Journal Reading

Hepatitis B vaccine alone or

with hepatitis B
immunoglobulin in neonates
of HBsAg1/HBeAg2 mothers
a systematic review and meta-analysis

Ummu Nafiah Nuur R

Pembimbing :
dr. Ariawan S., Sp. A.

Kepaniteraan Klinik Bagian Anak

RSUD Sunan Kalijaga Kabupaten Demak
Fakultas Kedokteran Unissula Semarang
 IDENTITAS JURNAL
Hepatitis B vaccine alone or with hepatitis B
immunoglobulin in neonates of HBsAg1/HBeAg2
Judul mothers: a systematic review and meta-analysis

Maria Machaira, Vassiliki Papaevangelou, Evridiki K.

Vouloumanou,
Penulis Giannoula S. Tansarli and Matthew E. Falagas

J Antimicrob Chemother 2015; 70: 396404

doi:10.1093/jac/dku404 Advance Access publication 31
Publikasi October 2014
 BACKGROUND

Hepatitis B (HB) is a chronic viral infection, associated

with considerable morbidity and mortality, and social and
economical implications

Mother-to-child transmission, occurring during the

perinatal period, is the most important cause of chronic
infection, accounting for 35%50% of carriers.

Evidence suggests that the mothers serological status

(HBsAg/HBeAg) may have a role in perinatal transmission
Data deriving from relevant studies suggest that the
risk of infection in infants born to HBsAg+/HBeAg+
mothers is considerably higher compared with those
born to HBsAg+/HBeAg- mothers.

The combined use of vaccine and HB immunoglobulin

(HBIG) within 24 h of birth is reported to reduce the
risk of chronic HB infection to 10%15% and ,1% for
infants born to HBeAg+ and HBeAg- mothers

But, some countries with inadequate resources use

only hepatitis vaccine for immunization of infants born
to HBsAg+ mothers, while most do not screen for the
maternal HBeAg status
Purpose

evaluate the effectiveness of vaccine

alone compared with combined
immunization (HBIG and vaccine) of
infants born to HBsAg+/HBeAg2
mothers by performing a meta-
analysis of relevant studies
 Material and metods

The articles included in this meta-analysis were retrieved from searches

performed in PubMed , Scopus and Cochrane Central Register of
Controlled Trials databases.
Both of these databases were last assessed in June 2014.

Method

Systemic review and meta-analysis

 Inclusion and exclusion criteria

comparative data regarding Case reports and

the effectiveness of HB abstracts
immunization strategies,
including vaccine only, presented in
compared with the scientific
combination of vaccine plus conferences
HBIG in babies of
HBsAg+/HBeAg2 mothers.
Studies providing
relevant data concerning anti-
HBeAg+ mothers

Inclusion exclusion
Statistical Analysis
analisa statistik dilakukan dengan Software
Review Manager (RevMan) versi 5.0 (The
Nordic Cochrane Centre, The Kolaborasi
Cochrane, Copenhagen, 2008)

Tes I2 digunakan untuk

menguji heterogenitas
statistik antara studi
yang dianalisa
efek acak digunakan
untuk estimasi OR
gabungan dan masing-
masing CI 95% untuk
hasil yang dianalisa
RESULT
No difference was found regarding the occurrence of infection between babies
immunized with vaccine alone, compared with those immunized with vaccine and
HBIG (four studies, 3426 patients, OR0.82, 95% CI0.411.64)

OR < 1, menunjukkan bayi dengan diimunisasi

vaksin hepatitis saja mempunyai faktor
protektif sebesar 0,82 dibandingkan bayi
diimunisasi dengan vaksin hepatitis B dan
HBIG
No difference was found regarding the seroprotection rate
between the compared groups (four studies, 1323 patients,
OR1.24, 95% CI0.971.58)

OR=1,24 (OR>1) menunjukkan tingkat

seroprotektif tidak mempunyai hubungan
antara pemberian vaksin hepatitis B maupun
vaksin hepatitis B dan HBIG, atau diperlukan
lebih banyak kasus untuk membuktikannya.
 No difference was found regarding the occurrence of
infection between the compared groups [three
studies (0 RCTs), 2041 patients, OR1.16, 95%
CI0.265.17; Figure 4].

OR = 1,16 (OR>1) menunjukan kejadian infeksi

tidak berhubungan dengan pemberian vaksin
hepatitis B saja maupun vaksin hepatitis B
beserta HBIG.
no difference was found regarding the seroprotection
rate between the compared groups [three studies (one RCT19),
258 patients, OR2.2.1, 95% CI0.578.41, Figure 5].
 Discussion
no difference was observed in occurrence of HB
infection in neonates of HBsAg+/HBeAg2
mothers who received either combined
immunization (vaccine plus HBIG) or vaccine
alone.
This finding was consistent with regard to
seroprotection rate
The combination of vaccine plus HBIG was not
significantly associated with lower seroprotection
rates, compared with HBV vaccine alone.
 The long-term effects of this observation may
remain unknown, but the literature provides
evidence that the co-administration of HBIG may
offer additional protection during early infancy
from horizontal transmission, in the event of
delayed administration of the second vaccine
dose.
the risk of chronic infection in children born to
HBsAg+/HBeAg2 mothers is low, there have been
several reports of fulminant acute hepatitis, thus
supporting the need for effective prevention of
transmission.
 Recently, the role of maternal HBV viraemia
has been further investigated
Increased maternal HBV viral load has been
associated with breakthrough infections
despite the administration of appropriate
prophylaxis in babies of both HBeAg+ and
HBeAg2 mothers.23
 Limitation
Firstly, the number of individual studies that
were finally incorporated into the statistical
analysis was rather small. An explanation that
may account for this observation is that most
of the relevant studies focus on
HBsAg+/HBeAg+ mothers, who are considered
to be more infective to their offspring
compared with HBsAg+/HBeAg2 mothers
 Conclusion

the addition of HBIG to vaccination seems to be

equally effective to vaccine alone for offspring of
HBsAg+/ HBeAg- mothers with regard to the
prevention of infection.
 Suggestion

to clarify the potential benefit of additional

HBIG administration to all newborns of
HBsAg+ mothers regardless of their HBeAg
status.
CRITICAL APPRAISAL
 Judul dan Pengarang
No. Kriteria Ya( ) atau tidak (-)
1 Jumlah kata dalam judul ,< 12 kata -

2. Deskripsi Judul Menggambarkan isi utama

penelitian, cukup menarik.

3. Daftar penulis sesuai aturan jurnal

4. Korespondensi penulis

5. Tempat & waktu penelitian dalam Tempat - , waktu -

judul
 Abstrak
No. Kriteria Ya (), tidak (-)

1. Abstrak 1 paragraf

2. Mencakup IMRC

3. Secara keseluruhan informatif

4. Tanpa singkatan selain yang baku

5. Kurang dari 250 kata

 Pendahuluan
No. Kriteria Ya (), tidak (-)

1. Terdiri dari 2 bagian atau 2 paragraf -

2. Paragraf pertama mengemukakan alasan -

dilakukan penelitian

3. Paragraf kedua menyatakan hipotesis atau -

tujuan penelitian

4. Didukung oleh pustaka yang relevan

5. Kurang dari 1 halaman

 Bahan dan Metode Penelitian
No. Kriteria Ya ( ), tidak (-)
1 Jenis dan rancangan penelitian Restrospective
2 Waktu dan tempat penelitian Waktu , tempat
3 Populasi sumber
4 Teknik sampling
5 Kriteria inklusi
6 Kriteria eksklusi
7 Perkiraan dan perhitungan besar sampel
8 Perincian cara penelitian
9 Blind
10 Uji statistik
11 Program komputer
12 Persetujuan subjektif
 Hasil
No. Kriteria Ya (), tidak (-)

1 Jumlah subjek

2 Tabel karakteristik subjek

3 Tabel hasil penelitian

4 Komentar dan pendapat penulis tentang hasil

5 Tabel analisis data dengan uji

 Bahasan, Kesimpulan dan Daftar
Pustaka
No Kriteria Ya (), Tidak (-)
1 Pembahasan dan Kesimpulan terpisah -

2 Pembahasan dan Kesimpulan dipaparkan dengan jelas

3 Pembahasan mengacu dari penelitian sebelumnya

4 Pembahasan sesuai landasan teori

5 Keterbatasan penelitian

6 Simpulan berdasarkan penelitian

7 Saran penelitian

8 Penulisan daftar pustaka sesuai aturan