Pregnant women who test positive for hepatitis B infection and have a high level of hepatitis B virus (HBV) in the blood should receive preventive antiviral therapy with tenofovir from the 28th week of pregnancy until birth, the World Health Organization (WHO) recommends in new guidelines on the prevention of mother-to-child hepatitis B transmission released this week.
The new WHO guidance aims to intensify efforts to reduce mother-to-child transmission of hepatitis B. Infant vaccination against hepatitis B has been highly effective in reducing the prevalence of hepatitis B in children. The proportion of children under five years of age chronically infected with hepatitis B 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 WHO.
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 recommends:
- 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 immunisation, 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.
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