Many Hepatitis B (HBV) carriers are asymptomatic and unaware they’re HBV positive. This is accompanied by ignorance that HBV can spread sexually (horizontally) (, 2, 3, 4, 5, 6). One case report from Japan suggests this can even happen several decades later (7). Thus, HBV continues spreading to sexual partners. HBV’s also transmitted vertically (perinatally from mother to child during birth or through breast milk) ( , ), another seriously worrying issue for an HBV positive adult.
Sounds like you’re already several steps ahead. You know your HBV status and likely intend to proactively minimize risk to your future spouse and children, else you wouldn’t be asking this question. Certainly, no bar to marriage and children since prophylaxis, i.e., disease prevention, to protect spouse and children greatly reduces their risk of HBV infection.
What type of prophylaxis? Answer depends on your status: asymptomatic, chronic carrier, HBsAg+, HBsAg+ and HBeAg+, liver function test results, presence/absence of anti-HBV antibodies, to mention some of the most important factors. Attending physician should screen and periodically perform risk assessment to determine whether situation mandates spouse and child prophylactic vaccination alone or Rx with hepatitis B immunoglobulin and anti-virals as well. This means regular screening for you, the index case, your spouse and future children.
What are rates of sexual transmission from infected to uninfected partner? What does HBV prophylaxis consist of for high-risk individuals (partners and children of HBV positive individuals) and how effective is it? These are some of the most pertinent questions for which the scientific literature has some answers.
Rates of sexual transmission vary in different studies
- As few as ~5% in an Israeli survey ( ).
- As many as 65% within two years of marriage in a Chinese survey ( ).
- In an Iranian study (12),
- ~65% in husbands of infected wives
- ~46% in wives of infected husbands
- More efficient female-to-male HBV transmission has also been reported in Turkey (13).
Selective vaccination of high-risk groups in Netherlands reduced HBV transmission (). High-risk in this study meant men who have sex with men, drug users, commercial sex workers, heterosexuals with frequent partner changes.
What about child/children? Vaccinate or vaccinate plus hepatitis B immunoglobulin post-birth? Decision depends on results of regular screening and risk factor assessment during pregnancy by attending physician (15).
- HBV vaccine is most effective in preventing vertical transmission when 1st dose is given within 24 hours of birth ( ).
- 2nd vaccine dose should be within 10 weeks of 1st dose, especially if hepatitis B immunoglobulin isn’t given at birth ( ).
- Timing is also important for hepatitis B immunoglobulin to be effective. Works best within 48 hours after single unprotected sexual exposure or parental exposure, not much use if given after >7 days (18).
Treat pregnant mother with anti-viral as well? Again, decision needs to be made after consulting attending physician and is based on mother’s HBV infection level. Is infection asymptomatic or chronic?
- For e.g., anti-viral lamivudine’s effective in mothers with high levels of HBV viral DNA in the 3rd trimester (19).
- OTOH, if mother is circulating HBV antigen positive, i.e., HBsAg and HBeAg, 70 to 90% of her children will become HBV infected without immunoprophylaxis (20) while 5 to 20% children will be infected if mother is HBsAg+ but HbeAg- ( ), i.e., much higher % children become infected if mother’s positive for both HBsAg and HBeAg compared to HBsAg alone (22). At birth HBV vaccine of children born to HBsAg+ mothers greatly reduces transmission, >50 to >80% depending on vaccine used (23).
So, this brief summary shows several options available to you and your future spouse and children. As well, many if not most countries have adopted universal childhood vaccination against HBV so children would anyway get vaccinated. Depending on your infection status, regular monitoring and risk assessment by attending physician would suggest whether spouse and children would need additional prophylaxis (immunoglobulin, anti-virals).
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19. Xu, W‐M., et al. “Lamivudine in late pregnancy to prevent perinatal transmission of hepatitis B virus infection: a multicentre, randomized, double‐blind, placebo‐controlled study.” Journal of viral hepatitis 16.2 (2009): 94-103.
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21. Mahoney, Francis J. “Update on diagnosis, management, and prevention of hepatitis B virus infection.” Clinical microbiology reviews 12.2 (1999): 351-366.
22. Chen, Huey–Ling, et al. “Effects of maternal screening and universal immunization to prevent mother-to-infant transmission of HBV.” Gastroenterology 142.4 (2012): 773-781.
23. Xu, Zhi-Yi, et al. “Prevention of perinatal acquisition of hepatitis B virus carriage using vaccine: preliminary report of a randomized, double-blind placebo-controlled and comparative trial.” Pediatrics 76.5 (1985): 713-718.