Skip to main content

Advertisement

Log in

Chronic hepatitis B in Asian women of childbearing age

  • Supplement Article
  • Published:
Hepatology International Aims and scope Submit manuscript

Abstract

Hepatitis B virus (HBV) infection is a serious clinical problem affecting approximately 2 billion people worldwide. An estimated 350 million live with chronic hepatitis B (CHB) infection and are at an increased risk for serious liver sequelae and death from acute or chronic consequences of CHB infection. Individuals with CHB have a 20–30% risk of early death from complications, including liver cirrhosis and hepatocellular carcinoma. In the Asia-Pacific region, half of the CHB burden results from vertical or mother-to-child transmission, with early childhood horizontal transmission accounting for the remaining half. Screening and vaccination are key factors in the successful prevention and control of HBV infection. Over the last 20 years, the implementation of screening programs and universal HBV vaccination for all individuals born in endemic areas have reduced the prevalence of HBV infection and HBV-related liver diseases among individuals younger than 30 years. Women of childbearing age are key stakeholders in preventing HBV infection and, as such, play a critical role in reducing the vertical and horizontal transmission of HBV. Further efforts are needed to implement screening and educational programs for women of childbearing age, particularly those with CHB, to prevent the transmission of HBV to newborns, spouses, other household members, and sexual partners. In addition, healthcare workers need to learn how to avoid iatrogenic transmission in the healthcare setting. This article reviews these issues and highlights areas in which their engagement with public health efforts serves to improve quality of life and society as a whole.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Zhao K. Epidemiology of hepatitis B in China. In Lam SK, Lai CL, Yeok EK, editors. Viral Hepatitis B Infection in the Western Pacific Region: Vaccine and Control. Singapore: World Scientific; 1984. 23–28

    Google Scholar 

  2. Centers for Disease Control and Prevention. Progress in hepatitis B prevention through universal infant vaccination—China, 1997–2006. MMWR Morb Mortal Wkly Rep 2007;56:441–445

    Google Scholar 

  3. Ebright JR, Altantsetseg T, Oyungerel R. Emerging infectious diseases in Mongolia. Emerg Infect Dis 2003;9:1509–1515

    PubMed  Google Scholar 

  4. Edstam JS, Dulmaa N, Nymadawa P, Rinchin A, Khulan J, Kimball AM. Comparison of hepatitis B vaccine coverage and effectiveness among urban and rural Mongolian 2-year-olds. Prev Med 2002;34:207–214

    Article  PubMed  Google Scholar 

  5. Hipgrave DB, Nguyen TV, Vu MH, Hoang TL, Do TD, Tran NT, et al. Hepatitis B infection in rural Vietnam and the implications for a national program of infant immunization. Am J Trop Med Hyg 2003;69:288–294

    PubMed  Google Scholar 

  6. Lavanchy D. Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures. J Viral Hepat 2004;11:97–107

    Article  PubMed  CAS  Google Scholar 

  7. Lin HH, Kao JH, Chang TC, Hsu HY, Chen DS. Secular trend of age-specific prevalence of hepatitis B surface and e antigenemia in pregnant women in Taiwan. J Med Virol 2003;69:466–470

    Article  PubMed  Google Scholar 

  8. Louisirirotchanakul S, Myint KS, Srimee B, Kanoksinsombat C, Khamboonruang C, Kunstadter P, et al. The prevalence of viral hepatitis among the Hmong people of northern Thailand. Southeast Asian J Trop Med Public Health 2002;33:837–844

    PubMed  CAS  Google Scholar 

  9. Merican I, Guan R, Amarapuka D, Alexander MJ, Chutaputti A, Chien RN, et al. Chronic hepatitis B virus infection in Asian countries. J Gastroenterol Hepatol 2000;15:1356–1361

    Article  PubMed  CAS  Google Scholar 

  10. Qu JB, Zhang ZW, Shimbo S, Watanabe T, Nakatsuka H, Matsuda-Inoguchi N, et al. Urban-rural comparison of HBV and HCV infection prevalence in eastern China. Biomed Environ Sci 2000;13:243–253

    PubMed  CAS  Google Scholar 

  11. Tran HT, Ushijima H, Quang VX, Phuong N, Li TC, Hayashi S, et al. Prevalence of hepatitis virus types B through E and genotypic distribution of HBV and HCV in Ho Chi Minh City. Vietnam Hepatol Res 2003;26:275–280

    Article  Google Scholar 

  12. Wiwanitkit V, Suyaphan A. High prevalence of HBsAg seropositivity in Hilltribers in the Mae Jam district in northern Thailand. Med Gen Med 2002;4:26

    Google Scholar 

  13. World Health Organization Regional Office for Western Pacific. REPORT on Working Group Meeting on Viral Hepatitis B. Manilla, Philippines: World Health Organization Regional Office for Western Pacific; July 2002. (WP)/ICP/EPI/5.2/001-A. Report Series No.: RS/2002/GE/05 (Japan)

  14. Fattovich G, Bortolotti F, Donato F. Natural history of chronic hepatitis B: special emphasis on disease progression and prognostic factors. J Hepatol 2008;48:335–352

    Article  PubMed  CAS  Google Scholar 

  15. Lee AKY, Ip H, Wong VCW. Mechanisms of maternal-fetal transmission of hepatitis B virus. J Infect Dis 1978;138:668–671

    PubMed  CAS  Google Scholar 

  16. Stevens CE, Beasley RP, Tsui J, Lee WC. Vertical transmission of hepatitis B antigen in Taiwan. N Engl J Med 1975;292:771–774

    PubMed  CAS  Google Scholar 

  17. Chang MH, Chen CJ, Lai MS, Hsu HM, Wu TC, Kong MS, et al. Universal hepatitis B vaccination in Taiwan and the incidence of hepatocellular carcinoma in children. N Eng J Med 1997;336:1855–1859

    Article  CAS  Google Scholar 

  18. Chen DS. Hepatocellular carcinoma in Taiwan. Hepatol Res 2007;37(Suppl 2):S101–S105

    Article  PubMed  Google Scholar 

  19. Chien YC, Jan CF, Kuo HS, Chen CJ. Nationwide hepatitis vaccination program in Taiwan: effectiveness in the 20 years after it was launched. Epidemiol Rev 2006;28:126–135

    Article  PubMed  Google Scholar 

  20. Ni YH, Huang LM, Chang MH, Yen CJ, Lu CY, You SL, et al. Two decades of universal hepatitis B vaccination in Taiwan: impact and implication for future strategies. Gastroenterology 2007;132:1287–1294

    Article  PubMed  Google Scholar 

  21. Lau GKK, Carman C, Locarnini SA, Okuda K, Lu Z-M, William R, et al. Treatment of chronic hepatitis B virus infection: an Asia-Pacific perspective. J Gastroenterol Hepatol 1999;14:3–12

    Article  PubMed  CAS  Google Scholar 

  22. Liaw YF, Chu CM. Hepatitis B virus infection. Lancet 2009;373:582–592

    Article  PubMed  CAS  Google Scholar 

  23. Fung J, Lai CL, But D, Wong D, Cheung TK, Yuen MF. Prevalence of fibrosis and cirrhosis in chronic hepatitis B: implications for treatment and management. Am J Gastroenterol 2008;103:1421–1426

    Article  PubMed  Google Scholar 

  24. Liaw YF, Chu CM, Lin DY, Sheen IS, Yang CY, Huang MJ. Age-specific prevalence and significance of hepatitis B e antigen and antibody in chronic hepatitis B virus infection in Taiwan: a comparison among asymptomatic carriers, chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma. J Med Virol 1984;13:385–391

    Article  PubMed  CAS  Google Scholar 

  25. Wang Z, Zhang J, Yang H, Li X, Wen S, Guo Y, et al. Quantitative analysis of HBV DNA level and HBeAg titer in hepatitis B surface antigen positive mothers and their babies: HBeAg passage through the placenta and the rate of decay in babies. J Med Virol 1993;71:360–366

    Article  CAS  Google Scholar 

  26. Yuen MF, Yuan HJ, Hui CK, Wong DK, Wong WM, Chan AO, et al. A large population study of spontaneous HBeAg seroconversion and acute exacerbation of chronic hepatitis B infection: implications for antiviral therapy. Gut 2003;52:416–419

    Article  PubMed  Google Scholar 

  27. Leung N, Yeung C, Chan R, et al. Features of chronic hepatitis B female patients of childbearing age in Hong Kong. Hepatol Int; 2009, in press

  28. Lok ASF. Chronic hepatitis B: perspective. N Engl J Med 2002;346:1682–1683

    Article  PubMed  Google Scholar 

  29. Carr BR, Parker CR Jr, Madden JD, MacDonald PC, Porter JC. Maternal plasma adenocorticotropin and cortisol relationships throughout human pregnancy. Am J Obstet Gynecol 1981;139:416–422

    PubMed  CAS  Google Scholar 

  30. Hidaka Y, Amino N, Iwatani Y, Kaneda T, Mitsuda N, Morimoto Y, et al. Changes in natural killer cell activity in normal pregnant and post-partum women increases in the first and second post-partum period and decrease in late pregnancy. J Reprod Immunol 1991;20:73–83

    Article  PubMed  CAS  Google Scholar 

  31. Lin HH, Chen PJ, Chen DS, Sung JL, Yang KH, Young YC, et al. Post-partum subsidence of hepatitis B viral replication in HBeAg positive carrier mothers. J Med Virol 1989;29:1–6

    Article  PubMed  CAS  Google Scholar 

  32. Söderström A, Norkrans G, Lindh M. Hepatitis B virus DNA during pregnancy and post partum: aspects on vertical transmission. Scand J Infect Dis 2003;35:814–819

    Article  PubMed  CAS  Google Scholar 

  33. Tan HH, Lui H-F, Chow W-C. Chronic hepatitis B virus (HBV) infection in pregnancy. Hepatol Int 2008;3:370–375

    Article  Google Scholar 

  34. Liaw Y-F, Leung N, Kao J-H, Piratvisuth T, Gane E, Han K-H, et al. Asian-Pacific consensus statement on the management of chronic hepatitis B: a 2008 update. Hepatol Int 2008;2:263–283

    Article  PubMed  Google Scholar 

  35. Hoofnagle JH, Doo E, Liang TJ, Fleischer R, Lok AS. Management of hepatitis B: summary of a clinical research workshop. Hepatology 2007;45:1056–1075

    Article  PubMed  CAS  Google Scholar 

  36. Xu WM, Cui YT, Wang L, Yang H, Liang ZQ, Li XM, et al. Lamivudine in late pregnancy to prevent perinatal transmission of hepatitis B virus infection: a multicentre, randomized, double-blind, placebo-controlled study. J Viral Hepat 2009;16:94–103

    Article  PubMed  Google Scholar 

  37. van Zonneveld M, van Nunen AB, Niesters HG, de Man RA, Schalm SW, Janssen HL. Lamivudine treatment during pregnancy to prevent perinatal transmission of hepatitis B virus infection. J Viral Hepat 2003;10:294–297

    Article  PubMed  Google Scholar 

  38. van Nunen AB, de Man RA, Heijtink RA, Niesters HG, Schalm SW. Lamivudine in the last 4 weeks of pregnancy to prevent perinatal transmission in highly viremic chronic hepatitis B patients. J Hepatol 2000;32:1040–1041

    Article  PubMed  Google Scholar 

  39. Li XM, Yang YB, Hou HY, Shi ZJ, Shen HM, Teng BQ, et al. Interruption of HBV intrauterine transmission: a clinical study. World J Gastroenterol 2003;9:1501–1503

    PubMed  CAS  Google Scholar 

  40. Su G-G, Pan H-K, Zhao N-F, Fang SH, Yang DH, Zhou Y. Efficacy and safety of lamivudine treatment for chronic hepatitis B in pregnancy. World J Gastroenterol 2004;10:910–912

    PubMed  CAS  Google Scholar 

  41. Chotiyaputta W, Lok AS. Role of antiviral therapy in the prevention of perinatal transmission of hepatitis B virus infection (editorial). J Viral Hepat 2009;16:91–93

    Article  PubMed  CAS  Google Scholar 

  42. Chang MH. Decreasing incidence of hepatocellular carcinoma among children following universal hepatitis B immunization. Liver Int 2003;23:309–314

    Article  PubMed  Google Scholar 

  43. Hsu HY, Chang MH, Ni YH, Chen HL. Survey of hepatitis B surface variant infection in children 15 years after nation-wide vaccination program in Taiwan. Gut 2004;53:11499–11503

    Article  Google Scholar 

  44. But DY, Lai CL, Lim WL, Fung J, Wong DK, Yuen MF. Twenty-two years follow-up of a prospective randomized trial of hepatitis B vaccines without booster dose in children: final report. Vaccine 2008;26:6587–6591

    Article  PubMed  Google Scholar 

  45. UNICEF. The State of the World’s Children 2008 Child Survival [updated December 2007; cited 2009 May 11]. Available from: http://www.unicef.org/sowc08/docs/sowc08.pdf

  46. Chongsrisawat V, Yoocharoen P, Theamboonlers A, Tharmaphornpilas P, Warinsathien P, Sinlaparatsamee S, et al. Hepatitis B seroprevalence in Thailand: 12 years after hepatitis B vaccine integration into the national expanded programme on immunization. Trop Med Int Health 2006;11:1496–1502

    Article  PubMed  Google Scholar 

  47. Chen CJ, Yang HI, Su J, Jen CL, You SL, Lu SN, et al. Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level. JAMA 2006;295:65–73

    Article  PubMed  CAS  Google Scholar 

  48. Iloeje UH, Yang HI, Su J, Jen CL, You SL, Chen CJ. Predicting cirrhosis risk based on the level of circulating hepatitis B viral load. Gastroenterology 2006;130:678–686

    Article  PubMed  Google Scholar 

  49. Nguyen VT, Law MG, Dore GJ. An enormous hepatitis B virus-related liver disease burden projected in Vietnam by 2025. Liver Int 2008;28:525–531

    PubMed  Google Scholar 

  50. Koblin BA, Xu G, Lucy D, Robertson V, Bonner S, Hoover DR, et al. Hepatitis B infection and vaccination among high-risk non-injection drug-using women: baseline data from the UNITY study. Sex Transm Dis 2007;34:917–922

    Article  PubMed  Google Scholar 

  51. Lin SY, Chang ET, So SK. Why we should routinely screen Asian American adults for hepatitis B: a cross-sectional study of Asians in California. Hepatology 2007;46:1034–1040

    Article  PubMed  Google Scholar 

  52. Taylor VM, Choe JH, Yasui Y, Li L, Burke N, Jackson JC. Hepatitis B awareness, testing, and knowledge among Vietnamese American men and omen. J Community Health 2005;30:477–490

    Article  PubMed  Google Scholar 

  53. Weinbaum CM, Williams I, Mast EE, Wang SA, Finelli L, Wasley A, et al. Recommendations for identification and public health management of persons with chronic hepatitis B virus infection. MMWR Recomm Rep 2008;57:1–20

    PubMed  Google Scholar 

  54. van der Eijk AA, de Man RA, Niesters HG, Schalm SW, Zaaijer HL. Hepatitis B virus (HBV) DNA levels and the management of HBV-infected health care workers. J Viral Hepat 2006;13:2–4

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

Editorial support in the development of the manuscript was provided by Kathleen Covino, PhD. This study has been supported by an independent educational grant from Bristol-Myers Squibb Company through the ACT-HBV Initiative.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nancy Leung.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Leung, N. Chronic hepatitis B in Asian women of childbearing age. Hepatol Int 3 (Suppl 1), 24–31 (2009). https://doi.org/10.1007/s12072-009-9142-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12072-009-9142-1

Keywords

Navigation