Low Hepatitis B Endemicity Found Among Pregnant Women in India

Suprabhat Giri

A new analysis of pregnant women in India shows mostly vertical transmission of hepatitis B virus (HBV).

A team, led by Suprabhat Giri, Department of Gastroenterology, Nizam's Institute of Medical Sciences, determined the pooled seroprevalence of HBV and its associated demographic factors.

Hepatitis B

HBV infections during pregnancy can often lead to perinatal transmission of the virus, contributing to the pool of HBV infections within the population.However, there is a wide variation in the data reported on the seroprevalence of HBV in pregnancy patients from various regions in India.

In the systematic review and meta-analysis, reviewed various databases for studies conducted between January 2000 and April 2022 evaluating the prevalence of HBV in pregnant patients from Indiana.

Overall, they identified 44 studies involving 272,595 patients. The pooled prevalence of hepatitis B surface antigen (HBsAg) in pregnant women was 1.6% (95% CI, 1.4-1.8).

Prevalence of HBV

The pooled prevalence of hepatitis B e antigen was 26.0% (95% CI, 17.4-34.7) among patients with HBsAg positivity.

However, the investigators did not find significant differences in the odds of HBV seroprevalence based on the age (<25 years vs. > 25 years) (OR, 1.07; 95% CI, 0.74–1.55), parity (primipara vs. multipara) (OR, 1.09; 95% CI, 0.70–1.70), or area of residence (urban vs. rural) (OR, 0.88; 95% CI, 0.56–1.39).

On the other hand, the odds of HBV seroprevalence in participants with no or primary education was higher than individuals with secondary level education or higher (OR, 2.29; 95% CI, 1.24–4.23).

The investigators also found a prior history of risk factor was identified in 13.5-22.7% of patients, which indicates a vertical mode of acquisition.

“There is a low endemicity of HBV among pregnant women in India,” the authors wrote. “Risk factors are seen in less than 25% of the cases, indicating vertical transmission as the predominant mode of acquisition, which can be reduced by improving vaccination coverage.”

Global HBV Trends

Earlier this year, the World Health Organization (WHO) reported a drop in the prevalence of HBV infections and deaths among the youngest populations.

A team of investigators called the GBD 2019 Hepatitis B Collaborators estimated the global, regional, and national prevalence of HBV along with the mortality and disability-adjusted life-years (DALYs) because of HBV.

In 2019, the last year of the study, the investigators estimated the global, all-age prevalence of chronic HBV infections was 4.1% (95% UI, 3.7-4.5). This equates to 316 million (284-351 million) infected individuals.

They also found a 31.3% (29-33.9%) decline in the all-age prevalence between 1990-2019. There was a more marked decline of 76.8% (76.2-77.5%) in the prevalence of children younger than 5 years.

In total, there were 555,000 (487,000-630,000) global deaths due to HBV-related diseases in 2019, while the number of HBV-related deaths increased between 1990-2019 by 5.9% (-5.6 to 19.2%).

Between 2015-2019 the number of HBV-related deaths increased by 2.9% (-5.9 to 11.3%). However, all-age and age-standardized death rates because of HBV-related diseases decreased during these periods.

The study, “Seroprevalence of Hepatitis B Virus Among Pregnant Women in India: A Systematic Review and Meta-Analysis,” was published online in the Journal of Clinical and Experimental Hepatology.