA July 20 - 22 2015.
Seroprevalence of
Vani MalhotraHepatitis-2015Orlando, USAJuly 20 - 22 2015
HEPATITIS B INFECTION DURING PREGNANCY EXPERIENCE AT TERTIARY CARE CENTRE OF NORTH INDIA
Dr Vani Malhotra MD MICOGProfessorDepartment of Obstetrics and GynecologyPGIMS, Rohtak, India
Hepatitis B Virus (HBV) infection is a global problem with nearly 350 million carriers at risk for cirrhosis and hepatocellular carcinoma50% carriers have acquired their infection vertically from mothers (MTCT)90% of vertically acquired infection become chronic
AASLDAll pregnant women be screened for HBsAg during the first trimester, even if previously vaccinated or tested
Lok ASF, McMahon BJ. Chronic Hepatitis B: update 2009. Hepatology 2009; 50: 661-2AASLD & ACOG POSITIVE MOTHERSMedical evaluation immediately-duration of disease-extent of liver disease-risk factors for MTCT(HBeAg status & viral load)VERTICAL TRANSMISSION (MTCT)Transmission of pathogen from mother to child during pregnancy or childbirth or by breastfeedingROUTE OF TRANSMISSIONIN UTERO-TRANSMISSIONMain risk factors Maternal HbeAg positivity High maternal viral load History of threatened abortion or preterm labor NATAL TRANSMISSIONTransfusion of mothers blood to fetus during labor contractions(microtransfusions)Infection after rupture of membranesDirect contact of the infants mucosal membranes POSTNATAL TRANSMISSIONIngestion of virus or by contact with skin lesions on mothers breastRISK FACTORS FOR MTCTHigh maternal viral loadPositive HBeAg statusANTIVIRAL DRUGSPotent antiviral suppressionSafe & well toleratedReduces perinatal HBV transmissionproblemsViral drug resistanceContraindication to breast feedingHepatitis flares upon discontinuationDrugFDA CategoryRemarksLamivudineCRecommendedTelbivudineBRecommended
TenofovirBMay be recommendedEntecavirCNot Recommended
AdefovirCNot Recommended
IMMUNOPROPHYLAXISInfants born to HBsAg positive mothers should receive both HBIG and HBV within 12 hours of birthNext two doses should be given within six months of birth90-95% protection
Follow up of infantsHBsAg and anti HBs at 9 months of ageHBsAg negative + anti-HBs>10mIU/ml are disease freeAnti-HBs