A Real-world Prospective Study of Mother-to-child Transmission of HBV in China Using a Mobile Health Application (Shield 01)

Abstract

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 pregnant women were enrolled at 10 hospitals. Immunoprophylaxis 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 infants 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 elimination MTCT target in this real-world study, indicating that a comprehensive management composed of immunoprophylaxis to infants and antiviral prophylaxis to mothers may be a feasible strategy to achieve the 2030 WHO elimination goal.

Incidence, pattern and severity of abnormal liver blood tests among hospitalised patients with SARS-COV2 (COVID-19) in South Wales

“…This observation is in contrast to other studies that have suggested that liver injury is predominantly due to an elevation in ALT or aspartate aminotransferase (AST) and that rises in ALP and bilirubin are relatively rare 10–12 …”

Association of liver steatosis and fibrosis with clinical outcomes in patients with SARS-CoV-2 infection (COVID-19)

“…( 2 ) Currently, there is no consensus on the exact mechanism of liver injury, but it may be related to: 1) direct cytopathic damage, 2) systemic inflammatory response, 3) liver hypoxia and ischemia, 4) acute-on-chronic liver injury, or 5) drug-induced liver injury. ( 18 ) It has been recently demonstrated the presence of SARS-CoV-2 virions inside hepatocytes( 19 ) and that death of cholangiocytes induced by SARS-CoV-2. ( 20 ) Even though it has not been demonstrated in humans, hepatic steatosis in mice models increases hepatic ACE2 mRNA( 21 ), which could explain, at least in theory, the relationship between SARS-CoV-2 and liver injury in MAFLD patients.…”

Transaminases are Potential Biomarkers of Disease Severity in COVID-19 Patients: A Single-Center Experience

“…Interestingly, Jin et al [ 5 ] also found a higher incidence of transaminitis in patients with GI symptoms, which could have indirectly caused worsening disease activity. Thus, data from all these studies does highlight the fact that the occurrence of abnormal liver function tests during hospitalization for COVID-19 is quite common and clinically significant liver injury or liver failure is rare [ 16 - 18 ]. However, it is still unclear if the elevated transaminases during hospitalization are indeed a surrogate clinical maker for higher levels of viremia.…”