Hbs antigen, what prevalence among pregnant women in Morocco? Preliminary results of a prospective study conducted in Hospital University Hassan II, Fez

doi:10.4236/ojgas.2013.37054

Paper Menu >>

Journal Menu >>

Open Journal of Gastroenterology, 2013, 3, 311-313 OJGas

http://dx.doi.org/10.4236/ojgas.2013.37054 Published Online November 2013 (http://www.scirp.org/journal/ojgas/)

Hbs antigen, what prevalence among pregnant women in

Morocco? Preliminary results of a prospective study

conducted in Hospital University Hassan II, Fez*

Laila Sedreddine, Meryem Sekkat, Sidi Adil Ibrahimi, Noureddine Aqodad

Department of Hepatology and Gastroenterology, Hassan II University Hospital of Fez, University Sidi Mohamed Ben Abdellah, Fez,

Morroco

Email: [email protected]

Received 11 October 2013; revised 5 November 2013; accepted 12 November 2013

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

The chronic viral hepatitis B is a public health prob-

lem and remains a global challenge with 350 million

carriers of HBs antigen (HBsAg). The prevalence of

HBsAg varies from one country or continent to an-

other. In France, it is estimated to be 0.5%. In Mo-

rocco, the data are rare but some studies have esti-

mated the prevalence to be 2.5%. Our aim is to esti-

mate the prevalence of HBsAg among women who

have recently given birth at the maternity CHU Has-

san II of Morocco Fez, and to describe the epidemi-

ological profile and risk facto rs for infe ction. In preg-

nancy, infection with hepatitis B virus (HBV) is do-

minated by the risk of mother to child transmission

(vertical transmission), which can be avoided by se-

rovaccination of the newborn. The search for HBsAg

should be performed in all pregnant women.

Keywords: HBs Antigen; Prevalence; Pregnancy

1. INTRODUCTION

Prenatal screening for hepatitis B is not currently ques-

tioned as the benefit of serovaccination of children born

to mothers carrying HBsAg is firmly established [1].

However, this recommendation has not yet been system-

atically applied, particularly in the areas of higher en-

demicity where vaccination policies are little or not im-

plemented for economic reasons. This justifies screening

for HBV infection in pregnant women and the systematic

newborns’ serovaccination to limit the spread of this in-

fection. Pregnant patients with high viral load, some

studies have demonstrated the benefit of antiviral treat-

ment allowing the reduction of the risk of transmission in

utero [2]. In Morocco, little epidemiological testing are

available but it is estimated that the prevalence of

HBsAg in the general population is 1.5% [3]. To our

knowledge ther e are no data on the prevalence of hepati-

tis B among pregnant women in Morocco. The aim of

our study is to find out whether the pregnant woman is

the main reservoir for the transmission of this virus in

our context so as to propose in this case a strategy

against HBV especially since it is a chemoprophylaxis

highly effective.

2. PATIENTS AND METHODS

This is a prospective, observational single center study

on the prevalence of HBsAg in pregnant women in hos-

pital university Hassan II of Fez, conducted ov er a period

of 18 months (February 2010-August 2011), and con-

ducted within the hepato-gastroenterology service, ma-

ternity center and obstetrics and immuno-serology labo-

ratory of the University Hospital Hassan II of Fez.

2.1. Inclusion Criteria

1) Pregnancy scalable for at least 4 months.

2) Informed Agreement gestating.

2.2. Exclusion Criteria

1) Chronic HBV carrying known by pregnant.

2) Carrying another viral marker known by pregnant

(HCV, HIV).

2.3. Terms of the Study

*Competing interest: The authors declare that they have no competing

interests.

Author’s contribution: All authors wrote, read and approved the manu-

script.

After an informed consent by the patients, the various

parameters were collected prospectively for all patients.

OPEN ACCESS

L. Sedreddine et al. / Open Journal of Gastroenterology 3 (2013) 311-313

312

Blood samples were taken by a trained nurse for this

study during a prenatal consultation (2nd or 3rd quarter

view) or at the time of delivery. HBsAg assay was per-

formed in the laboratory of immuno-serology of the

University Hospital Hassan II of Fez by manual ELISA.

3. RESULTS

During the study period, 350 parturient have been in-

cluded, their average age was 29 years [16 - 46 ± 6]. The

average age of the current pregnancy was 39 [17 - 45 SA

± 4] weeks of amenorrhea. The enrollment rate was

35.5%. All these women had had at least one pregnancy

in 36% of cases (127/350) with an average of 2.5 [0 - 9].

Eighty-two women had received dental care (23.5%) of

which 16% were traditional care. One hundred and two

women had received parenteral injections (29%). Six

pregnant were transfused (1.7%), 16.33% had a piercing

(N = 57), 3.15% had a tattoo (N = 11) (Figure 1).

Among our patients, 58% of women have given birth

vaginally (N = 74) and 24.4% have given birth by cae-

sarean section. Sixty-three pregnant unaware of their

HIV status vis-à-vis the HBV (18%) about 17 2 who wer e

not vaccinated (4 9%).

HBsAg was found in two of our pregnant (0.5%). No

vaccination against hepatitis B prior to pregnancy was

observed in any of our seronegative patients as the two

HBsAg positive patients.

4. DISCUSSION

The HBV infection is one of the most common infections

in the world with about 350 million chronic carriers of

HBs antigen (HBsAg): 5% of th e general population is a

reservoir for the perpetuation of viral transmission [2,3].

In some countries, the HBsAg is required in the sixth

month of pregnancy. [4] This testing should be per-

formed in all pregnant women, even those who have

been vaccinated against HBV, as vaccination could be

performed while the woman was already chronic carriers

of HBV. The detection of HBsAg in pregnant women

should always lead to a well standardized approach [4].

The detection the presence of HBsAg in pregnant women

Figure 1. Risk factors of viral contamination in our serie.

should always lead to a well standardized approach [4].

Firstly, it’s important to inform the mother of this infec-

tion and the necessity of the serovaccination of her child

at birth. Secondly, a serological survey for HBV (HBsAg,

anti-HBc and anti-HBs) should be proposed in the en-

tourage of the pregnant woman. Finally, a further as-

sessment should be performed in pregnant women, and

hepatology consultation should be provided.

The prevalence of HBsAg in pregnant women in the

world is variable (Table 1). These prevalences are proba-

bly consistent with the level of endemicity of HBV in-

fection in these countries.

In our series, the prevalence of HBsAg on 350 preg-

nant was 0.5%.Our study allowed us to assess the preva-

lence of HBsAg in pregnant women, and this result is

identical to that found in countries geographically and

demographically close to Morocco, like Tunisia, and

identical to the results of some French series. Moreover,

our study allowed us to detect and to treat two cases of

hepatitis B in pregnant women.

Four modes of transmission from mother to child can

be observed: [10]

1) Transmission in utero.

2) Transmission by amniocentesis and mode of deliv-

ery.

3) Neonatal transmission.

4) Transmission postnatal.

The hepatitis B virus is detectable in breast milk by

PCR and breastfeeding could theoretically be a mode of

transmission. This may be due to the ingestion of the

virus, or by contact with excoriations or abscesses pre-

sent on the nipple. Insofar newborns are properly immu-

nized; there is no contraindication to breastfeeding [10].

The prevention of mother to child transmission of

hepatitis B virus (HBV) is a measure of universal public

health. The risk of mother to child transmission can in-

deed reach 90% depending on the viral load of the

mother [2]. More than 90% of infected newborns de-

velop chronic infection with subsequent risk of cirrhosis

and hepato-cellular carcinoma [2,11]. Newborn of chro-

nic carrier mothers’ serovaccination is an effective meas-

Table 1. Literature’s review.

Series Total

Number

AgHB+ Percentage

AgHB+ (%)

Burkina Faso [5] 492 84 17 %

Tanzanie [6] 980 62 6.3 %

Tunisie [7] 2023 92 4 %

Limoges 1999 [8] France 913 5 0.54 %

Picardie 2010 [9] France 1178 2 0.18 %

Our serie 350 2 0.5 %

L. Sedreddine et al. / Open Journal of Gastroenterology 3 (2013) 311-313

313

ure to fight against this mode of transmission [12]. In

France for example, the obligation to detect HBsAg in

the fourth prenatal examination (sixth month of preg-

nancy) was established in 1992 by decree [13]. The anti-

HBs immunoglobulin administration and vaccination in

the first 24 hours after birth are recommended for infants

whose mother is a carrier of HBsAg [11]. Recent publi-

cations also suggest that treatment with lamivudine dur-

ing the last trimester of pregnancy in pregnant women

with high viral load reduces the risk of transmission in

utero and perinatal of HBV whether this drug is given in

combination with serovaccination [11]. Our study allowed

detecting two cases of hepatitis B in pregnant women in

the University Hospital Hassan II of Fez, which shows

that the detection of HBsAg during pregnancy should

absolutely be part of prenatal diagnosis. The continuation

of the study would recruit a sufficient number of patients

to specify the precise prevalence of this virus in pregnant

women, identify risk factors and to adopt a strategy and

effective control not only in Fez and regions but nation-

ally.

OPEN ACCESS

5. CONCLUSION

The current situation is worrying given the severe short-

age of vaccine policy. The public health actions should

be assessed, strengthened and accompanied. It is impor-

tant to promote screening for HBsAg and premarital

pregnancy. The continuity of the study would recruit a

sufficient number of patients to determine the exact

prevalence of this virus in pregnant women, and to iden-

tify risk factors and would allow us to adopt a strategy

and effective control not only in Fez and regions but also

in the whole nat i on.

REFERENCES

[1] Haute Autorité de Santé (2009) Dépistage prénatal de

l’hépatite virale B.

[2] Pol, S. (2010) L’hépatite B demeure un problème de

santé publique en France. Archives de Pédiatrie, 17, 1-5.

http://dx.doi.org/10.1016/S0929-693X(10)70007-5

[3] Ezzikouri, S., et al. (2008) Genotype determination in

Moroccan hepatitis B chronic carriers. Infection, Genetics

and Evolution, 8, 306-312.

http://dx.doi.org/10.1016/j.meegid.2008.01.010

[4] Back, Y. (2008) Hépatitevirale B etgrossesse. Gastro-

entérologie Clinique et Biologique, 32, S12-S19.

[5] Collenberg, E., et al. (2006) Seroprevalence of six dif-

ferent viruses among pregnant women and blood donors

in rural and urban Burkina Faso: A comparative analysis.

Journal of Medical Virology, 78, 683-692.

http://dx.doi.org/10.1002/jmv.20593

[6] Menendez, C., et al. (1999) Prevalence and mother-to-in-

fant transmission of hepatitis viruses B, C, and E in

Southern Tanzania. Journal of Medical Virology, 58,

215-220.

http://dx.doi.org/10.1002/(SICI)1096-9071(199907)58:3<

215::AID-JMV5>3.0.CO;2-K

[7] Hannachi, N., et al. (2009) Hépatite virale B chez les

femmes enceintes tunisiennes: Facteurs de risque et in-

térêt de l’étude de la réplication virale en cas d’antigène

HBe négatif. Pathologie Biologie, 57, e43-e47.

http://dx.doi.org/10.1016/j.patbio.2008.04.017

[8] Denis, F., et al. (1999) Dépistage de l’Ag HBs chez les

femmes enceintes: Quel taux de couverture? Enquête en

Haute-Vienne, 33.

[9] Braillon, A., et al. (2010) Grossesse et hépatite B en

Picardie: Traçabililité du dépistage et prévalence. Gynéc-

ologie Obstétrique & Fertilité, 38, 13-17.

http://dx.doi.org/10.1016/j.gyobfe.2009.11.002

[10] Pol, S., et al. (2005) Virus de l’hépatite B (VHB) et

grossesse. AFEF.

[11] Recommandations de pratiques cliniques de l’EASL.

Prise en charge de l’hépatite chronique B (2009) EASL

clinical practice guidelines. Management of chroniche-

patitis B. Gastroentérologie Clinique et Biologique, 33,

539-554.

[12] Yoshizawa, H. (2003) Combined passive and active im-

munoprophylaxis for preventing perinatal transmission of

the hepatitis B virus carrier state in Shizuoka, Japan dur-

ing 1980-1994. Journal of Gastroenterology and Hepato-

logy, 18, 943-949.

http://dx.doi.org/10.1046/j.1440-1746.2003.03092.x

[13] Circulaire DGS/SD5C/DHOS/E2 no 2004-532 du 10

novembre 2004 relative au dépistage obligatoire au cours

de la grossesse de l’antigène HBs du virus de l’hépatite B

(VHB) et à la vaccination des nouveau-nés de femmes

porteuses de l’antigène du virus de l’hépatite B NOR.