Razi Journal of Medical Sciences

fa شیوع عفونت هپاتیت B در نوزادان ایمن شده متولد شده از مادران HBsAg مثبت The Prevalence of Hepatitis B Infection in Immunized Infants Born to Mothers with HBsAg Positive میکروبیولوژی Microbiology مروري review article <div style="text-align: justify;">زمینه و هدف: هپاتیت ویروسی دارای طیف گسترده‌ای از تظاهرات بالینی است و می‌تواند از حالت بدون علامت و یا دارای علائم اندک تا ناکارایی کبدی و نهایتاً مرگ متغیر باشد. یکی از مسیرهای اصلی انتقال ویروس هپاتیت B، انتقال از مادر به جنین به شمار می‌رود که در سال‌های اخیر با فراگیری روش‌های ایمن‌سازی، میزان انتقال از این مسیر کاهش یافته است. هدف از مطالعه حاضر بررسی شیوع عفونت هپاتیت B در نوزادان ایمن شده‌ی متولد شده از مادران مبتلا به هپاتیت B مزمن می باشد. روش کار: در این مطالعه، پایگاه‌های اطلاعاتی PubMed، Scopus، Web of Science، Google Scholar، SID، Magiran و IranDoc جستوجو شده و مقالات و مطالعات مرتبط با عنوان، در بازه‌ی زمانی 2002 تا 2024 مورد ارزیابی قرار گرفتند. یافته‌ها: تعداد 40 مطالعه بر اساس معیارهای مورد نظر وارد مطالعه حاضر شدند که در این میان مبتلایان OBI (Occult Hepatitis B infection) در انتقال خون از 0.04 تا 5.4% گزارش شد. در این میان، در نوزادان متولد شده از مادران HBsAg مثبت، علی رغم واکسیناسیون و دریافت پروفیلاکسی ضدویروسی، شیوع ابتلا به HBV از 7.5 تا 42% گزارش شده است. نتیجه‌گیری: براساس مطالعات بررسی شده در مطالعه حاضر شیوع OBI در کودکان متولد شده از مادران CHB یا HBsAg مثبت در ایران از 3.1 تا 21% علی رغم پروفیلاکسی، واکسیناسیون HBV و ایمونیزاسیون غیرفعال (IVIG) در نوزادان می باشد و این میزان در جهان از 6.4 تا 42% در جوامع مختلف گزارش شده است. یکی از مسیرهای اصلی انتقال ویروس هپاتیت B، انتقال از مادر به جنین به شمار می‌رود که در سال‌های اخیر برخی بر تأثیر مثبت واکسن و ایمن‌سازی غیرفعال تأکید کرده و برخی دیگر نیز، تأثیر آن را چشمگیر نمی‌دانند. انجام مطالعات بیشتر در جوامع گوناگون، به منظور دستیابی به نتیجه‌ای متقن و راهنمایی سیاست‌گذاران حوزه‌ی سلامت، ضروری به نظر می‌رسد.</div> <div style="text-align: justify;">Background & Aims: Viral hepatitis is a leading cause of death worldwide and is caused by five liver related viruses: hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), and hepatitis E virus (HEV) (1). These viruses, which are referred to as hepatotropic, are considered a major public health threat (1, 2). Among them, blood-borne viruses, including HBV and HCV, have the potential to cause significant morbidity and mortality worldwide (1, 3). These two viruses were responsible for 1.3 million deaths in 2020, with the highest prevalence of HBV in Africa and the highest prevalence of HCV in Eastern Europe, followed by Central Asia (4). Viral hepatitis has a wide spectrum of clinical manifestations and can range from asymptomatic or mild symptoms to liver failure and ultimately death (1, 5). Occult hepatitis B infection (OBI) is the presence of replicating hepatitis B virus DNA in the liver or blood of individuals in whom HBsAg is undetectable (6, 7). OBI is more prevalent in areas with high HBV prevalence but has been reported in all regions of the world (8). According to the World Health Organization (WHO) report in 2019, 296 million people were infected with chronic hepatitis B (CHB), which leads to 820,000 deaths annually, most of which are due to liver cirrhosis and hepatocellular carcinoma (HCC) (6). The projected incidence and mortality rate from 2015 to 2030 is shown in Figure 1. Accordingly, it is estimated that the incidence and mortality rate of hepatitis B will decrease (9). Hepatitis B virus is 50 to 100 times more transmissible and infectious than human immunodeficiency virus (HIV) (9). One of the main routes of transmission of hepatitis B virus is from mother to fetus, which in recent years has decreased with the widespread use of immunization methods, including antiviral treatments, vaccines, immunoglobulins, and post-vaccination monitoring (10-13). The aim of the present study was to investigate the prevalence of hepatitis B infection in immunized infants born to mothers with chronic hepatitis B. Methods: The present study was conducted using a search strategy based on relevant keywords and considering all authoritative sources to ensure comprehensive research coverage. This search will include national and international databases such as PubMed, Scopus, Web of Science, Embase, Google Scholar, as well as Persian sources such as MagIran, SID, and Irandoc. Keywords and search terms include MeSH terms and keywords related to the research question including OBI, occult hepatitis B Infection, HBV, Hepatitis B, occult hepatitis B infection, hepatitis B, occult infection, occult hepatitis B, and a combination of them, and articles and studies related to the title were evaluated between 2002 and 2024. Inclusion and exclusion criteria were precisely specified and included studies that investigated occult hepatitis B infection in Iranian populations and provided quantitative data on prevalence, diagnostic methods, or clinical outcomes. After searching, studies were assessed based on title and abstract, and full texts of selected studies were extracted for further review. Studies related to occult hepatitis B virus infection in Iranian populations, especially pregnant women, were selected and quantitative data on prevalence, diagnostic methods, or patient outcomes were reviewed. Full texts of studies that passed the screening were also retrieved and reviewed for eligibility. Studies that followed infants immunized with HBV vaccine were also included. Data were extracted by two independent reviewers using standard forms to ensure accuracy and consistency of results. These data included study characteristics, study population, diagnostic methods, and clinical outcomes. Subgroup analyses were performed based on key variables such as population type such as HIV-positive patients, hemodialysis patients, hemophiliac patients, as well as types of diagnostic methods used such as Nested RT-PCR, Real-time PCR, etc., or other demographic factors. Overall effects were calculated for each subgroup and differences between subgroups were compared using appropriate statistical tests. Any significant differences between subgroups were identified and recorded as possible factors influencing the prevalence of OBI. Subgroup analyses were performed based on the type of viral detection method and patient groups to determine the impact of different variables on the results. The results were reported in detail and in accordance with the PRISMA guidelines. Results: In general, OBI can be observed in three groups of patients: patients with a known history of acute HBV infection, patients with chronic hepatitis B (CHB), and patients without a prior history of HBV infection (14). If HBV infection occurs in unvaccinated individuals, the probability of developing chronic infection is 90% in the age group <1 year, 30% in the age group 1–5 years, and 2% in the age group >5 years. Furthermore, most (>95%) adults infected with HBV do not develop chronic disease (14, 15). Of the total number of hepatitis B cases worldwide, approximately 6 million are children <5 years (16), indicating the importance of investigating the prevalence of infection in this age group. Several studies have investigated the prevalence of OBI, but its prevalence in the general population in different parts of the world is still largely unknown (17). The prevalence of OBI varies widely in different regions and may be related to population heterogeneity, viral detection techniques, and the quality of HBsAg screening tests (6). </div> هپاتیت B مزمن (CHB), مادران HBsAg مثبت, عفونت مخفی هپاتیت B Chronic hepatitis B (CHB), HBsAg positive mothers, Occult hepatitis B infection 1 11 http://rjms.iums.ac.ir/browse.php?a_code=A-10-2555-6&slc_lang=fa&sid=1 Hamid Mohammadi حمید محمدی 3900319475328460088847 3900319475328460088847 No Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran گروه ویروس شناسی، دانشکده‌ پزشکی، دانشگاه علوم پزشکی ایران، تهران، ایران Amir Mohammad Arbabi امیرمحمد اربابی 3900319475328460088848 0009-0005-6854-1705 No Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran گروه ویروس شناسی، دانشکده‌ پزشکی، دانشگاه علوم پزشکی ایران، تهران، ایران Zahra Mohammadi زهرا محمدی 3900319475328460088849 0009-0007-5498-7698 No Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran گروه ویروس شناسی، دانشکده‌ پزشکی، دانشگاه علوم پزشکی ایران، تهران، ایران Farshad Divsalar فرشاد دیوسالار 3900319475328460088850 3900319475328460088850 No Department of Infectious Diseases, School of Medicine, Iran University of Medical Sciences, Tehran, Iran گروه بیماری های عفونی، دانشکده پزشکی، دانشگاه علوم پزشکی ایران، تهران، ایران Hossein Ajdarkosh حسین اژدرکش 3900319475328460088851 3900319475328460088851 No Gastrointestinal and liver diseases research center, Iran University of Medical Sciences, Tehran, Iran مرکز تحقیقات بیماری‌های گوارش و کبد، دانشگاه علوم پزشکی ایران، تهران، ایران Elham Pishgar الهام پیشگر 3900319475328460088852 3900319475328460088852 No Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran مرکز تحقیقات کلورکتال، دانشگاه علوم پزشکی ایران، تهران، ایران Mahshid Panahi مهشید پناهی 3900319475328460088853 3900319475328460088853 No Department of Pathology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran پاتولوژی، دانشکده پزشکی، دانشگاه علوم پزشکی ایران، تهران، ایران Mohammad Hadi Karbalaie Niya محمدهادی کربلائی‌نیا mohamad.karbalai@yahoo.com 3900319475328460088854 3900319475328460088854 Yes Associate Professor, Gastrointestinal and liver diseases research center, Iran University of Medical Sciences, Tehran, Iran دانشیار، مرکز تحقیقات بیماری‌های گوارش و کبد، دانشگاه علوم پزشکی ایران، تهران، ایران