Proportion of HBV-infected pregnant women eligible for antiviral prophylaxis to prevent vertical transmission: a systematic review and meta-analysis

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Delamare, Hugues | Ishii-Rousseau, Julian Euma | Rao, Adya | Cresta, Mélanie | Vincent, Jeanne Perpétue | Ségéral, Olivier | Nayagam, Shevanthi | Shimakawa, Yusuke

Edité par CCSD ; Elsevier -

International audience. Background & AimsIn 2020, WHO recommended peripartum antiviral prophylaxis (PAP) for HBV-infected pregnant women with high viremia (≥200,000 IU/mL). Hepatitis B e antigen (HBeAg) was also recommended as an alternative where HBV DNA is unavailable. To inform policy-making and implementation of prevention of mother-to-child transmission, we conducted a systematic review and meta-analysis to estimate proportion of HBV-infected pregnant women eligible for PAP at global and regional levels.MethodsWe searched PubMed/EMBASE/Scopus/CENTRAL for studies of HBV-infected pregnant women. We extracted proportions of women with high viremia (≥200,000 IU/mL), positive HBeAg, cross-stratified proportions based on HBV DNA and HBeAg, and the child infection risk. Proportions were pooled using random-effects meta-analysis.ResultsOf 6,999 articles, 131 studies involving 71,712 HBV-infected pregnant women were included. The number of studies per WHO region was 66 (Western Pacific), 21 (Europe), 17 (Africa), 11 (Americas), 9 (Eastern Mediterranean), and 7 (South-East Asia). The overall pooled proportion of high viremia was 21.27% (95% CI 17.77-25.23), with significant regional variation: Western Pacific (31.56%), Americas (23.06%), South-East Asia (15.62%), Africa (12.45%), Europe (9.98%) and Eastern Mediterranean (7.81%). HBeAg positivity showed similar regional variation. After cross-stratification, the proportions of high viremia and positive HBeAg, high viremia and negative HBeAg, low viremia and positive HBeAg, and low viremia and negative HBeAg were 14.80% (10.75-20.05), 2.62% (1.81-3.78), 3.66% (2.83-4.73), and 76.18% (69.79-81.58%), respectively. The corresponding risks of child infection following birth dose vaccination without immune globulin and PAP were 14.86% (8.43-24.88), 6.94% (2.92-15.62), 7.14% (1.00-37.03), and 0.14% (0.02-1.00).ConclusionsApproximately 20% of HBV-infected pregnant are eligible for PAP. Given significant regional variations, each country should tailor strategies for HBsAg screening, risk stratification, and PAP in routine antenatal care.

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