Intermediate hepatitis B virus infection prevalence among 1622 pregnant women in rural Burkina Faso and implications for mother-to-child transmission

Abstract

In highly endemic countries for hepatitis B virus (HBV) infection, childhood infection, including mother-to-child transmission (MTCT), represents the primary transmission route. High maternal DNA level (viral load ≥ 200,000 IU/mL) is a significant factor for MTCT. We investigated the prevalence of HBsAg, HBeAg, and high HBV DNA among pregnant women in three hospitals in Burkina Faso and assessed the performance of HBeAg to predict high viral load. Consenting pregnant women were interviewed on their sociodemographic characteristics and tested for HBsAg by a rapid diagnostic test, and dried blood spot (DBS) samples were collected for laboratory analyses. Of the 1622 participants, HBsAg prevalence was 6.5% (95% CI, 5.4-7.8%). Among 102 HBsAg-positive pregnant women in DBS samples, HBeAg was positive in 22.6% (95% CI, 14.9-31.9%), and viral load was quantified in 94 cases, with 19.1% having HBV DNA ≥ 200,000 IU/mL. HBV genotypes were identified in 63 samples and predominant genotypes were E (58.7%) and A (36.5%). The sensitivity of HBeAg by using DBS samples to identify high viral load in the 94 cases was 55.6%, and the specificity was 86.8%. These findings highlight the need to implement routine HBV screening and effective MTCT risk assessment for all pregnant women in Burkina Faso to enable early interventions that can effectively reduce MTCT.

Figure 1

Study and laboratory analysis flow. RDT, Rapid diagnostic test; CLEIA, chemiluminescent enzyme immunoassay; HBsAg, Hepatitis B surface antigen; HBeAg, Hepatitis B e antigen; HBeAb, Hepatitis B e antibody, DBS, Dried Blood Spot.

Figure 2

Prevalence of HBsAg and HBeAg in pregnant women in Yako, rural Burkina Faso. HBsAg was screened by rapid diagnostic test (RDT) in 1622 pregnant women visiting the study centers for antenatal care, and 106 were positive. Of the 106 HBsAg-positive by RDT, 105 DBS samples were available for serological analyses. 102 DBS samples were positive for HBsAg by CLEIA in DBS samples and underwent HBeAg measurement. The numbers on top of each graph indicate the HBsAg prevalence, while the numbers inside each bar represent the corresponding HBeAg prevalence.

Figure 3

Distribution of HBV DNA by a) HBeAg and b) HBeAg and age among pregnant women in Yako, rural Burkina Faso. The red dots show HBeAg-positive cases, and the blue dots represent HBeAg-negative cases. Numbers on the top of each graph represent the percentage of pregnant women with HBV DNA ≥ 200,000 IU/mL, the recommended cut-off for antiviral prophylaxis.