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.
can be protected against hepatitis B infection through a safe and effective
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.
proportion of children under five years of age chronically infected with 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 WHO.
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.
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.
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.
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.
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.