Maternal tenofovir along with Vaccination may prevent Vertical Hepatitis B transmission

In babies, a combination of hepatitis B vaccination and immunoglobulin is the cornerstone of vertical transmission prevention for women who are positive for both hepatitis B surface and envelope antigens, says an article published in American Journal of Obstetrics & Gynecology.

This study was carried out by Ha T. Nguyen and colleagues to examine the efficiency and safety of pharmaceutical therapies to prevent vertical transmission of the hepatitis B virus.

Cochrane, Medline, and Scopus databases were searched for this study up to October 28th, 2020. All randomized controlled studies that reported vertical hepatitis B viral transmission with pharmaceutical intervention were properly searched and included in the analysis. The Cochrane Risk-of-Bias tool Version 2 was used to assess the risk of bias. The effectiveness of the treatment was calculated using a stratified network meta-analysis which was based on maternal hepatitis B envelope antigen status.

The results of this study stated as follow:

1. There were 19 studies that involved moms who tested positive for hepatitis B surface and envelope antigens.

2. The combination of hepatitis B vaccination and immunoglobulin in babies lowered transmission risk much more than the vaccine alone, with a risk ratio of 0.52. (95% confidence interval 0.30, 0.91).

3. With a pooled risk ratio of 0.10, only the inclusion of maternal tenofovir disoproxil fumarate, but not telbivudine, lamivudine, or maternal hepatitis B immunoglobulin, further lowered transmission risk in newborns compared to a combination of hepatitis B vaccination and hepatitis B immunoglobulin.

4. Twelve studies in mothers with hepatitis B surface antigen positivity but mixed, unknown, or negative hepatitis B envelope antigen status provided limited evidence that maternal hepatitis B immunoglobulin combined with hepatitis B vaccine and immunoglobulin in infants was the likely best treatment, but this failed to reach statistical significance when compared to a combination of hepatitis B vaccine and immunoglobulin in infants.

5. Similarly, adding newborn hepatitis B immunoglobulin to immunization gives potential extra benefit but fails to attain statistical significance.

In conclusion, the inclusion of maternal tenofovir in this newborn combination regimen was thought to be the most probable successful therapy. No further agents offered extra benefit beyond the hepatitis B vaccination alone for newborns of women with hepatitis B surface antigen positivity and mixed, unknown, or negative hepatitis B envelope antigen status.

Reference:

Nguyen, H. T., Thavorncharoensap, M., Phung, T. L., Anothaisintawee, T., Chaikledkaew, U., Sobhonslidsuk, A., Talungchit, P., Chaiyakunapruk, N., Attia, J., McKAY, G. J., & Thakkinstian, A. (2022). Comparative efficacy and safety of pharmacological interventions to prevent Mother-to-Child transmission of hepatitis B virus: A systematic review and network meta-analysis. In American Journal of Obstetrics and Gynecology. Elsevier BV. https://doi.org/10.1016/j.ajog.2022.02.042

Keywords: Hepatitis B, Vaccine, immunization, immunoglobulin, antigen, vertical transmission, tenofovir, American Journal of Obstetrics and                   Gynecology