ผลลัพธ์ในโครงการป่้องกันการติดเชื้อไวรัสตับอักเสบบีจากแม่สู่ลูกในโรงพยาบาลพหลพลพยุหเสนาระหว่างปี พ.ศ. 2562 - 2565

Nuchanat Thamniamdee

Authors

Nuchanat Thamniamdee Pediatric department, Phaholpolpayuhasena Hospital

Abstract

Background Prevention of mother to child transmission of hepatitis B virus (PMTCT) is a key to eliminate of chronic HBV infection that increase risk of developing cirrhosis and hepatocellular carcinoma in adulthood. WHO has set a global strategies to eradicate viral hepatitis in 2030. Goal of prevalence of hepatitis B infection in children less than 5 years of age is < 0.1%. The immunoprophylaxis strategies including screening of hepatitis B infection in pregnant women, tenofovir for whom with HBeAg positive, administration of HBV and HBIG to all infants. In Thailand, PMTCT was set in 2018 and at Paholpolpayuhasena hospital had followed the program since 2019. Objectives To determine the outcome following the PMTCT program at Paholpolpayuhasena hospital.

Methods This is a retrospective descriptive study. The medical record of infants born to mothers with positive HBsAg between January 2019 to September 2022 were reviewed. Infant dead before 9 months of age and loss follow-up at age 9-12 months were excluded. At age of 9-12 months, each infant was checked for HBsAg and Anti-HBsAb. The definition of positive anti-HBsAb or immune considered as a level 10 International Unit/Litre (IU/L).

Results A total of 163 infants born to mother with positive HBsAg between January 2019 to September 2022, 2 were dead before 9 months of age and 75 had loss to follow-up. Of 86 infants were checked for HBsAg and anti-HBsAb at age 9-12 months, their mother had positive HBeAg 19 (22.09%) and 39 were not tested for HBeAg (45.35%). Of those HBeAg positive mothers had taken Tenofovir during pregnancy 16 (84.21%). Infants were administered hepatitis B vaccine (HBV) and HBIG within 12 hours after birth for 80 (93.06%) and 6 were administered only HBV. All infants were administered of HBV at age 1,2,4 and 6 months. At age 9-12 months, none of infant had positive HBsAg and 100% had a positive anti-HBsAb with a median level > 1,000 IU/L (72.37, >1,000)

Conclusion : Outcome of our PMTCT program achieve the goal of WHO and Thai Ministry of Public Health but limitation is a rate of HBeAg testing in mother with positive HBsAg is lower than expected target and a large number of infants had loss to follow-up. There is a need for program strengthening to ensure serologic testing in these infants.

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