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Systematic review with meta‐analysis: the risk of mother‐to‐child transmission of hepatitis B virus infection in sub‐Saharan Africa
Author(s) -
Keane E.,
Funk A. L.,
Shimakawa Y.
Publication year - 2016
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.13795
Subject(s) - medicine , hepatitis b virus , transmission (telecommunications) , meta analysis , hepatitis b , observational study , pediatrics , relative risk , hbsag , demography , immunology , virus , confidence interval , electrical engineering , engineering , sociology
Summary 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 ( HB sAg) and e antigen ( HB eAg), and 5–30% among HB sAg‐positive HB eAg‐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 HB eAg 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 HB sAg or HBV DNA between 3 and 12 months of age. Results Fifteen articles from 11 African countries were included. Among HB eAg‐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 HB eAg‐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.