Introduction: Human papillomavirus (HPV) infection is the most widespread sexually transmitted infection in the world. Today, there is growing evidence that HPV can be transmitted early in life, and one potential rout...Introduction: Human papillomavirus (HPV) infection is the most widespread sexually transmitted infection in the world. Today, there is growing evidence that HPV can be transmitted early in life, and one potential route is mother-to-child transmission. Data on this route of HPV transmission are scarce in Africa and particularly in Burkina Faso, where no data on the subject are yet available. The aim of our study was to estimate the rate of mother-to-child transmission of HPV infection and to identify circulating genotypes. Methodology: Cervico-uterine samples were collected from 100 full-term pregnant women and, buccal samples were obtained from their newborns at Hopital Saint Camille de Ouagadougou (HOSCO) by the specialist physician. HPV DNA amplification and genotyping were performed by PCR followed by hybridization using the HPV Direct Flow Chips kit, detecting 36 genotypes including 18 high-risk and 18 low-risk. Results: The prevalence of HPV in newborns was 8% (8/100). Six (6) HPV-positive neonates had HPV-positive mothers, while 2 HPV-positive neonates had HPV-negative mothers. The vertical transmission rate was 26.09% (6/23). Mother-newborn genotypes were concordant. However, the genotype profile of the newborns was more restricted than that of the mothers. Conclusion: HPV DNA was found in 8% of newborns in our study. The genotype profile of the mother-newborn pair was concordant. Asymptomatic HPV infection in a pregnant woman could constitute a risk factor for vertical transmission.展开更多
The elimination of vertical transmission of HIV from mother to child is a major global goal. In Senegal, the transmission rate was estimated at 3.2% in 2017. To reduce or even eliminate this transmission, Senegal has ...The elimination of vertical transmission of HIV from mother to child is a major global goal. In Senegal, the transmission rate was estimated at 3.2% in 2017. To reduce or even eliminate this transmission, Senegal has implemented various strategies and programs adopted and applied nationally. Thus access to services for the prevention of mother-to-child transmission of HIV has been extended to the level of the health post (the lowest level of the country’s health pyramid) with a delegation of tasks to paramedical staff (nurse, midwife) in the diagnosis and therapeutic management. Objectives: To describe the epidemiological profile of HIV (Human Immunodeficiency Virus)-positive mothers, to assess the care of children born to HIV-positive mothers, to determine the rate of HIV transmission from mother to child. Patients and Method: We carried out a retrospective, cross-sectional and descriptive study of all live newborns of HIV-positive mothers who gave birth at the Gaspard Kamara Health Center (a level 2 health center in Dakar, Senegal) between January 1, 2015 and December 31, 2018. The data were collected from prevention of mother-to-child transmission (PMTCT) prenatal follow-up registers and files, delivery files and registers, and neonatology and pediatric follow-up files, and exploited using the Epi info 7 software. Results: There were 98 children of seropositive mothers. The epidemiological profile of the HIV-positive woman was that of a young woman aged between 16 and 43 with an average of 31.31 years, pauciparous (>65% of cases) from Dakar center (>75% of cases), housewife with a low socio-economic level (63.1% of cases), married in almost all cases, with HIV profile (in almost all cases) and diagnosed before pregnancy (51.02%). The analysis of the children’s data revealed a predominance of girls (52.04%) with a good birth weight (2964g on average) and a pregnancy carried to term in more than 95% of cases. ARV prophylaxis was almost entirely respected with triple therapy (AZT + 3TC + NVP) in a fixed combination as protocol. Protected breastfeeding (80.21%), including 6 months of exclusive protected breastfeeding, was the rule for the mode of feeding. Three children were diagnosed positive with PCR1 as with serology (3.06%). Discussion and Conclusion: the initiatives and strategies put in place in Senegal have enabled a significant reduction in mother-to-child transmission of HIV and deserve to be supported by insisting on primary prevention, programming and good follow-up of pregnancies, and a good support for HIV-positive women.展开更多
Introduction: For several years, the fight against the human immunodeficiency virus (HIV) has been a major public health issue in Africa. Since 2012, Senegal has adopted WHO option B+, consisting of systematic triple ...Introduction: For several years, the fight against the human immunodeficiency virus (HIV) has been a major public health issue in Africa. Since 2012, Senegal has adopted WHO option B+, consisting of systematic triple therapy for HIV-positive pregnant women, combined with breastfeeding and antiretroviral (ARV) prophylaxis for exposed newborns. It is in this dynamic that we set ourselves the objectives of evaluating the rate of transmission of HIV from mother to child and taking stock of the monitoring of children born to HIV-positive mothers at the Pediatric Department of the CHN of Pikine located in the Dakar suburbs. Methodology: Thus, we conducted a descriptive and analytical cross-sectional cohort follow-up study from 11/25/2014 to 03/09/2022 including all children born to HIV-positive mothers followed at the Pikine CHN since the start of care. Results: We had collected 51 children exposed to HIV and followed in our structure. They were exposed to HIV1 in 92% of cases. The HIV status of the mothers was known before pregnancy in more than half of the cases. The couples were serodiscordant in 56% of cases. The mothers were in clinical stage 1 of the disease in 69.6% of cases and were already under treatment in 47% of cases. The most used treatment regimen was ATRIPLA with Tenofovir (TDF) + Emtracitabine (FTC) + Efavirenz (EFV) in 59% of cases. Compliance was good in the majority of cases. The CD4 count during pregnancy was low in 10.6% of cases. The pregnancy was well followed in only 36.2% of cases. The mothers had given birth in our structure in 91.4% of cases. The vaginal route was found in 72.5% of cases and delivery was carried out by a midwife in 69.4% of cases. The average birth weight was 2733 ± 564. The majority of newborns had received antiretroviral (ARV) prophylaxis after birth, half of them between 12 and 24 hours. The most used therapeutic protocol was Zidovudine (AZT) + Lamivudine (3TC) + Lopinavir/Ritonavir (LPV/r). Protected breastfeeding was the option chosen in 76.8% of cases. The PCR performed at 6 weeks was negative in more than half of the cases. Retroviral serology was carried out after 14 months in 43% of cases. We noted a single positive case with a negative initial PCR, representing an overall transmission rate of 1.96%. Conclusion: Senegal’s current policy targeting EMTCT of HIV is on good momentum with a fairly low transmission rate thanks to screening of pregnant women and prophylaxis with antiretrovirals (ARV) for HIV-positive mothers during pregnancy and for life. And children exposed from birth and during breastfeeding up to 6 weeks with regular monitoring.展开更多
AIM： To determine the therapeutic effect of lamivu- dine in late pregnancy for the interruption of motherto-child transmission （MTCT） of hepatitis B virus （HBV）. METHODS： Studies were identified by searching ava...AIM： To determine the therapeutic effect of lamivu- dine in late pregnancy for the interruption of motherto-child transmission （MTCT） of hepatitis B virus （HBV）. METHODS： Studies were identified by searching available databases up to January 2011. Inclusive criteria were HBV-carrier mothers who had been involved in randomized controlled clinical trials （RCTs） with lamivudine treatment in late pregnancy, and newborns or infants whose serum hepatitis B surface antigen （HBsAg）, hepatitis B e antigen （HBeAg） or HBV DNA had been documented. The relative risks （RRs） for inerruption of MTCT as indicated by HBsAg, HBV DNA or HBeAg of newborns or infants were calculated with 95% confidence interval （CI） to estimate the efficacy of lamivudine treatment. RESULTS： Fifteen RCTs including 1693 HBV-carrier mothers were included in this meta-analysis. The overall RR was 0.43 （95% CI, 0.25-0.76; 8 RCTs; Phet- erogeneity= 0.04） and 0.33 （95% CI, 0.23-0.47; 6 RCTs; Pheterogeneity = 0.93） indicated by newborn HBsAg or HBV DNA. The RR was 0.33 （95% CI, 0.21-0.50; 6 RCTs; Pheterogeneity = 0.46） and 0.32 （95% CI, 0.20-0.50; 4 RCTs; Pheterogeneity = 0.33） indicated by serum HBsAg or HBV DNA of infants 6-12 mo after birth. The RR （lamivudine vs hepatitis B immunoglobulin） was 0.27 （95% CI, 0.16-0.46; 5 RCTs; Pheterogeneity = 0.94） and 0.24 （95% CI, 0.07-0.79; 3 RCTs; Pheterogeneity = 0.60） indicated by newborn HBsAg or HBV DNA, respectively. In the mothers with viral load 〈 106 copies/mL after lamivudine treatment, the efficacy （RR, 95% CI） was 0.33, 0.21-0.53 （5 RCTs; Pheterogeneity = 0.82） for the interruption of MTCT, however, this value was not significant if maternal viral load was 〉 106 copies/mL after lamivudine treatment （P = 0.45, 2 RCTs）, as indicated by newborn serum HBsAg. The RR （lamivudine initiated from 28 wk of gestation vs control） was 0.34 （95% CI, 0.22-0.52; 7 RCTs; Pheterogeneity = 0.92） and 0.33 （95% CI, 0.22-0.50; 5 RCTs; Pheterogeneity = 0.86） indicated by newborn HBsAg or HBV DNA. The incidence of adverse effects of lamivudine was not higher in the mothers than in controls （P = 0.97）. Only one study reported side effects of lamivudine in newborns. CONCLUSION： Lamivudine treatment in HBV carrier- mothers from 28 wk of gestation may interrupt MTCT of HBV efficiently. Lamivudine is safe and more efficient than hepatitis B immunoglobulin in interrupting MTCT. HBV MTCT might be interrupted efficiently if maternal viral load is reduced to 〈 106 copies/mL by lamivudine treatment.展开更多
In 2016, there were 17.8 million (15.4-20.3 million) women living with HIV/AIDS across the world and the prevalence of reproductive desire among this group was 26%-49%[1]. If pregnant women living with HIV/AIDS are le...In 2016, there were 17.8 million (15.4-20.3 million) women living with HIV/AIDS across the world and the prevalence of reproductive desire among this group was 26%-49%[1]. If pregnant women living with HIV/AIDS are left untreated, the rates of HIV transmission from mother-to-child would range from 14% to 48%, depending on the presence and duration of breastfeeding[2].展开更多
Mother-to-child transmission(MTCT)of syphilis remains a leading cause of stillbirth and death among neonates in many developing countries.In 2007,World Health Orgernization launched the global elimination of MTCT(EMTC...Mother-to-child transmission(MTCT)of syphilis remains a leading cause of stillbirth and death among neonates in many developing countries.In 2007,World Health Orgernization launched the global elimination of MTCT(EMTCT)of syphilis.Given the high burden of congenital syphilis,China subsequently released the specific national EMTCT policies and programs to reduce MTCT of syphilis.The congenital syphilis incidence rate per 100,000 live births in China has markedly decreased from 69.9 in 2013 to 11.9 in 2019.However,due to the global pandemic of COVID-19,the current measures for eliminating MTCT of syphilis are greatly challenged.In this article,we summarize the strategies and measures for the EMTCT of syphilis in China in the past 20 years,the remarkable achievements by the policy support under the leadership of the government.In the context of COVID-19 pandemics,strengthening emergency response to the regional outbreaks of COVID-19,adopting safe,rapid,early and high-quality clinical care for 100%of pregnant women to receive prenatal syphilis testing services,ensuring the availability of Benzathine penicillin for the treatment,and strengthening the closed-loop management of pregnant women and newborns infected with syphilis are the key measures to determine the effectiveness of MTCT for syphilis.Lessons from China may be valuable for other countries that are planning to eliminate MTCT of syphilis.展开更多
The main source of HIV infection in young children is of their mothers, during pregnancy, labor and delivery, or by breastfeeding. The rate of HIV transmission from infected mothers to their newborn children varies fr...The main source of HIV infection in young children is of their mothers, during pregnancy, labor and delivery, or by breastfeeding. The rate of HIV transmission from infected mothers to their newborn children varies from 15% to 40% with one-thirds of these infections was through breastfeeding. This paper examines cross-sectional population-based survey data of HIV test results among mothers and their children in Uganda, Swaziland to estimates of mother-to- child transmission (MTCT) rate of HIV infection. The prevalence of HIV among women aged 15 - 49 who gave birth in the past 5 years in Uganda is 7.3%, and in Swaziland is 37.9%. The HIV prevalence of children who mothers were HIV positive were very similar: 10.3% in Uganda and 11.5% in Swaziland. This association represents the crude rate of MTCT in these two countries at the time of the survey. Presence of HIV antibody in early age (0 - 11 months) is due to both true infection and passive antibody from mothers. The seroconversion dropped nearly half in the second year of age which was likely that many of these children died before reaching the age of 12 - 23 months and passive antibody were gradually cleared at this point. This analysis demonstrated that cross-sectional data can be used to estimate indirectly the magnitude and dynamic of MTCT.展开更多
Missed Prevention of Mother-to-Child Transmission of HIV (PMTCT) visits have contributed to the delayed achievement of elimination of mother-to-child transmission of HIV. Missed visits promote attrition from preventio...Missed Prevention of Mother-to-Child Transmission of HIV (PMTCT) visits have contributed to the delayed achievement of elimination of mother-to-child transmission of HIV. Missed visits promote attrition from prevention of mother-to-child transmission of HIV program and antiretroviral drug resistance. The purpose of the study was to determine the prevalence of missed PMTCT visits and its associated predictors. A descriptive cross sectional survey was carried out at a District Hospital in Goromonzi, Zimbabwe. Fifty-three women completed closed-ended questionnaires pertaining to PMTCT visits and exposure to PMTCT activities. A total of 24.5% missed at least one scheduled PMTCT visit. Statistically significant predictors of not missing a PMTCT visit were satisfaction with family support (β = −0.73, p = 0.029) and level of satisfaction with PMTCT services (β = −0.00076;p = 0.04). The number of days by which scheduled visits were missed were inversely correlated with visit number (β = −2.99, p = 0.04). Enhanced family support and quality improvement to improve patient satisfaction may reduce missed visits. Availing women with a more active role in PMTCT may also reduce the prevalence of missed visits.展开更多
Objective: To determine the knowledge and awareness of Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) and mother-to-child transmission (MTCT) among women attending the antenatal clinic. M...Objective: To determine the knowledge and awareness of Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) and mother-to-child transmission (MTCT) among women attending the antenatal clinic. Methods and Subjects: This was primarily a descriptive cross-sectional study carried out at the antenatal clinic of Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, Nigeria from July 1st, 2010 to October 31st, 2010. Results: The age range of the respondents was 18 - 41 years, (mean 29 ± 5 years). One hundred and forty-nine (92.5%) were married. All the respondents interviewed were aware of HIV/AIDS and 93 (57.8%) had been aware of the disease for ≥5 years. The main sources of information were television 93 (57.8%), radio 77 (47.8%), health workers 53 (32.9%), friends, relatives and neighbors 41 (25.5%) and posters 34 (21.1%). Majority of the respondents identified sexual intercourse as a route of transmission of HIV. Sharing of sharp objects and blood transfusion were identified as routes of transmission by 99 (61.5%) and 82 (50.9%) respectively. One hundred and sixteen (72%) of the respondents knew an apparently healthy person could be living with HIV. Majority of the respondents 125 (77.6%) were aware that HIV can coexist with pregnancy and 120 (74.5%) were aware of MTCT of HIV. Vaginal delivery and breastfeeding were identified as routes of HIV transmission by 44 (27.3%) and 53 (32.9%) of respondents respectively. Delivery by caesarean section was identified as a method of prevention of MTCT by 25 (15.5%) respondents while as many as 48 (29.8%) respondents did not know any method of prevention of MTCT of HIV. Conclusion: This study demonstrates a low level of awareness of methods of prevention of MTCT of HIV among pregnant women booking for antenatal care in our center. Thus, there is the need for adequate counseling about HIV/AIDS and specific aspects of prevention of mother-to-child transmission in our antenatal clinics.展开更多
Background: The elimination of HIV transmission from mother to child is currently possible. Cote d’Ivoire, which has a 4.6% HIV prevalence among women, is one of 22 pilot countries for the elimination of mother-to-ch...Background: The elimination of HIV transmission from mother to child is currently possible. Cote d’Ivoire, which has a 4.6% HIV prevalence among women, is one of 22 pilot countries for the elimination of mother-to-child transmission of HIV. Since 2015, Cote d’Ivoire has adopted new strategies according to the WHO B+ guidelines. Objective: To identify factors associated with mother-to-child HIV transmission in children born of seropositive mothers managed at Treichville university hospital. Material and methods: A case-control study was conducted in the obstetrics department at Treichville university hospital, between January 2013 and December 2015. It involved children born to mothers infected with HIV, whose first PCR (Polymerase Chain Reaction) result was available during this period. A standardized questionnaire on data related to exposed children and their mother was used. Factors associated with mother-to-child HIV transmission were investigated using logistic regression. Results: A total of 214 HIV-exposed children were included in the study with a sex ratio of 0.9. The majority of the children were born by vaginal route (52.8%) and received post-exposure prophylaxis (88.3%) and replacement feed (51.9%). Their mothers received antiretroviral therapy during pregnancy in 45.3% of the cases. The first PCR was performed at the sixth week of life in 52.3% of cases. The prevalence of HIV infection in exposed children was 7.5% (95% CI = 4.5% - 11.8%). In multivariate analysis, the absence of antiretroviral prophylaxis in children [aOR = 4.3, 95% (1.2 to 15.6), p = 0.03], the mixed feed [aOR = 3.8, 95% (1.1 - 13.1), p < 0.03], the failure to take antiretroviral regimen during pregnancy [aOR = 8.0, 95% CI (1.9 - 32.4), p < 0.003], were associated with mother-child HIV transmission. Conclusion: The mother-to-child HIV transmission rate remains high in our practice. Strategies to reduce situations that do not comply with current recommendations should be considered to prevent mother-to-child HIV transmission.展开更多
Evaluation of the effectiveness of the mother-to-child HIV Prevention Program, in Benin in 2016 reported a national rate of 6.7%. The Region of Couffo, within 12 Regions (departments) in the country, had the highest r...Evaluation of the effectiveness of the mother-to-child HIV Prevention Program, in Benin in 2016 reported a national rate of 6.7%. The Region of Couffo, within 12 Regions (departments) in the country, had the highest rate of transmission, which was 16.1%. The study aimed to determine transmission rate during pregnancy and delivery as well as the factors associated with it. This is a retrospective and analytical study based on a sample of seventy (70) babies born to HIV-infected mothers in 2016 in Couffo. Key findings showed, there is a perinatal transmission of five percent (5%) and the factors associated with this transmission are: delay in carrying out first antenatal visits at the health facility, low frequency of visits performed versus number requested and appropriate time, poor health condition of mothers during pregnancy, absence or late start of antiretroviral care and treatment during pregnancy, irregular intake of intermittent presumptive treatment at sulfadoxine-pyrimethamine to prevent malaria, a short antiretroviral therapy (less than three months) for mothers before delivery and the default in cleaning mother’s genital tract with betadine after the woman’s water broke.展开更多
The Chinese Clinical Practice Guidelines for the prevention and treatment ofmother-to-child transmission of hepatitis B virus,developed by the Chinese Society of Infectious Diseases of the Chinese Medical Association ...The Chinese Clinical Practice Guidelines for the prevention and treatment ofmother-to-child transmission of hepatitis B virus,developed by the Chinese Society of Infectious Diseases of the Chinese Medical Association in 2019,serves as a valuable reference for standardizing the process of preventing mother-to-child transmission in China.As new evidence emerges,it is crucial that timely and regular updates are made to the clinical practice guidelines so as to optimize guidance for clinical practice and research.To this end,the Infectious Disease Physician Branch of Chinese Medical Doctor Association and the Chinese Society of Infectious Diseases of Chinese Medical Association,in collaboration with multidisciplinary experts,have updated the guidelines based on the latest domestic and international research advancements and clinical practice,in order to provide guidance and reference for clinicians andmaternal and child healthcare workers.展开更多
The Chinese Clinical Practice Guidelines for the Prevention and Treatment of Mother-to-child Transmission of Hepatitis B Virus,developed by the Chinese Society of Infectious Diseases of the Chinese Medical Association...The Chinese Clinical Practice Guidelines for the Prevention and Treatment of Mother-to-child Transmission of Hepatitis B Virus,developed by the Chinese Society of Infectious Diseases of the Chinese Medical Association in 2019,serves as a valuable reference for standardizing the prevention of mother-to-child transmission in China.As new evidence continues to emerge,it is essential to update these guidelines regularly to optimize clinical practice and research.To this end,the Infectious Disease Physician Branch of the Chinese Medical Doctor Association and the Chinese Society of Infectious Diseases of the Chinese Medical Association,in collaboration with multidisciplinary experts,have updated the guidelines based on the latest domestic and international research advancements and clinical practices,providing upto-date guidance for clinicians and maternal and child healthcare workers.展开更多
Mother-to-child transmission(MTCT)of hepatitis B virus(HBV)is the primary cause of chronic HBV infection worldwide.MTCT prevention and antiviral treatment of infected individuals could eliminate this public health bur...Mother-to-child transmission(MTCT)of hepatitis B virus(HBV)is the primary cause of chronic HBV infection worldwide.MTCT prevention and antiviral treatment of infected individuals could eliminate this public health burden.Antiviral treatment of hepatitis B surface antigen(HBsAg)-positive pregnant women and immunoprophylaxis with HBV vaccine and hepatitis B immune globulin are the most effective strategies to interfere with MTCT of HBV.However,for worldwide application of those strategies,feasibility,availability,cost,safety,and effectiveness should be considered.Cesarean section and breastfeeding avoidance in hepatitis B e antigenpositive mothers with a high viral load and without antiviral therapy during pregnancy could be an option,but more supporting evidence is needed.HBsAg screening of all pregnant women is recommended when initiating antiviral therapy and immunoprophylaxis for MTCT prevention,except in areas with limited resources.Timely HBV vaccination series administered soon after birth might be the mainstay of prevention.This review aimed to provide a concise update on the effectiveness of available strategies to prevent MTCT of HBV.展开更多
Introduction: Acquired immunodeficiency syndrome is one of the leading causes of mortality among women of reproductive age and Mother to Child Transmission of Human immunodeficiency virus is still a challenge affectin...Introduction: Acquired immunodeficiency syndrome is one of the leading causes of mortality among women of reproductive age and Mother to Child Transmission of Human immunodeficiency virus is still a challenge affecting many countries. Globally, an estimation of 180,000 children under 15 years acquire the Human immunodeficiency virus every day, and more than 90% of those infections are due to Mother to Child Transmission. The study sought to explore the experiences of mothers on the Elimination of Mother to Child Transmission-HIV services at Mtendere Clinic, Lusaka. Materials and Methods: Qualitative interpretive phenomenology study design was employed using in-depth interviews to collect data from a sample that was selected using purposive sampling technique. Thirteen participants were recruited, and these were HIV-positive mothers at least between the ages of 15 and 49 years and enrolled in the Elimination of Mother To Child Transmission-HIV program. The in-depth interviews were audiotape recorded and transcribed verbatim. Data was analyzed using thematic method. Findings: Three main themes that emerged are;living with HIV, support system and barriers to utilization of Elimination of Mother To Child Transmission-HIV services. Most of the participants expressed having acquired knowledge from the program, and received counselling and support from spouses, family as well as health personnel at Mtendere health facility which culminated into a positive experience and enhanced their uptake of the Elimination of Mother to Child Transmission-HIV services. However, barriers to service utilization were identified and these included fear of stigma, negative attitudes from health workers, long waiting times, lack of support and lack of transport to the health facility. Conclusion: Interventions such as community awareness campaigns on Elimination of Mother To Child Transmission-HIV, male involvement and implementing mother-to-mother peer support strategies in Elimination of Mother To Child Transmission-HIV service utilization should be prioritized so as to alleviate stigma and enhancing a positive experience for these mothers thus reducing on the Mother to Child HIV Transmission burden and mortality rates.展开更多
Hepatitis B virus(HBV)infection is a major public health burden.In HBV endemic regions,high prevalence is also correlated with the infections acquired in infancy through perinatal transmission or early childhood expos...Hepatitis B virus(HBV)infection is a major public health burden.In HBV endemic regions,high prevalence is also correlated with the infections acquired in infancy through perinatal transmission or early childhood exposure to HBV,the socalled mother-to-child transmission(MTCT).Children who are infected with HBV at a young age are at higher risk of developing chronic HBV infection than those infected as adults,which may lead to worse clinical outcome.To reduce the incidence of HBV MTCT,several interventions for the infants or the mothers,or both,are already carried out.This review explores the newest information and approaches available in literature regarding HBV MTCT prevalence and its challenges,especially in high HBV endemic countries.This covers HBV screening in pregnant women,prenatal intervention,infant immunoprophylaxis,and postvaccination serological testing for children.展开更多
China has the world’s largest burden of hepatitis B virus(HBV)infection,but the country has made considerable progress in preventing its mother-to-child transmission(MTCT)in the past three decades.This feat is made p...China has the world’s largest burden of hepatitis B virus(HBV)infection,but the country has made considerable progress in preventing its mother-to-child transmission(MTCT)in the past three decades.This feat is made possible due to the high coverage of birth-dose hepatitis B vaccine(HepB,>95%),hepatitis B surface antigen(HBsAg)screening for pregnant women(>99%),and hepatitis B immunoglobulin plus HepB for newborns whose mothers are HBsAg positive(>99%).Studies on the optimal antiviral treatment regimen for pregnant women with high HBV-DNA load have also been conducted.However,China still faces challenges in eliminating MTCTof HBV.The overall HBsAg prevalence among pregnant women is considered an intermediate endemic.The prevalence of HBsAg among pregnant women from remote,rural,or ethnic minority areas is higher than that of the national level because of limited health resources and public health education for HBV.The coverage for maternal and child healthcare and immunization services should be improved,especially in western regions.Integration of current services to prevent MTCTof HBV with other relevant health services can increase the acceptability,efficiency,and coverage of these services,particularly in remote areas and ethnic minority areas.By doing so,progress toward key milestones and targets to eliminate hepatitis B as the main public health threat by 2030 can be achieved.展开更多
Background and Aims:The World Health Organization(WHO)Western Pacific Region set a target of eliminating mother-to-child transmission(MTCT)of hepatitis B virus(HBV)by 2030.To assess the feasibility of this target in C...Background and Aims:The World Health Organization(WHO)Western Pacific Region set a target of eliminating mother-to-child transmission(MTCT)of hepatitis B virus(HBV)by 2030.To assess the feasibility of this target in China,we carried out an epidemiological study to investigate the status quo of MTCT in the real-world setting.Methods:One thousand and eight hepatitis B surface antigen-positive preg-nant women were enrolled at 10 hospitals.Immunoprophy-laxis was administered to infants.In addition,mothers with HBV DNA level>2,000,000 IU/mL were advised to initiate antiviral therapy during late pregnancy.A health application called SHIELD was used to manage the study.Results:Nine hundred and five of the enrolled mothers,with 924 infants,completed the follow-up.Birth-dose hepatitis B vaccine and hepatitis B immunoglobulin were received by 99.7%and 99.7%of infants,respectively,within 24 h after birth.There ;were 446 mothers who received antiviral therapy,including 72.3%of the mothers with HBV DNA level>2,000,000 IU/mL and 21.0%of the mothers with HBV DNA level<2,000,000 IU/mL.Eight infants were infected with HBV.The overall rate of MTCT was 0.9%.Birth defects were rare(0.5%among in-fants with maternal antiviral exposure versus 0.7%among infants without exposure;p=1.00).Conclusions:The MTCT rate was lower than the WHO Western Pacific Region elimina-tion MTCT target in this real-world study,indicating that a comprehensive management composed of immunoprophy-laxis to infants and antiviral prophylaxis to mothers may be a feasible strategy to achieve the 2030 WHO elimination goal.展开更多
To develop the evidence-based guidelines for managing mother-to-child transmission of hepatitis B virus in China, a multidisciplinary guideline development group was estab-lished. Clinical questions were identified fr...To develop the evidence-based guidelines for managing mother-to-child transmission of hepatitis B virus in China, a multidisciplinary guideline development group was estab-lished. Clinical questions were identified from two rounds of surveys on the concerns of first-line clinicians. We conducted a comprehensive search and review of the literature. A grading of recommendations' assessment, development, and evaluation system was adopted to rate the quality of evidence and the strength of recommendations. Recommen-dations were formulated based on the evidence, overall balance of benefits and harms (at individual and population levels), patient/health worker values and preferences, re-sources available, cost-effectiveness, and feasibility. Even-tually, recommendations related to 13 main clinical concerns were developed, covering diagnostic criteria, treatment in-dications, antiviral therapy choice, timing to initiate and discontinue treatment, immunoprophylaxis strategy at birth, and how to deal with special situations, such as unintended pregnancy, assisted reproduction, and breastfeeding. The guidelines are intended to serve as guidance for clinicians and patients, to optimize the management of majority of pregnant women who are positive for hepatitis B surface antigen. Guideline registration: International Practice Guide Registration Platform (IPGRP-2018CN040).展开更多
Prevention of mother-to-child transmission(PMTCT)of HIV with highly active antiretroviral therapy(HARRT)allows the HIV^+pregnant mothers to have vaginal delivery and breastfeed.Here we investigated the maternal plasma...Prevention of mother-to-child transmission(PMTCT)of HIV with highly active antiretroviral therapy(HARRT)allows the HIV^+pregnant mothers to have vaginal delivery and breastfeed.Here we investigated the maternal plasma immunoglobulin,cytokine secretion and the outcome of the exposed infants among the HIV^+HAART treated pregnan women in Nigeria.In this study,different plasma immunoglobulins and cytokines were measured in the HIV^+HAART treated pregnant mothers.Pooled culture supernatants of B and T lymphocytes showed lower levels of IFN-γ,IL-10 and IL-4.There were lower IFN-γand IL-10 secretions at 1st trimester;however,IL-10 continued to be lower throughout 2nd and 3rd trimesters.TNF-αsecretion significantly decreased as pregnancy progressed to term.There were high plasma IgG and low IgM in the HIV^+HAART treated pregnant women.Plasma IgG was high during 1st and 3rd trimesters.After one year of follow up,all the exposed children were seronegative for HIV-1 and HIV-2.Vaginal delivery and breastfeeding among HIV^+HAART treated mothers have shown to be safe.The use of HAART by the infected mothers and the use of septrin and niverapin by the exposed infants prevented mother to-child transmission of HIV.展开更多
文摘Introduction: Human papillomavirus (HPV) infection is the most widespread sexually transmitted infection in the world. Today, there is growing evidence that HPV can be transmitted early in life, and one potential route is mother-to-child transmission. Data on this route of HPV transmission are scarce in Africa and particularly in Burkina Faso, where no data on the subject are yet available. The aim of our study was to estimate the rate of mother-to-child transmission of HPV infection and to identify circulating genotypes. Methodology: Cervico-uterine samples were collected from 100 full-term pregnant women and, buccal samples were obtained from their newborns at Hopital Saint Camille de Ouagadougou (HOSCO) by the specialist physician. HPV DNA amplification and genotyping were performed by PCR followed by hybridization using the HPV Direct Flow Chips kit, detecting 36 genotypes including 18 high-risk and 18 low-risk. Results: The prevalence of HPV in newborns was 8% (8/100). Six (6) HPV-positive neonates had HPV-positive mothers, while 2 HPV-positive neonates had HPV-negative mothers. The vertical transmission rate was 26.09% (6/23). Mother-newborn genotypes were concordant. However, the genotype profile of the newborns was more restricted than that of the mothers. Conclusion: HPV DNA was found in 8% of newborns in our study. The genotype profile of the mother-newborn pair was concordant. Asymptomatic HPV infection in a pregnant woman could constitute a risk factor for vertical transmission.
文摘The elimination of vertical transmission of HIV from mother to child is a major global goal. In Senegal, the transmission rate was estimated at 3.2% in 2017. To reduce or even eliminate this transmission, Senegal has implemented various strategies and programs adopted and applied nationally. Thus access to services for the prevention of mother-to-child transmission of HIV has been extended to the level of the health post (the lowest level of the country’s health pyramid) with a delegation of tasks to paramedical staff (nurse, midwife) in the diagnosis and therapeutic management. Objectives: To describe the epidemiological profile of HIV (Human Immunodeficiency Virus)-positive mothers, to assess the care of children born to HIV-positive mothers, to determine the rate of HIV transmission from mother to child. Patients and Method: We carried out a retrospective, cross-sectional and descriptive study of all live newborns of HIV-positive mothers who gave birth at the Gaspard Kamara Health Center (a level 2 health center in Dakar, Senegal) between January 1, 2015 and December 31, 2018. The data were collected from prevention of mother-to-child transmission (PMTCT) prenatal follow-up registers and files, delivery files and registers, and neonatology and pediatric follow-up files, and exploited using the Epi info 7 software. Results: There were 98 children of seropositive mothers. The epidemiological profile of the HIV-positive woman was that of a young woman aged between 16 and 43 with an average of 31.31 years, pauciparous (>65% of cases) from Dakar center (>75% of cases), housewife with a low socio-economic level (63.1% of cases), married in almost all cases, with HIV profile (in almost all cases) and diagnosed before pregnancy (51.02%). The analysis of the children’s data revealed a predominance of girls (52.04%) with a good birth weight (2964g on average) and a pregnancy carried to term in more than 95% of cases. ARV prophylaxis was almost entirely respected with triple therapy (AZT + 3TC + NVP) in a fixed combination as protocol. Protected breastfeeding (80.21%), including 6 months of exclusive protected breastfeeding, was the rule for the mode of feeding. Three children were diagnosed positive with PCR1 as with serology (3.06%). Discussion and Conclusion: the initiatives and strategies put in place in Senegal have enabled a significant reduction in mother-to-child transmission of HIV and deserve to be supported by insisting on primary prevention, programming and good follow-up of pregnancies, and a good support for HIV-positive women.
文摘Introduction: For several years, the fight against the human immunodeficiency virus (HIV) has been a major public health issue in Africa. Since 2012, Senegal has adopted WHO option B+, consisting of systematic triple therapy for HIV-positive pregnant women, combined with breastfeeding and antiretroviral (ARV) prophylaxis for exposed newborns. It is in this dynamic that we set ourselves the objectives of evaluating the rate of transmission of HIV from mother to child and taking stock of the monitoring of children born to HIV-positive mothers at the Pediatric Department of the CHN of Pikine located in the Dakar suburbs. Methodology: Thus, we conducted a descriptive and analytical cross-sectional cohort follow-up study from 11/25/2014 to 03/09/2022 including all children born to HIV-positive mothers followed at the Pikine CHN since the start of care. Results: We had collected 51 children exposed to HIV and followed in our structure. They were exposed to HIV1 in 92% of cases. The HIV status of the mothers was known before pregnancy in more than half of the cases. The couples were serodiscordant in 56% of cases. The mothers were in clinical stage 1 of the disease in 69.6% of cases and were already under treatment in 47% of cases. The most used treatment regimen was ATRIPLA with Tenofovir (TDF) + Emtracitabine (FTC) + Efavirenz (EFV) in 59% of cases. Compliance was good in the majority of cases. The CD4 count during pregnancy was low in 10.6% of cases. The pregnancy was well followed in only 36.2% of cases. The mothers had given birth in our structure in 91.4% of cases. The vaginal route was found in 72.5% of cases and delivery was carried out by a midwife in 69.4% of cases. The average birth weight was 2733 ± 564. The majority of newborns had received antiretroviral (ARV) prophylaxis after birth, half of them between 12 and 24 hours. The most used therapeutic protocol was Zidovudine (AZT) + Lamivudine (3TC) + Lopinavir/Ritonavir (LPV/r). Protected breastfeeding was the option chosen in 76.8% of cases. The PCR performed at 6 weeks was negative in more than half of the cases. Retroviral serology was carried out after 14 months in 43% of cases. We noted a single positive case with a negative initial PCR, representing an overall transmission rate of 1.96%. Conclusion: Senegal’s current policy targeting EMTCT of HIV is on good momentum with a fairly low transmission rate thanks to screening of pregnant women and prophylaxis with antiretrovirals (ARV) for HIV-positive mothers during pregnancy and for life. And children exposed from birth and during breastfeeding up to 6 weeks with regular monitoring.
基金Supported by National Natural Science Foundation of China,No. 81025015 and No. 30921006
文摘AIM： To determine the therapeutic effect of lamivu- dine in late pregnancy for the interruption of motherto-child transmission （MTCT） of hepatitis B virus （HBV）. METHODS： Studies were identified by searching available databases up to January 2011. Inclusive criteria were HBV-carrier mothers who had been involved in randomized controlled clinical trials （RCTs） with lamivudine treatment in late pregnancy, and newborns or infants whose serum hepatitis B surface antigen （HBsAg）, hepatitis B e antigen （HBeAg） or HBV DNA had been documented. The relative risks （RRs） for inerruption of MTCT as indicated by HBsAg, HBV DNA or HBeAg of newborns or infants were calculated with 95% confidence interval （CI） to estimate the efficacy of lamivudine treatment. RESULTS： Fifteen RCTs including 1693 HBV-carrier mothers were included in this meta-analysis. The overall RR was 0.43 （95% CI, 0.25-0.76; 8 RCTs; Phet- erogeneity= 0.04） and 0.33 （95% CI, 0.23-0.47; 6 RCTs; Pheterogeneity = 0.93） indicated by newborn HBsAg or HBV DNA. The RR was 0.33 （95% CI, 0.21-0.50; 6 RCTs; Pheterogeneity = 0.46） and 0.32 （95% CI, 0.20-0.50; 4 RCTs; Pheterogeneity = 0.33） indicated by serum HBsAg or HBV DNA of infants 6-12 mo after birth. The RR （lamivudine vs hepatitis B immunoglobulin） was 0.27 （95% CI, 0.16-0.46; 5 RCTs; Pheterogeneity = 0.94） and 0.24 （95% CI, 0.07-0.79; 3 RCTs; Pheterogeneity = 0.60） indicated by newborn HBsAg or HBV DNA, respectively. In the mothers with viral load 〈 106 copies/mL after lamivudine treatment, the efficacy （RR, 95% CI） was 0.33, 0.21-0.53 （5 RCTs; Pheterogeneity = 0.82） for the interruption of MTCT, however, this value was not significant if maternal viral load was 〉 106 copies/mL after lamivudine treatment （P = 0.45, 2 RCTs）, as indicated by newborn serum HBsAg. The RR （lamivudine initiated from 28 wk of gestation vs control） was 0.34 （95% CI, 0.22-0.52; 7 RCTs; Pheterogeneity = 0.92） and 0.33 （95% CI, 0.22-0.50; 5 RCTs; Pheterogeneity = 0.86） indicated by newborn HBsAg or HBV DNA. The incidence of adverse effects of lamivudine was not higher in the mothers than in controls （P = 0.97）. Only one study reported side effects of lamivudine in newborns. CONCLUSION： Lamivudine treatment in HBV carrier- mothers from 28 wk of gestation may interrupt MTCT of HBV efficiently. Lamivudine is safe and more efficient than hepatitis B immunoglobulin in interrupting MTCT. HBV MTCT might be interrupted efficiently if maternal viral load is reduced to 〈 106 copies/mL by lamivudine treatment.
基金supported by National Science and Technology Major Project of the Ministry of Science and Technology of China [2015ZX10001001]
文摘In 2016, there were 17.8 million (15.4-20.3 million) women living with HIV/AIDS across the world and the prevalence of reproductive desire among this group was 26%-49%[1]. If pregnant women living with HIV/AIDS are left untreated, the rates of HIV transmission from mother-to-child would range from 14% to 48%, depending on the presence and duration of breastfeeding[2].
基金National Natural Science Foundation of China(81772209 and 81601804).
文摘Mother-to-child transmission(MTCT)of syphilis remains a leading cause of stillbirth and death among neonates in many developing countries.In 2007,World Health Orgernization launched the global elimination of MTCT(EMTCT)of syphilis.Given the high burden of congenital syphilis,China subsequently released the specific national EMTCT policies and programs to reduce MTCT of syphilis.The congenital syphilis incidence rate per 100,000 live births in China has markedly decreased from 69.9 in 2013 to 11.9 in 2019.However,due to the global pandemic of COVID-19,the current measures for eliminating MTCT of syphilis are greatly challenged.In this article,we summarize the strategies and measures for the EMTCT of syphilis in China in the past 20 years,the remarkable achievements by the policy support under the leadership of the government.In the context of COVID-19 pandemics,strengthening emergency response to the regional outbreaks of COVID-19,adopting safe,rapid,early and high-quality clinical care for 100%of pregnant women to receive prenatal syphilis testing services,ensuring the availability of Benzathine penicillin for the treatment,and strengthening the closed-loop management of pregnant women and newborns infected with syphilis are the key measures to determine the effectiveness of MTCT for syphilis.Lessons from China may be valuable for other countries that are planning to eliminate MTCT of syphilis.
文摘The main source of HIV infection in young children is of their mothers, during pregnancy, labor and delivery, or by breastfeeding. The rate of HIV transmission from infected mothers to their newborn children varies from 15% to 40% with one-thirds of these infections was through breastfeeding. This paper examines cross-sectional population-based survey data of HIV test results among mothers and their children in Uganda, Swaziland to estimates of mother-to- child transmission (MTCT) rate of HIV infection. The prevalence of HIV among women aged 15 - 49 who gave birth in the past 5 years in Uganda is 7.3%, and in Swaziland is 37.9%. The HIV prevalence of children who mothers were HIV positive were very similar: 10.3% in Uganda and 11.5% in Swaziland. This association represents the crude rate of MTCT in these two countries at the time of the survey. Presence of HIV antibody in early age (0 - 11 months) is due to both true infection and passive antibody from mothers. The seroconversion dropped nearly half in the second year of age which was likely that many of these children died before reaching the age of 12 - 23 months and passive antibody were gradually cleared at this point. This analysis demonstrated that cross-sectional data can be used to estimate indirectly the magnitude and dynamic of MTCT.
文摘Missed Prevention of Mother-to-Child Transmission of HIV (PMTCT) visits have contributed to the delayed achievement of elimination of mother-to-child transmission of HIV. Missed visits promote attrition from prevention of mother-to-child transmission of HIV program and antiretroviral drug resistance. The purpose of the study was to determine the prevalence of missed PMTCT visits and its associated predictors. A descriptive cross sectional survey was carried out at a District Hospital in Goromonzi, Zimbabwe. Fifty-three women completed closed-ended questionnaires pertaining to PMTCT visits and exposure to PMTCT activities. A total of 24.5% missed at least one scheduled PMTCT visit. Statistically significant predictors of not missing a PMTCT visit were satisfaction with family support (β = −0.73, p = 0.029) and level of satisfaction with PMTCT services (β = −0.00076;p = 0.04). The number of days by which scheduled visits were missed were inversely correlated with visit number (β = −2.99, p = 0.04). Enhanced family support and quality improvement to improve patient satisfaction may reduce missed visits. Availing women with a more active role in PMTCT may also reduce the prevalence of missed visits.
文摘Objective: To determine the knowledge and awareness of Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) and mother-to-child transmission (MTCT) among women attending the antenatal clinic. Methods and Subjects: This was primarily a descriptive cross-sectional study carried out at the antenatal clinic of Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, Nigeria from July 1st, 2010 to October 31st, 2010. Results: The age range of the respondents was 18 - 41 years, (mean 29 ± 5 years). One hundred and forty-nine (92.5%) were married. All the respondents interviewed were aware of HIV/AIDS and 93 (57.8%) had been aware of the disease for ≥5 years. The main sources of information were television 93 (57.8%), radio 77 (47.8%), health workers 53 (32.9%), friends, relatives and neighbors 41 (25.5%) and posters 34 (21.1%). Majority of the respondents identified sexual intercourse as a route of transmission of HIV. Sharing of sharp objects and blood transfusion were identified as routes of transmission by 99 (61.5%) and 82 (50.9%) respectively. One hundred and sixteen (72%) of the respondents knew an apparently healthy person could be living with HIV. Majority of the respondents 125 (77.6%) were aware that HIV can coexist with pregnancy and 120 (74.5%) were aware of MTCT of HIV. Vaginal delivery and breastfeeding were identified as routes of HIV transmission by 44 (27.3%) and 53 (32.9%) of respondents respectively. Delivery by caesarean section was identified as a method of prevention of MTCT by 25 (15.5%) respondents while as many as 48 (29.8%) respondents did not know any method of prevention of MTCT of HIV. Conclusion: This study demonstrates a low level of awareness of methods of prevention of MTCT of HIV among pregnant women booking for antenatal care in our center. Thus, there is the need for adequate counseling about HIV/AIDS and specific aspects of prevention of mother-to-child transmission in our antenatal clinics.
文摘Background: The elimination of HIV transmission from mother to child is currently possible. Cote d’Ivoire, which has a 4.6% HIV prevalence among women, is one of 22 pilot countries for the elimination of mother-to-child transmission of HIV. Since 2015, Cote d’Ivoire has adopted new strategies according to the WHO B+ guidelines. Objective: To identify factors associated with mother-to-child HIV transmission in children born of seropositive mothers managed at Treichville university hospital. Material and methods: A case-control study was conducted in the obstetrics department at Treichville university hospital, between January 2013 and December 2015. It involved children born to mothers infected with HIV, whose first PCR (Polymerase Chain Reaction) result was available during this period. A standardized questionnaire on data related to exposed children and their mother was used. Factors associated with mother-to-child HIV transmission were investigated using logistic regression. Results: A total of 214 HIV-exposed children were included in the study with a sex ratio of 0.9. The majority of the children were born by vaginal route (52.8%) and received post-exposure prophylaxis (88.3%) and replacement feed (51.9%). Their mothers received antiretroviral therapy during pregnancy in 45.3% of the cases. The first PCR was performed at the sixth week of life in 52.3% of cases. The prevalence of HIV infection in exposed children was 7.5% (95% CI = 4.5% - 11.8%). In multivariate analysis, the absence of antiretroviral prophylaxis in children [aOR = 4.3, 95% (1.2 to 15.6), p = 0.03], the mixed feed [aOR = 3.8, 95% (1.1 - 13.1), p < 0.03], the failure to take antiretroviral regimen during pregnancy [aOR = 8.0, 95% CI (1.9 - 32.4), p < 0.003], were associated with mother-child HIV transmission. Conclusion: The mother-to-child HIV transmission rate remains high in our practice. Strategies to reduce situations that do not comply with current recommendations should be considered to prevent mother-to-child HIV transmission.
文摘Evaluation of the effectiveness of the mother-to-child HIV Prevention Program, in Benin in 2016 reported a national rate of 6.7%. The Region of Couffo, within 12 Regions (departments) in the country, had the highest rate of transmission, which was 16.1%. The study aimed to determine transmission rate during pregnancy and delivery as well as the factors associated with it. This is a retrospective and analytical study based on a sample of seventy (70) babies born to HIV-infected mothers in 2016 in Couffo. Key findings showed, there is a perinatal transmission of five percent (5%) and the factors associated with this transmission are: delay in carrying out first antenatal visits at the health facility, low frequency of visits performed versus number requested and appropriate time, poor health condition of mothers during pregnancy, absence or late start of antiretroviral care and treatment during pregnancy, irregular intake of intermittent presumptive treatment at sulfadoxine-pyrimethamine to prevent malaria, a short antiretroviral therapy (less than three months) for mothers before delivery and the default in cleaning mother’s genital tract with betadine after the woman’s water broke.
基金supported by the Key Research and Development Projects of Shaanxi Province(2018ZDXM-SF-037,2024SF-LCZX-14).
文摘The Chinese Clinical Practice Guidelines for the prevention and treatment ofmother-to-child transmission of hepatitis B virus,developed by the Chinese Society of Infectious Diseases of the Chinese Medical Association in 2019,serves as a valuable reference for standardizing the process of preventing mother-to-child transmission in China.As new evidence emerges,it is crucial that timely and regular updates are made to the clinical practice guidelines so as to optimize guidance for clinical practice and research.To this end,the Infectious Disease Physician Branch of Chinese Medical Doctor Association and the Chinese Society of Infectious Diseases of Chinese Medical Association,in collaboration with multidisciplinary experts,have updated the guidelines based on the latest domestic and international research advancements and clinical practice,in order to provide guidance and reference for clinicians andmaternal and child healthcare workers.
文摘The Chinese Clinical Practice Guidelines for the Prevention and Treatment of Mother-to-child Transmission of Hepatitis B Virus,developed by the Chinese Society of Infectious Diseases of the Chinese Medical Association in 2019,serves as a valuable reference for standardizing the prevention of mother-to-child transmission in China.As new evidence continues to emerge,it is essential to update these guidelines regularly to optimize clinical practice and research.To this end,the Infectious Disease Physician Branch of the Chinese Medical Doctor Association and the Chinese Society of Infectious Diseases of the Chinese Medical Association,in collaboration with multidisciplinary experts,have updated the guidelines based on the latest domestic and international research advancements and clinical practices,providing upto-date guidance for clinicians and maternal and child healthcare workers.
基金The work was supported by a grant from Thai Pediatric Gastroenterology,Hepatology and Immunology(TPGHAI)Research Unit,Chulalongkorn University,Bangkok,10330,Thailand.
文摘Mother-to-child transmission(MTCT)of hepatitis B virus(HBV)is the primary cause of chronic HBV infection worldwide.MTCT prevention and antiviral treatment of infected individuals could eliminate this public health burden.Antiviral treatment of hepatitis B surface antigen(HBsAg)-positive pregnant women and immunoprophylaxis with HBV vaccine and hepatitis B immune globulin are the most effective strategies to interfere with MTCT of HBV.However,for worldwide application of those strategies,feasibility,availability,cost,safety,and effectiveness should be considered.Cesarean section and breastfeeding avoidance in hepatitis B e antigenpositive mothers with a high viral load and without antiviral therapy during pregnancy could be an option,but more supporting evidence is needed.HBsAg screening of all pregnant women is recommended when initiating antiviral therapy and immunoprophylaxis for MTCT prevention,except in areas with limited resources.Timely HBV vaccination series administered soon after birth might be the mainstay of prevention.This review aimed to provide a concise update on the effectiveness of available strategies to prevent MTCT of HBV.
文摘Introduction: Acquired immunodeficiency syndrome is one of the leading causes of mortality among women of reproductive age and Mother to Child Transmission of Human immunodeficiency virus is still a challenge affecting many countries. Globally, an estimation of 180,000 children under 15 years acquire the Human immunodeficiency virus every day, and more than 90% of those infections are due to Mother to Child Transmission. The study sought to explore the experiences of mothers on the Elimination of Mother to Child Transmission-HIV services at Mtendere Clinic, Lusaka. Materials and Methods: Qualitative interpretive phenomenology study design was employed using in-depth interviews to collect data from a sample that was selected using purposive sampling technique. Thirteen participants were recruited, and these were HIV-positive mothers at least between the ages of 15 and 49 years and enrolled in the Elimination of Mother To Child Transmission-HIV program. The in-depth interviews were audiotape recorded and transcribed verbatim. Data was analyzed using thematic method. Findings: Three main themes that emerged are;living with HIV, support system and barriers to utilization of Elimination of Mother To Child Transmission-HIV services. Most of the participants expressed having acquired knowledge from the program, and received counselling and support from spouses, family as well as health personnel at Mtendere health facility which culminated into a positive experience and enhanced their uptake of the Elimination of Mother to Child Transmission-HIV services. However, barriers to service utilization were identified and these included fear of stigma, negative attitudes from health workers, long waiting times, lack of support and lack of transport to the health facility. Conclusion: Interventions such as community awareness campaigns on Elimination of Mother To Child Transmission-HIV, male involvement and implementing mother-to-mother peer support strategies in Elimination of Mother To Child Transmission-HIV service utilization should be prioritized so as to alleviate stigma and enhancing a positive experience for these mothers thus reducing on the Mother to Child HIV Transmission burden and mortality rates.
基金Supported by Rumah Program 2024 of Research Organization for Health,National Research and Innovation Agency(BRIN)of Indonesia.
文摘Hepatitis B virus(HBV)infection is a major public health burden.In HBV endemic regions,high prevalence is also correlated with the infections acquired in infancy through perinatal transmission or early childhood exposure to HBV,the socalled mother-to-child transmission(MTCT).Children who are infected with HBV at a young age are at higher risk of developing chronic HBV infection than those infected as adults,which may lead to worse clinical outcome.To reduce the incidence of HBV MTCT,several interventions for the infants or the mothers,or both,are already carried out.This review explores the newest information and approaches available in literature regarding HBV MTCT prevalence and its challenges,especially in high HBV endemic countries.This covers HBV screening in pregnant women,prenatal intervention,infant immunoprophylaxis,and postvaccination serological testing for children.
基金supported by the grant from the National Natural Science Foundation of China(Nos.71874003,71934002,and 81703240).
文摘China has the world’s largest burden of hepatitis B virus(HBV)infection,but the country has made considerable progress in preventing its mother-to-child transmission(MTCT)in the past three decades.This feat is made possible due to the high coverage of birth-dose hepatitis B vaccine(HepB,>95%),hepatitis B surface antigen(HBsAg)screening for pregnant women(>99%),and hepatitis B immunoglobulin plus HepB for newborns whose mothers are HBsAg positive(>99%).Studies on the optimal antiviral treatment regimen for pregnant women with high HBV-DNA load have also been conducted.However,China still faces challenges in eliminating MTCTof HBV.The overall HBsAg prevalence among pregnant women is considered an intermediate endemic.The prevalence of HBsAg among pregnant women from remote,rural,or ethnic minority areas is higher than that of the national level because of limited health resources and public health education for HBV.The coverage for maternal and child healthcare and immunization services should be improved,especially in western regions.Integration of current services to prevent MTCTof HBV with other relevant health services can increase the acceptability,efficiency,and coverage of these services,particularly in remote areas and ethnic minority areas.By doing so,progress toward key milestones and targets to eliminate hepatitis B as the main public health threat by 2030 can be achieved.
基金the China Foundation for Hepatitis Prevention and Control(CFHPC)and National Natural Science Foundation of China(Grant No.81673243)the Chinese National Research Grant of the Thirteenth Five-Year Plan for the Key Projects in Infectious Diseases(Grant No.2017ZX10201201).
文摘Background and Aims:The World Health Organization(WHO)Western Pacific Region set a target of eliminating mother-to-child transmission(MTCT)of hepatitis B virus(HBV)by 2030.To assess the feasibility of this target in China,we carried out an epidemiological study to investigate the status quo of MTCT in the real-world setting.Methods:One thousand and eight hepatitis B surface antigen-positive preg-nant women were enrolled at 10 hospitals.Immunoprophy-laxis was administered to infants.In addition,mothers with HBV DNA level>2,000,000 IU/mL were advised to initiate antiviral therapy during late pregnancy.A health application called SHIELD was used to manage the study.Results:Nine hundred and five of the enrolled mothers,with 924 infants,completed the follow-up.Birth-dose hepatitis B vaccine and hepatitis B immunoglobulin were received by 99.7%and 99.7%of infants,respectively,within 24 h after birth.There ;were 446 mothers who received antiviral therapy,including 72.3%of the mothers with HBV DNA level>2,000,000 IU/mL and 21.0%of the mothers with HBV DNA level<2,000,000 IU/mL.Eight infants were infected with HBV.The overall rate of MTCT was 0.9%.Birth defects were rare(0.5%among in-fants with maternal antiviral exposure versus 0.7%among infants without exposure;p=1.00).Conclusions:The MTCT rate was lower than the WHO Western Pacific Region elimina-tion MTCT target in this real-world study,indicating that a comprehensive management composed of immunoprophy-laxis to infants and antiviral prophylaxis to mothers may be a feasible strategy to achieve the 2030 WHO elimination goal.
基金This work was supported by Beijing Chen Jumei Foundation,Key R&D Program of Shaanxi(S2018-YF-ZDSF-0240)National Natural Science Foundation of China Grants(81670537,81770594)+1 种基金Chinese National Research Grant of the Thirteenth Five-Year Plan for Key Projects in Infectious Diseases(13th Five Year,ChinaProject No.2017ZX10202202-002006).The meeting expenses of the Guidelines Steering Committee and the Guidelines Development Panel were funded by Beijing Chen Jumei Foundation.
文摘To develop the evidence-based guidelines for managing mother-to-child transmission of hepatitis B virus in China, a multidisciplinary guideline development group was estab-lished. Clinical questions were identified from two rounds of surveys on the concerns of first-line clinicians. We conducted a comprehensive search and review of the literature. A grading of recommendations' assessment, development, and evaluation system was adopted to rate the quality of evidence and the strength of recommendations. Recommen-dations were formulated based on the evidence, overall balance of benefits and harms (at individual and population levels), patient/health worker values and preferences, re-sources available, cost-effectiveness, and feasibility. Even-tually, recommendations related to 13 main clinical concerns were developed, covering diagnostic criteria, treatment in-dications, antiviral therapy choice, timing to initiate and discontinue treatment, immunoprophylaxis strategy at birth, and how to deal with special situations, such as unintended pregnancy, assisted reproduction, and breastfeeding. The guidelines are intended to serve as guidance for clinicians and patients, to optimize the management of majority of pregnant women who are positive for hepatitis B surface antigen. Guideline registration: International Practice Guide Registration Platform (IPGRP-2018CN040).
文摘Prevention of mother-to-child transmission(PMTCT)of HIV with highly active antiretroviral therapy(HARRT)allows the HIV^+pregnant mothers to have vaginal delivery and breastfeed.Here we investigated the maternal plasma immunoglobulin,cytokine secretion and the outcome of the exposed infants among the HIV^+HAART treated pregnan women in Nigeria.In this study,different plasma immunoglobulins and cytokines were measured in the HIV^+HAART treated pregnant mothers.Pooled culture supernatants of B and T lymphocytes showed lower levels of IFN-γ,IL-10 and IL-4.There were lower IFN-γand IL-10 secretions at 1st trimester;however,IL-10 continued to be lower throughout 2nd and 3rd trimesters.TNF-αsecretion significantly decreased as pregnancy progressed to term.There were high plasma IgG and low IgM in the HIV^+HAART treated pregnant women.Plasma IgG was high during 1st and 3rd trimesters.After one year of follow up,all the exposed children were seronegative for HIV-1 and HIV-2.Vaginal delivery and breastfeeding among HIV^+HAART treated mothers have shown to be safe.The use of HAART by the infected mothers and the use of septrin and niverapin by the exposed infants prevented mother to-child transmission of HIV.
