Hepatitis B Virus Infection: Sharing Some Concerns

hepatitis B vaccineIt is generally believed that hepatitis B virus infection (HBV) is not as stigmatized as HIV/AIDS because of the campaign approach adopted in its awareness and education in the country. It is also believed that the Pharmaceutical Society of Ghana (together with Roche & GSK) need to be commended for the great role they played in mobilizing support throughout the country to curb the menace.

Notwithstanding this, there are lingering concerns about hepatitis B virus infection. Let us look at this scenario:  A couple came over to the clinic for advice about hepatitis B infection.

The female was hepatitis B positive but the man was negative. The man had already been vaccinated against HBV. He had three injections of the hepatitis vaccine over a period of six months (0, 1, 6 months).

At the time of the visit, the woman was about six weeks pregnant. I explained to them that it was important to quickly inform their regular health care provider.

A lot of investigations would be done to ascertain the actual situation of her hepatitis B virus (HBV) infection- the length of the infection, the level of infectivity, the state of the liver and the viral load. The health care provider would do all this to determine the nature of interventions required for the management of HBV infection in the light of the pregnancy.

It is important to note that worldwide, a large number of people with chronic HBV infection acquired the infection at birth or in early childhood. The age at infection determines the risk of progression to chronicity with 90 per cent of neonatal infections resulting in HBV chronic infection.

It was important for the couple to identify a health facility for ante-natal care for the woman. Steps would be taken to prevent mother-to-child transmission of HBV infection. This will be done at the birth of the baby.

The baby would have a combination of the hepatitis B immunoglobulin (HBIG) and the hepatitis B vaccine. The HBIG is not readily available throughout the country and also very expensive (about GH¢400.00).

For a neonate born to a mother with HBV infection, hepatitis B vaccination reduces the risk of infection by 70 per cent. The addition of HBIG (derived from the plasma of blood donors with high antibodies to the hepatitis B) reduces the risk of infection to about 90%.

Ideally both HBIG and hepatitis B vaccine should be administered immediately after birth. The HBIG should not be delayed beyond 12 hours after birth.

HBIG protects for a few months while hepatitis B vaccine protects for several years. Hepatitis B vaccine should be given within 24 hours of birth.

The efficacy of the hepatitis B vaccine in preventing perinatal transmission declines with increasing intervals between birth and the administration of the vaccine. The hepatitis B vaccine given to newborn is considered as a post-exposure prophylaxis.

In Ghana there is the five-in-one vaccine given to children when they are six weeks old. This has the hepatitis B vaccine incorporated. The normal hepatitis B vaccine schedule will require you to take the second dose of the vaccine one month after the first one. This should not be a source of worry at all.

You should let your baby continue with the five-in-one vaccine schedule at six weeks. Currently routine investigations done at ante-natal covers hepatitis B virus infection screening (just like HIV). I believe that the cost of HBIG and hepatitis B vaccine for babies (at birth doses) of mothers who are hepatitis B positive should be absorbed by the nation.

Another issue is whether hepatitis B virus positive mothers can breast feed. To this, I will simply give a response of the World Health Organisation (WHO) the question of whether breastfeeding plays a significant role in the transmission of hepatitis B has been asked for many years. It is important given the critical role of breastfeeding and the fact that about 5% of mothers worldwide are chronic hepatitis B virus (HBV) carriers.

Examination of relevant studies indicates that there is no evidence that breastfeeding poses any additional risk to infants of HBV carrier mothers. The use of hepatitis B vaccine in infant immunisation programmes, recommended by WHO and now implemented in 80 countries, is a further development that will eventually eliminate the risk of transmission.

I started by saying that notwithstanding the shared common routes of transmission between hepatitis B virus infection and HIV, there appears to be no stigma at all for persons with HBV infection.

Indeed, there are a number of couples who knew their partners had hepatitis B virus infection before committing themselves to each other.  The WHO says that globally, there are over 350 million chronic carriers of HBV who are at high risk of developing severe complications including chronic active hepatitis, cirrhosis, and primary hepatocellular carcinoma (liver cancer).

These complications kill more than 1 million persons per year. It is estimated that about 20% of individuals who become chronic carriers will eventually die from these complications if not adequately managed or treated. In spite of this there is no stigma associated with HBV infection, perhaps due to the way we communicated issues pertaining to the infection. -  Edward O. Amporful

Print Friendly

Leave a Comment