title: An algorithm for risk assessment and intervention of mother to child transmission of hepatitis B virus.
abstract: OBJECTIVE
  Despite immunoprophylaxis, mother to child transmission (MTCT) of hepatitis B virus (HBV) still occurs in infants born to hepatitis B surface antigen (HBsAg)-positive mothers. We analyzed methods of risk assessment and interventions for MTCT.
  
  
  METHODS
  We reviewed 63 articles and abstracts published from 1975-2011 that were relevant to MTCT; articles were identified using the PubMed bibliographic database.
  
  
  RESULTS
  Administration of HB immunoglobulin and HB vaccine to infants at birth (within 12 hours), followed by 2 additional doses of vaccines within 6-12 months, prevented approximately 95% of HBV transmission from HBsAg-positive mothers to their infants. However, HBV was still transmitted from 8%-30% of mothers with high levels of viremia. It is important to assess the risk for MTCT and identify mothers who are the best candidates for intervention. The most important risk factor is maternal level of HBV DNA >200,000 IU (10(6) copies)/mL; other factors include a positive test result for the HB e antigen, pregnancy complications such as threatened preterm labor or prolonged labor, and failure of immunoprophylaxis in prior children. Antiviral therapy during late stages of pregnancy is the most effective method to reduce transmission from mothers with high levels of viremia, but elective cesarean section might also be effective. Antepartum administration of HB immunoglobulin, giving infants a double dose of HB vaccine, or avoiding breastfeeding had no impact on MTCT.
  
  
  CONCLUSIONS
  HBsAg-positive mothers should be assessed for risk of MTCT, and infants should receive immunoprophylaxis. Pregnant women with levels of HBV DNA >200,000 IU/mL should be considered for strategies to reduce the risk for MTCT. We propose an algorithm for risk assessment and patient management that is based on a review of the literature and the opinion of a panel of physicians with expertise in preventing MTCT.
authors.affiliation: Division of Liver Diseases, Mount Sinai Medical Center, Mount Sinai School of Medicine, New York, New York 11355, USA. cpan11355@yahoo.com
authors.forename: Calvin Q
authors.initials: CQ
authors.lastname: Pan
authors.forename: Zhong-Ping
authors.initials: ZP
authors.lastname: Duan
authors.forename: Kalyan R
authors.initials: KR
authors.lastname: Bhamidimarri
authors.forename: Huai-Bin
authors.initials: HB
authors.lastname: Zou
authors.forename: Xiao-Feng
authors.initials: XF
authors.lastname: Liang
authors.forename: Jie
authors.initials: J
authors.lastname: Li
authors.forename: Myron J
authors.initials: MJ
authors.lastname: Tong
mesh_terms: D000465:Algorithms; D019411:Clinical Laboratory Techniques / Q000379:methods; D005260:Female; D006509:Hepatitis B / Q000175:diagnosis* / Q000635:transmission*; D006801:Humans; D007167:Immunotherapy / Q000379:methods; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D018743:Perinatal Care / Q000379:methods; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis*; D018570:Risk Assessment; D014611:Vaccination / Q000379:methods