Perinatal transmission of bloodborne infections - Revision history

Aidan at 15:28, 18 September 2020

2020-09-18T15:28:35Z

@@ Line 11: / Line 11: @@
 ==HIV==
 {| class="wikitable"
 |-
 |-
 |-
-|40-999||ART||Maybe||ART
+|40-999
 |-
 |-
-|-
+|yes
-|-
+|yes
 |}
-====Selection of antiretrovirals====
+=== Management of Mother ===
-====Breastfeeding====
+=== Management of Neonate ===
 ==Hepatitis B virus==

Aidan at 18:33, 15 September 2020

2020-09-15T18:33:05Z

Show changes

Aidan: /* Hepatitis C virus */ moved to own page

2020-08-06T15:38:12Z

Hepatitis C virus: moved to own page

← Older revision		Revision as of 15:38, 6 August 2020
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	== Hepatitis C virus ==		== Hepatitis C virus ==
			* [[Hepatitis C virus#Management\|Management of the mother]]
	* About 5% risk of vertical transmission, though higher if coinfected with [[HIV]]
			* [[Neonatal HCV\|Management of the neonate]]
	** About half are transmitted antepartum and half intrapartum
	* Not urgent, as it is a chronic illness that may not manifest for decades
	* Serology to be done at 12-18 months for diagnosis
	* If significant anxiety, can send HCV-PCR at 3 to 6 months
	** 25-30% will spontaneous clear it
	** Still need serology at 12-18 months, and repeat PCR around 18 months

	== Further Reading ==		== Further Reading ==

Aidan: /* Hepatitis B virus */ moved to separate pages

2020-08-06T15:37:02Z

Hepatitis B virus: moved to separate pages

← Older revision		Revision as of 15:37, 6 August 2020
Line 84:		Line 84:

	== Hepatitis B virus ==		== Hepatitis B virus ==
			* [[Hepatitis B in pregnancy#Management\|Management of the mother]]
	=== Background ===
			* [[Neonatal HBV#Prevention\|Management of the neonate]]
	* Pregnant women are screened with HBsAg for active infection, usually during the first trimester
	* Transmission mostly occurs intrapartum, and is highest if they have acute infection in the third trimester

	=== Management ===
	==== Antepartum management ====
	* [[Tenofovir]] is safe in pregnancy; [[lamivudine]] and [[telbivudine]] are alternatives
	* Treatment is started if the viral load is greater than 200,000 copies/mL at 28-32 weeks gestation, and continued until delivery

	==== Peripartum management ====
	* Prophylaxis should be considered it mother has active hepatitis B (i.e. HBsAg positive), or her status is unknown
	** If status is unknown, try to get HBsAg done STAT (but often not possible)
	* Prophylaxis is with [[hepatitis B immune globulin]] (HBIG) and [[hepatitis B vaccine]] given within 12 hours of life into different limbs
	** Vaccine prevents about 90% of infections, with HBIG adding a bit more
	** HBIG can be given up to 7 days of life but is most effective when given earlier
	* Despite optimal treatment, there is still a 2% risk of vertical transmission

	==== Postpartum management ====
	* Complete a routine vaccination schedule for hepatitis B in the infant
	** If the birth weight is less than 2000 g, this birth dose should not count towards their vaccine series
	* Check infant serology for HBsAb and HBsAg at 9 to 12 months
	** Maternal HBcAb may be detected up to 24 months post-partum and should not be tested
	* Remember to screen other family members for [[hepatitis B]]
	* Recommend breastfeeding, since hepatitis B is not a contraindication

	=== Further Reading ===
	* Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. ''MMWR Recomm Rep''. 2018;67(RR-1):1–31. doi: [https://doi.org/10.15585/mmwr.rr6701a1 10.15585/mmwr.rr6701a1]

	== Hepatitis C virus ==		== Hepatitis C virus ==

Aidan: /* Hepatitis B virus */

2020-07-04T18:56:20Z

Hepatitis B virus

← Older revision		Revision as of 18:56, 4 July 2020
Line 85:		Line 85:
	== Hepatitis B virus ==		== Hepatitis B virus ==
	=== Background ===		=== Background ===
	* Pregnant women are screened with HBsAg for active infection		* Pregnant women are screened with HBsAg for active infection, usually during the first trimester
	* Transmission mostly occurs intrapartum, and is highest if they have acute infection in the third trimester		* Transmission mostly occurs intrapartum, and is highest if they have acute infection in the third trimester

Line 91:		Line 91:
	==== Antepartum management ====		==== Antepartum management ====
	* [[Tenofovir]] is safe in pregnancy; [[lamivudine]] and [[telbivudine]] are alternatives		* [[Tenofovir]] is safe in pregnancy; [[lamivudine]] and [[telbivudine]] are alternatives
			* Treatment is started if the viral load is greater than 200,000 copies/mL at 28-32 weeks gestation, and continued until delivery

	==== Peripartum management ====		==== Peripartum management ====
	* Prophylaxis should be considered it mother has active hepatitis B (i.e. HBsAg positive), or her status is unknown		* Prophylaxis should be considered it mother has active hepatitis B (i.e. HBsAg positive), or her status is unknown
	** If status is unknown, try to get HBsAg done STAT (but often not possible)		** If status is unknown, try to get HBsAg done STAT (but often not possible)
	* Prophylaxis is with [[hepatitis B immune globulin]] (HBIG) and hepatitis B vaccine given within 12 hours of life		* Prophylaxis is with [[hepatitis B immune globulin]] (HBIG) and [[hepatitis B vaccine]] given within 12 hours of life into different limbs
	* Vaccine prevents about 90% of infections, with HBIG adding a bit more		** Vaccine prevents about 90% of infections, with HBIG adding a bit more
	* HBIG can be given up to 7 days of life but is most effective when given earlier		** HBIG can be given up to 7 days of life but is most effective when given earlier
	* Despite optimal treatment, there is still a 2% risk of vertical transmission		* Despite optimal treatment, there is still a 2% risk of vertical transmission

	==== Postpartum management ====		==== Postpartum management ====
			* Complete a routine vaccination schedule for hepatitis B in the infant
			** If the birth weight is less than 2000 g, this birth dose should not count towards their vaccine series
			* Check infant serology for HBsAb and HBsAg at 9 to 12 months
			** Maternal HBcAb may be detected up to 24 months post-partum and should not be tested
	* Remember to screen other family members for [[hepatitis B]]		* Remember to screen other family members for [[hepatitis B]]
	* Recommend breastfeeding		* Recommend breastfeeding, since hepatitis B is not a contraindication

			=== Further Reading ===
			* Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. ''MMWR Recomm Rep''. 2018;67(RR-1):1–31. doi: [https://doi.org/10.15585/mmwr.rr6701a1 10.15585/mmwr.rr6701a1]

	== Hepatitis C virus ==		== Hepatitis C virus ==

Aidan: /* Hepatitis C virus */

2019-12-04T20:17:42Z

Hepatitis C virus

← Older revision		Revision as of 20:17, 4 December 2019
Line 108:		Line 108:
	** About half are transmitted antepartum and half intrapartum		** About half are transmitted antepartum and half intrapartum
	* Not urgent, as it is a chronic illness that may not manifest for decades		* Not urgent, as it is a chronic illness that may not manifest for decades
	* Serology to be done at 18 months for diagnosis		* Serology to be done at 12-18 months for diagnosis
	* If significant anxiety, can send HCV-PCR		* If significant anxiety, can send HCV-PCR at 3 to 6 months
			** 25-30% will spontaneous clear it
			** Still need serology at 12-18 months, and repeat PCR around 18 months

	== Further Reading ==		== Further Reading ==

Aidan: /* Hepatitis C virus */

2019-12-04T20:15:57Z

Hepatitis C virus

← Older revision		Revision as of 20:15, 4 December 2019
Line 105:		Line 105:

	== Hepatitis C virus ==		== Hepatitis C virus ==
	* About 5% risk of transmission		* About 5% risk of vertical transmission, though higher if coinfected with [[HIV]]
			** About half are transmitted antepartum and half intrapartum
	* Not urgent, as it is a chronic illness that may not manifest for decades		* Not urgent, as it is a chronic illness that may not manifest for decades
	* Serology to be done at 18 months for diagnosis		* Serology to be done at 18 months for diagnosis

Aidan: /* Hepatitis B virus */

2019-12-04T20:14:33Z

Hepatitis B virus

← Older revision		Revision as of 20:14, 4 December 2019
Line 93:		Line 93:

	==== Peripartum management ====		==== Peripartum management ====
	* If mother has hepatitis B, or her status is unknown~~, then consider post-exposure prophylaxis with hepatitis B immune globulin and hepatitis B vaccine given within 12 hours of life~~		* Prophylaxis should be considered it mother has active hepatitis B (i.e. HBsAg positive), or her status is unknown
			** If status is unknown, try to get HBsAg done STAT (but often not possible)
⚫	** Vaccine prevents about 90% of infections, with HBIG adding a bit more
			* Prophylaxis is with [[hepatitis B immune globulin]] (HBIG) and hepatitis B vaccine given within 12 hours of life
⚫	** HBIG can be given up to 7 days of life but is most effective when given earlier
		⚫	* Vaccine prevents about 90% of infections, with HBIG adding a bit more
		⚫	* HBIG can be given up to 7 days of life but is most effective when given earlier
	* Despite optimal treatment, there is still a 2% risk of vertical transmission		* Despite optimal treatment, there is still a 2% risk of vertical transmission

Aidan: /* Hepatitis B virus */

2019-12-04T20:12:16Z

Hepatitis B virus

← Older revision		Revision as of 20:12, 4 December 2019
Line 88:		Line 88:
	* Transmission mostly occurs intrapartum, and is highest if they have acute infection in the third trimester		* Transmission mostly occurs intrapartum, and is highest if they have acute infection in the third trimester

	=== ~~Antepartum management~~ ===		=== Management ===
			==== Antepartum management ====
	* [[Tenofovir]] is safe in pregnancy; [[lamivudine]] and [[telbivudine]] are alternatives		* [[Tenofovir]] is safe in pregnancy; [[lamivudine]] and [[telbivudine]] are alternatives

	=== Peripartum management ===		==== Peripartum management ====
	* If mother has hepatitis B, or her status is unknown, then consider post-exposure prophylaxis with hepatitis B immune globulin and hepatitis B vaccine given within 12 hours of life		* If mother has hepatitis B, or her status is unknown, then consider post-exposure prophylaxis with hepatitis B immune globulin and hepatitis B vaccine given within 12 hours of life
	** Vaccine prevents about 90% of infections, with HBIG adding a bit more		** Vaccine prevents about 90% of infections, with HBIG adding a bit more
Line 97:		Line 98:
	* Despite optimal treatment, there is still a 2% risk of vertical transmission		* Despite optimal treatment, there is still a 2% risk of vertical transmission

	=== Postpartum management ===		==== Postpartum management ====
	* Remember to screen other family members for [[hepatitis B]]		* Remember to screen other family members for [[hepatitis B]]
	* Recommend breastfeeding		* Recommend breastfeeding

Aidan at 20:11, 4 December 2019

2019-12-04T20:11:56Z

← Older revision		Revision as of 20:11, 4 December 2019
Line 1:		Line 1:
	* Main risk is for [[HIV]] and [[HBV]]		* Main risk is for [[HIV]] and [[HBV]]
⚫	* ~~Also see~~ [[HIV in pregnancy]] for management of an HIV-positive mother
⚫	** Note that integrase inhibitors are effective for achieving fast viral suppression

	== Investigations ==		== Investigations ==
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	=== Management ===		=== Management ===
			==== Antepartum management ====
		⚫	* See [[HIV in pregnancy]] for management of an HIV-positive mother
		⚫	* Note that integrase inhibitors are effective for achieving fast viral suppression

	==== Peripartum management ====		==== Peripartum management ====
	* Immediate management depends on maternal viral load and treatment status		* Immediate management depends on maternal viral load and treatment status