Información del artículo
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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Bibliografía
[1.]
M. Bruguera.
Prevención de la hepatitis vírica.
Enf Inf Microbiol Clin, 24 (2006), pp. 649-656
[2.]
L. Salleras, A. Dominguez, M. Bruguera, N. Cardeñosa, J. Batalla, G. Carmona, et al.
Dramatic decline in acute hepatitis B and disease incidence rates among adolescents and young people after 12 years of a mass hepatitis B vaccination programme of pre-adolescents in the school in Catalonia (Spain).
Vaccine, 23 (2005), pp. 2181-2184
[3.]
T. Stroffolini, A. Mele, M.E. Tosti, G. Gallo, E. Balocchini, P. Ragni, et al.
The impact of the hepatitis B mass immunisation campaign on the incidence and risk factors of acute hepatitis B in Italy.
J Hepatol, 33 (2000), pp. 980-985
[4.]
M. Bruguera, J.M. Sánchez Tapias.
Hepatitis vírica en inmigrantes y niños adoptados.
Med Clin (Barc), 117 (2001), pp. 595-596
[5.]
G.G. Baaten, G.J. Sonder, N.H. Dukers, R.A. Coutinho, J.A. Van del Hoek.
Population-based study on the seroprevalence of hepatitis A, B and C virus infection in Amsterdam, 2004.
J Med Virol, 79 (2007), pp. 1802-1810
[6.]
H.H. Lin, T.Y. Lee, D.S. Chen, J.L. Suns, H. Ohto, T. Etoh, et al.
Transplacental leakage of HBeAg positive maternal blood as the most likely route in causing intrauterine infection with hepatitis B virus.
J Pediatr, 111 (1987), pp. 877-881
[7.]
C.E. Stevens, R.P. Beasley, J. Tsui, W.C. Lee.
Vertical transmission of hepatitis B antigen in Taiwan.
N Engl J Med, 292 (1975), pp. 771-774
[8.]
P. Santa Olalla, A. Dominguez.
Hepatitis vaccination policy, vaccine coverage and impact of immunization programmes in Spain.
Viral Hepatitis, 15 (2007), pp. 14-17
[9.]
O. Chazouillères, Y. Bacq.
Foie et grossesse.
Gastroenterol Clin Biol, 28 (2004), pp. D84-D91
[10.]
T. Stroffolini, P. Pasquini, A. Mele, Collaborating Group.
A nation wide vaccination programme in Italy against hepatitis B virus infection in infants of hepatitis B surface antigen carrier mothers.
Vaccine, 7 (1989), pp. 142-154
[11.]
T. Stroffolini, P. Pasquini, Collaborating Group.
Five years of vaccination campaign against hepatitis B in Italy in infants of hepatitis B antigen carrier mothers.
Ital J Gastroenterol, 22 (1990), pp. 195-197
[12.]
T. Stroffolini, E. Bianco, A. Szklo, R. Bernacchia, C. Bove, M. Colucci, et al.
Factors affecting the compliance of the antenatal hepatitis B screening programme in Italy.
Vaccine, 21 (2003), pp. 1246-1249
[13.]
Papaevangelou V, Hadjichristodoulou C, Cassimos D, Theodoridou M. Adherence to the screening program for HBV vaccination in pregnant women delivering in Greece. BMC Infectious Diseases. Disponible en: http://www.biomedcentral.com/1471-2334/6/84
[14.]
Y.M. Song, J. Sung, S. Yang, Y.H. Choe, Y.S. Chang, W.S. Park.
Factors associated with immunoprophylaxis failure against vertical transmission of hepatitis B virus.
Eur J Pediatr, 166 (2007), pp. 813-818
[15.]
Y. Poovorawan, A. Theambooniers, T. Vimolket, S. Sinlaparatsamee, K. Chalear, T. Siraprapasiri, et al.
Impact of hepatitis B immunization as part of the EPI.
Vaccine, 19 (2000), pp. 943-949
[16.]
A. Milne, D.G. West, D.V. Chinh, C.D. Moyes, G. Poerschke.
Field evaluation of the efficacy and immunogenicity of recombinant hepatitis B vaccine without HBIG in new-born Vietnamese infants.
J Med Virol, 67 (2002), pp. 327-333
[17.]
M. Van Zonneveld, A.B. Van Nunen, H.G. Niesters, R.A. De Man, S.W. Schalm, H.L. Janssen.
Lamivudine treatment during pregnancy to prevent perinatal transmission of hepatitis B virus infection.
J Viral Hepat, 10 (2003), pp. 294-297
[18.]
W.M. Xu, Y.T. Cui, L. Wang, H. Yang, Z.Q. Liang, X.M. Li, et al.
Efficacy and safety of lamivudine in late pregnancy for the prevention of mother - child transmission of hepatitis B: a multicentre, randomized, double-blind, place-bo-controlled study.
Hepatology, 40 (2004), pp. 272A
[19.]
Comité Asesor de Vacunas de la Asociación Española de Pediatría.
Calendario de vacunación de la Asociación Española de Pediatría: recomendaciones 2007.
An Pediatr (Barc), 66 (2007), pp. 62-69
[20.]
European Consensus Group on Hepatitis B Immunity.
Are booster immunisations needed for lifelong hepatitis B immunity?.
Lancet, 355 (2000), pp. 561-565
[21.]
G. Da Villa, L. Romano, A. Sepe, R. Iorio, N. Paribello, A. Zappa, et al.
Impact of hepatitis B vaccination in a highly endemic area of south Italy and long-term duration of anti-HBs antibody in two cohorts of vaccinated individuals.
Vaccine, 25 (2007), pp. 3133-3136
[22.]
Y.H. Ni, L.M. Huang, M.H. Chang, C.J. Yen, C.Y. Lu, S.L. You, et al.
Two decades of universal hepatitis B vaccination in Taiwan: impact and implication for future strategies.
Gastroenterology, 132 (2007), pp. 1287-1293
[23.]
A.R. Zanetti, A. Mariano, L. Romanò, R. D’Amelio, M. Chironna, R.C. Coppola, The Study Group.
Long-term immunogenicity of hepatitis B vaccination and policy for booster: an Italian multicentre study.
Lancet, 366 (2005), pp. 1379-1384
[24.]
C.Y. Lu, B.L. Chiang, W.K. Chi, M.H. Chang, Y.H. Ni, H.M. Hsu, et al.
Waning immunity to plasma-derived Hepatitis B vaccine and the need for boosters 15 years after neonatal vaccination.
Hepatology, 40 (2004), pp. 1415-1420
[25.]
M. Sciveres, G. Maggiore.
Hepatitis B. ‘By Proxy’: An emerging presentation of chronic hepatitis B in children.
J Pediatr Gastroenterol Nutr, 44 (2007), pp. 268-269
[26.]
M.H. Chang, H.Y. Hsu, H.C. Hsu, Y.H. Ni, J.S. Chen, D.S. Chen.
The significance of spontaneous hepatitis B e antigen seroconversion in childhood: with special emphasis on the clearance of hepatitis B e antigen before 3 years of age.
Hepatology, 22 (1995), pp. 1387-1392
[27.]
M.H. Chang.
Natural history of hepatitis B virus infection in children.
J Gastroenterol Hepatol, 15 (2000), pp. E16-E19
[28.]
T. Fujisawa, H. Komatsu, A. Inui, Y. Miyagawa, S. Fujitsuka, I. Sekine, et al.
Long term outcome of chronic hepatitis B in adolescents or young adults in follow-up from childhood.
J Pediatr Gastroenterol Nutr, 30 (2000), pp. 201-206
[29.]
F. Bortolotti, P. Jara, C. Crivellaro, L. Hierro, P. Cadrobbi, E. Frauca, et al.
Outcome of chronic hepatitis B in caucasian children during a 20-year observation period.
J Hepatol, 29 (1998), pp. 184-190
[30.]
F. Bortolotti, P. Cadrobbi, C. Crivellaro, M. Guido, M. Rugge, F. Noventa, et al.
Long-term outcome of chronic hepatitis type B hepatitis in patients who acquire hepatitis B virus infection in childhood.
Gastroenterology, 99 (1990), pp. 805-810
[31.]
L. Hierro, C. Camarena, A. De la Vega, M.C. Díaz, E. Frauca, G. Muñoz-Bartolo, et al.
Hepatitis B in children moving from other countries.
J Pediatr Gastroenterol Nutr, 39 (2004), pp. S170
[32.]
F. Bortolotti, M. Guido, S. Bartolacci, P. Cadrobbi, C. Crivellaro, F. Noventa, et al.
Chronic Hepatitis B in children after e antigen seroclearance: final report of a 29-year longitudinal study.
Hepatology, 43 (2006), pp. 556-562
[33.]
S.M. Lin, M.L. Yu, C.M. Lee, R.N. Chien, I.S. Sheen, C.M. Chu, et al.
Interferon therapy in HBeAg positive chronic hepatitis reduces progression to cirrhosis and hepatocellular carcinoma.
J Hepatol, 46 (2007), pp. 45-52
[34.]
F. Bortolotti, P. Jara, C. Barbera, G.V. Gregorio, A. Vegnente, L. Zancan, et al.
Long-term effect of alpha interferon in children with chronic hepatitis B.
Gut, 46 (2000), pp. 715-718
[35.]
D. Torre, R. Tambini.
Interferon alfa-2ª therapy for chronic hepatitis B in children: a meta-analysis.
Clin Infect Dis, 23 (1996), pp. 131-137
[36.]
M.M. Jonas, D.A. Kelley, J. Mizerski, I.B. Badía, J.A. Areias, K.B. Schwarz, For the International Pediatric Lamivudine Investigator Group, et al.
Clinical trial of lamivudine in children with chronic hepatitis B.
N Engl J Med, 346 (2002), pp. 1706-1713
[37.]
E.M. Sokal, D.A. Kelly, J. Mizerski, I.B. Badia, J.A. Areias, K.B. Schwarz, et al.
Long-term Lamivudine therapy for children with HBeAg-positive chronic hepatitis B.
Hepatology, 43 (2006), pp. 225-232
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