40 And thus, a more sensitive assay such as the nucleic acid amplification test to detect occult HBV infection should be implemented to minimize the transmission through blood transfusion.41 X-396 cost As to perinatal transmission, the most effective means for prevention is immunization (vide infra). Nevertheless, whether modes of obstetric delivery are associated with HBV infection has been studied. A meta-analysis based on four randomized controlled clinical trials including a total of 789 HBsAg carrier mothers found perinatal HBV infection in infants delivered by elective cesarean section

and vaginal delivery was 10.5% and 28.2%, respectively.42 However, other studies did not favor cesarean section in preventing maternal transmission of HBV.43,44 Elective cesarean section in HBsAg-carrier mothers

is not recommended as long as the newborn infant receives appropriate hepatitis B see more immunoprophylaxis.45 Under immunoprophylaxis, breast-feeding also does not pose additional risk for HBV transmission from chronic HBV-carrier mothers.46 Because of the extreme effectiveness of hepatitis B vaccine in precluding HBV infection, universal vaccination against hepatitis B is regarded to be the key toward elimination and eradication of hepatitis B.5 Pre-exposure prophylaxis with hepatitis B vaccine has been most extensively studied in men who have sex with men and health-care workers. Randomized, Resveratrol double-blind, placebo-controlled clinical trials demonstrated a protective efficacy of 80–88% in male homosexuals as well as health-care workers (reviewed in 5). The efficacy in immunocompromised

hosts, such as patients with end-stage renal disease, chronic liver disease, HIV infection or organ transplants, was inadequate. However, if these patients have been vaccinated against hepatitis B before, a booster before transplantation can yield good protection. This was documented by a recent study from Taiwan where a mass hepatitis B vaccination has been implemented since 1984.47 The study indicated that boosting the antibody to HBsAg (anti-HBs) in children who had received hepatitis B vaccination in infancy prevented HBV infection in most of the 60 children who received living donor liver transplantation. Those with anti-HBs levels of more than 1000 IU/L were all protected from HBV infection in this study.48 In this setting, the most thoroughly population studied is infants born to HBeAg-positive HBsAg carrier mothers. Because HBeAg-positive mothers are highly infectious, the gap between exposure to maternal HBV and the newborn’s own active production of anti-HBs induced by hepatitis B vaccine should be bridged as soon as possible with hepatitis B immune globulin (HBIG). The efficacy of protecting from chronic HBsAg carriage with passive-active immunoprophylaxis in these infants is more than 90%.