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Aliment Pharmacol Ther. 2016 Nov;44(10):1005-1017. doi: 10.1111/apt.13795. Epub 2016 Sep 15.

Systematic review with meta-analysis: the risk of mother-to-child transmission of hepatitis B virus infection in sub-Saharan Africa.

Author information

1
École Pasteur/CNAM de Santé Publique, Paris, France.
2
Mater Misercicordiae University Hospital, Dublin, Ireland.
3
Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France.
4
Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France. yusuke.shimakawa@gmail.com.

Abstract

BACKGROUND:

The risk of mother-to-child transmission of hepatitis B virus (HBV) has been quoted as 70-90% among women positive for hepatitis B surface antigen (HBsAg) and e antigen (HBeAg), and 5-30% among HBsAg-positive HBeAg-negative women. These risks are derived from Asia; little is known about sub-Saharan Africa.

AIM:

To determine the risk of mother-to-child transmission in sub-Saharan Africa, according to maternal HBeAg and type of prophylaxis.

METHODS:

We searched Medline, Global Health, Embase, African Journals Online and African Index Medicus. We included observational or interventional studies that enrolled infants of HBV-infected women, and that tested for HBsAg or HBV DNA between 3 and 12 months of age.

RESULTS:

Fifteen articles from 11 African countries were included. Among HBeAg-positive women, the pooled risk was 38.3% (95% CI: 7.0-74.4%) without prophylaxis, which was significantly lower than the lower bound of 70-90% risk in the literature (P = 0.007). Among HBeAg-negative women, the pooled risk was 4.8% (95% CI: 0.1-13.3%) without prophylaxis, which lays within the lower range of the 5-30% risk in Asia. By extrapolating the pooled transmission risks to the number of births to infectious mothers, an estimated 1% of newborns (n = 367 250) are annually infected with HBV at birth in sub-Saharan Africa.

CONCLUSIONS:

Compared to Asia, the risk of mother-to-child transmission is low in sub-Saharan Africa. However, the annual number of infants perinatally infected with HBV is twice the number of incident paediatric HIV infections in sub-Saharan Africa (n = 190 000). This highlights the importance of preventing mother-to-child transmission of HBV in sub-Saharan Africa, which has been long neglected.

PMID:
27630001
DOI:
10.1111/apt.13795
[Indexed for MEDLINE]
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