The Effect Of Feeding Methods On Infant Transmission Of Hepatitis B Virus After Combined Immunoprophylaxis: A Meta Analysis

Background:Hepatitis B virus(HBV) infection is a worldwide health problem.It is one of the most common and important human viral infections.The infection can cause acute and chronic liver diseases,ranging from fulminant hepatitis to cirrhosis and eventually hepatocellular carcinoma(HCC).Worldwide,as many as 350 million people are chronically infected with HBV,and 1 million deaths are attributed to its infection. HBV can be transmitted either perinatally or horizontally to the child.Perinatal transmission from highly infectious mothers to their neonates is an important route for HBV infection.It accounts for about 40-50%.Infection with HBV in infancy or early childhood may lead to a high rate of persistent infection(25-90%).Hence,the control of HBV infection is extremely important.Transmission of HBV through breast feeding has been reported in several studies.Several groups have recommended against breast-feeding on the basis of those data.The proscription of breast-feeding appears justified,if it is associated with any increased risk,of HBV transmission and its long-term consequences.However,the mechanism and risks of transmission of hepatitis B in breast milk are not well understood.In order to explore the safety of HBV transmission in breast-feeding infants of HBV carriers after combination immunoprophylaxis,we collected related literatures by systematic literature search,and compared the risk of HBV transmission from HBV carriers to infants who were and were not breast-fed.Objective:To explore the risk of HBV transmission in breast-feeding infants of HBV carriers after combination immunoprophylaxis. Methods:Relevant literatures were collected by systematic literature search. Meta-analysis was applied to the selected literatures that met the criteria.The heterogeneity across the studies was checked.The pooled OR and 95%confidence interval were calculated.The meta-analysis software,review manager 4.2,was applied for statistical analysis.The influence of HBV carrier mothers' different feeding modes on the infection of hepatitis B in infants was overall evaluated.Results:A total of 1575 cases from 10 studies which met the criteria were included. The breast-feeding cases were 707,from which 31 HBV infection cases;while 868 artificial feeding,from which 42 HBV infection cases.There was no statistically difference between the two feeding methods of HBV carrier mothers after combined immunoprophylaxis with respect to the HBV-infectious rate of newborns(z=1.53, P=0.13＞0.05).The pooled OR value was 0.67,with 95%confidence interval ranging from 0.41 to 1.12.Conclusion:With the combined immunoprophylaxis,breast-feeding infants of HBV carriers poses no additional risk for the transmission of HBV.