Chen ZX, et al. - A network meta-analysis of randomized controlled trials was planned to compare the effectiveness of prophylactic strategies for perinatal transmission of hepatitis B virus. The universal infantile vaccination program indicated a further reduction in transmission with hepatitis B immunoglobulin (HBIG) for infants born to hepatitis B virus (HBV) carrier mothers. For highly viremic mothers whose children are still at risk for transmission under current immunoprophylaxis, researchers recommended considering prenatal HBIG administration or antiviral therapy in late pregnancy if more long-term evidence supports its efficacy and safety.

Methods

• Through Dec 2016, a comprehensive search was performed for randomized controlled trials (RCTs) that compared the following measures among HBV carrier mothers: placebo/none, active immunoprophylaxis (hepatitis B vaccine series starting at birth, HBVac), passive-active immunoprophylaxis (hepatitis B immunoglobulin and vaccine, HBIG+HBVac), prenatal HBIG administration (HBIG/HBIG+HBVac) and prenatal antiviral therapy (AVT/HBIG+HBVac).
• Direct, indirect and network meta-analyses were performed for all treatment comparisons.

Results

• For analysis, 15 RCTs involving 2706 infants of HBV carrier mothers were eligible.
• In this study, network meta-analysis indicated similar results as direct and indirect comparisons.
• A significant reduction in the risk of hepatitis B infection in infants of HBV carrier mothers was observed with HBVac alone (RR 0.32, 95%CI 0.21–0.50).
• The combination of immunoglobulin with vaccine proved superior to vaccine alone (RR 0.37, 95%CI 0.20–0.67).
• Further advantages were evident with prenatal HBIG administration or antiviral therapy over current passive-active immunoprophylaxis for infants of highly viremic (HBV DNA level higher than 2×10 ⁵ IU/ml) mothers (RR 0.47, 95%CI 0.29–0.75 and RR 0.31, 95%CI 0.10–0.99 respectively).
• No significant publication bias was observed.