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El virus de la hepatitis B puede causar en embarazadas y niños una hepatitis aguda, una hepatitis crónica o una cirrosis hepática. La infección adquirida en el nacimiento causa una infección persistente en el 90% de los casos que puede evitarse mediante la administración de vacuna de la hepatitis B e inmunoglobulina específica en el primer día de vida. La prevención de la transmisión materno-filial exige el cribado de HBsAg en las gestantes para identificar los recién nacidos que deben ser inmunizados. En algunos países se sustituye esta estrategia por la de la vacunación universal de los recién nacidos.
En los niños infectados suele producirse una inactivación de la replicación viral con conversión de HBeAg positivo en anti-HBe positivo. Si esta seroconversión no se produce y persiste la actividad necroinflamatoria en el hígado, está justificado el empleo de agentes antivirales como interferón o los análogos de nucleósidos y nucleótidos.
Palabras clave:
Virus de la hepatitis B
Hepatitis aguda B
Hepatitis crónica B
Transmisión vertical
Transmisión perinatal
Transmisión materno-filial
Vacuna de la hepatitis B
Inmunoglobulina antihepatitis B
In pregnant women and children, the hepatitis B virus can cause acute or chronic hepatitis or liver cirrhosis. Perinatally-acquired infection causes persistent infection in 90% of cases and can be avoided through administration of the hepatitis B vaccine and specific immunoglobulin in the first day of life. Prevention of mother-to-child transmission requires screening for hepatitis B surface antigen (HBsAg) in pregnant women to identify which newborns should be immunized. In some countries this strategy is substituted by universal vaccination of neonates.
In infected children, inactivation of viral replication with conversion of HBeAG-positive to anti-HBe-positive status usually occurs. If this seroconversion does not take place and necroinflammatory activity persists in the liver, the use of antiviral agents such as interferon or nucleoside and nucleotide analogs is warranted.
Key words:
Hepatitis B virus
Acute hepatitis B
Chronic hepatitis B
Vertical transmission
Perinatal transmission
Mother-to-child transmission
Hepatitis B vaccine
Antihepatitis B immunoglobulin
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