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Hepatitis B Dalam Kehamilan
Hepatitis B Dalam Kehamilan
Type of Hepatitis
A
A B
B C
C D
D E
E
Source of feces blood/ blood/ blood/ feces
virus blood-derived blood-derived blood-derived
body fluids body fluids body fluids
Fulminant
deaths/year 100 150 ? 35
Chronic 0 1-1.25 3.5
infections million million 70,000
80
60 60
Chronic Infection
40 40
20 20
Symptomatic Infection
0 0
Birth 1-6 months 7-12 months 1-4 years Older Children
and Adults
Age at Infection
Elimination of Hepatitis B Virus
Transmission in the United States
Strategy
• Prevent perinatal HBV transmission
• Routine vaccination of all infants
• Vaccination of children in high-risk groups
• Vaccination of adolescents
– all unvaccinated children at 11-12 years of age
– “high-risk” adolescents at all ages
• Vaccination of adults in high-risk groups
Interpretation of the Hepatitis B Panel
Tests Results Interpretation
HBsAg negative Susceptible
anti-HBc negative
anti-HBs negative
HBsAg negative Immune due to natural infection
anti-HBc positive
anti-HBs positive
HBsAg negative Immune due to hepatitis B vaccination
anti-HBc negative
anti-HBs positive
HBsAg positive Acutely
anti-HBc positive infected
IgM anti-HBc positive
anti-HBs negative
HBsAg positive Chronically
anti-HBc positive infected
IgM anti-HBc negative
anti-HBs negative
HBsAg negative 1. Might be recovering from acute HBV infection.
anti-HBc positive 2. Might be distantly immune and test not sensitive enough to detect very low level of anti-HBs in serum.
anti-HBs negative 3. Might be susceptible with a false positive anti-HBc.
4. Might be undetectable level of HBsAg present in the serum and the person is actually chronically infected
Definitions
• Hepatitis B Surface Antigen (HBsAg): A serologic
marker on the surface of HBV. It can be detected in
high levels in serum during acute or chronic hepatitis.
The presence of HBsAg indicates that the person is
infectious. The body normally produces antibodies to
HBsAg as part of the normal immune response to
infection.
• Hepatitis B Surface Antibody (anti-HBs): The presence
of anti-HBs is generally interpreted as indicating
recovery and immunity from HBV infection. Anti-HBs
also develops in a person who has been successfully
vaccinated against hepatitis B.
Definitions
• Total Hepatitis B Core Antibody (anti-HBc):
Appears at the onset of symptoms in acute
hepatitis B and persists for life. The
presence of anti-HBc indicates previous or
ongoing infection with hepatitis B virus
(HBV) in an undefined time frame.
• IgM Antibody to Hepatits B Core Antigen
(IgM anti-HBc): This antibody appears during
acute or recent HBV infection and is present
for about 6 months.
Transmission of HBV
• Transmissibility 100 times greater than HIV1
• Vertical
– Infected mother-to-infant during first year of life
• Earlier age at exposure increases the risk of
developing chronic HBV infection2
1. WHO-CSR
2. WHO and CDC fact sheets, available at www.who.int and www.cdc.gov
INTRAUTERINE INFECTION OF HBV
• Chronicity : 100%
Tang JR et al. J Pediatr 1998 ; 133: 374
Lamivudine Therapy During Pregnancy to Prevent
Perinatal Transmission of HBV Infection