Preventing Perinatal Transmission of HBV: An Australian Perspective
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Hepatitis B infection is best controlled by prevention rather than treatment, as chronic infection is usual once infected at a young age. Infant immune-prophylaxis is highly efficacious, although in the setting of high maternal viral load, breakthrough infection still occurs in almost 10 % of babies. Ante partum antiviral therapy for the purpose of preventing mother to child transmission in this group is important to consider. This article provides an up-to-date account of the available evidence of the safety and efficacy of ante partum antiviral therapy options and a management plan is proposed. Mothers with HBV infection and high viral load should have the opportunity to consider this evidence. Post-partum HBV flares are common but usually mild. It is unclear whether post partum flares are best ignored till they settle or if they represent an opportunity for intervention to increase the chance of HBV clearance.