Cytomegalovirus and herpes simplex infections in mothers and newborns in a Havana maternity hospital.

INTRODUCTION: Cytomegalovirus and herpes simplex virus are associated with congenital or perinatal infection, causing potential damage to the newborn. OBJECTIVES: Determine the prevalence of active or latent infection by cytomegalovirus and herpes simplex virus in a population of mothers, congenital infection by these agents in their infants, and association between prevalence of virus infection in mothers and in their newborns. METHODS: A cross-sectional study was conducted from June to September 2012 in a population of 95 pregnant women admitted to the Dr Ramón González Coro University Maternity Hospital during the third trimester of pregnancy, and their infants (98). Patients were tested for antibodies specific to these viruses; vaginal swabs and urine from the women and serum and urine from the newborns were tested for viral genome. The Fisher exact test with 95% confidence interval was used for comparisons. RESULTS: Of the women studied, 89.5% tested positive for cytomegalovirus and 83.2% for herpes simplex. Active infection from cytomegalovirus was detected in 16.7%, and from herpes simplex in 3.2%. Congenital cytomegalovirus infection was detected in 4.1% of newborns; no herpes simplex virus infection was found in this group. Two newborns of women with active cytomegalovirus infection were congenitally infected. CONCLUSIONS: Serology demonstrated that most of the women were immune to both viruses. Active cytomegalovirus infections are common in this population, and newborns of women with active cytomegalovirus infection during pregnancy are at increased risk of congenital infection.

Evaluación serológica de la inmunización pasiva-activa en la profilaxis de la transmisión perinatal de la hepatitis B / Serological evaluation of active-passive immunization for the prophylaxis of perinatal transmisión of hepatitis B

La administración conjunta de gammaglobulina antihepatitis B y la vacuna se recomienda mundialmente para prevenir la transmisión perinatal en hijos de madres HBsAg(+). Se evaluó la inmunización pasiva-activa a los tres días, 7 y 18 meses de vida, como forma preventiva de esta transmisión. Se estudiaron 87 sueros de hijos de madres HBsAg(+), tomados a los 3 días, 7 y 18 meses de nacidos, para un total de 261 muestras. A los recién nacidos se les administró una dosis de inmunoglobulina humana antihepatitis B cubana (Ganmahep B) y de vacuna recombinante cubana Heberbiovac-HB ® antes de las 12 horas de nacidos y posteriormente a los 1, 2 y 12 meses, según el esquema de vacunación Los niños fueron evaluados con los marcadores HBsAg y anti-HBs. Al tercer día el 8,0 por ciento de los niños fueron HBsAg(+), el 92,5 por ciento de los niños HBsAg(-) resultaron seroprotegidos. A los 7 meses de edad el 1,1 por cientofue HBsAg(+), la seroprotección de los niños HBsAg(-) fue de 89,5 por ciento. El 3,4 por ciento fue HBsAg(+) a los 18 meses, con un 97,6 por ciento de seroprotección en los niños HBsAg(-). Predominó la respuesta normoprotectora en los tres tiempos, con diferencias estadísticamente significativas en la seroprotección y títulos ³ 100 UI/L. Los títulos promedios geométricos (TPG) fueron 72,9 UI/L, 168,66 UI/L y 175,62 UI/L, respectivamente, con significación estadística entre ellos. Se sugiere que el uso de Ganmahep B, conjuntamente con la vacuna cubana reduce el riesgo de transmisión perinatal del VHB y es el primer estudio realizado en Cuba para evaluar la eficacia profiláctica en este grupo de riesgo(AU)

The joint administration of the anti-hepatitis B gammaglobulin and the vaccine is worldwide recommended for the prevention of perinatal transmission to children from HBsAg(+) mothers. As a preventive measure of transmission, passive-active immunization was evaluated after 3 days and at 7 and 18 months of life. Eighty-seven sera from children from HBsAg(+) mothers were studied; these sera were collected 3 days, and 7 and 18 months after birth, for a total amount of 261 samples. Newborns were administered a dose of Cuban Human Anti-hepatitis B Immunoglobulin (Ganmahep B) and a dose of the Cuban recombinant vaccine Heberbiovac-HB® before the first 12 hours after birth. Afterwards, the vaccination scheme at months 1, 2, and 12 was followed. Children were evaluated with HBsAg and anti-HBs markers. At the third day, 8.0 percent of the children were HBsAg(+); the 92.5 percent of HBsAg(-) children turned out to be seroprotected. At 7 months of age, 1.1 percent was HBsAg(+), seroprotection of HBsAg(-) children was 89.5percent. At 18 months of age, 3.4percent was HBsAg(+), with a 97.6percent of protection of HBsAg(-) children. The normoprotective response was predominant at the three periods of time, with statistically significant differences in seroprotection and titers =100 UI/L. Geometric Mean Titer (GMT) values were 72.9 UI/L, 168.66 UI/L and 175.62 UI/L, respectively, with statistical significance among them. It is suggested that the use of Ganmahep B, along with the administration of the Cuban vaccine reduces the risk of HBV perinatal transmission and this is the first study carried out in Cuba to evaluate the prophylactic efficacy within this risk group(AU)

Occult hepatitis B in Cuban HIV patients.

INTRODUCTION Co-infections between hepatitis B and HIV viruses are frequent due to their similar epidemiological characteristics. Worldwide, hepatitis B infection is one of the main causes of hepatocellular carcinoma and cirrhosis. In Cuba as elsewhere, prevalences of hepatitis B and hepatitis C viral infections are higher in persons with HIV. These hepatitis viruses act as opportunistic infections in persons with HIV. In other contexts, persons with HIV have been found to be at higher risk for occult hepatitis B, defined as the presence in serum or plasma of hepatitis B virus DNA and antibodies to its core antigen, in the absence of hepatitis B surface antigen. OBJECTIVES Describe occult hepatitis B prevalence in Cuban HIV-positive patients and explore possible associations with their clinical characteristics. METHODS A total of 325 serum samples from patients positive for HIV and negative for hepatitis B surface antigen were studied, divided into two groups, Group 1, negative for hepatitis C virus; and Group 2, positive for hepatitis C virus. Exposure to hepatitis B was determined by testing for hepatitis B core antigen; samples positive for hepatitis B core antigen were then examined for presence of antibodies to hepatitis B surface antigen. Both determinations were done by ultramicroELISA. In samples positive for hepatitis B core antigen with levels of antibodies to hepatitis B surface antigen of <50 IU/L, real-time polymerase chain reaction was used to detect hepatitis B DNA and its presence examined in relation to several clinical variables. All data were obtained from patients' clinical records. RESULTS In the hepatitis-C-negative group, 27.9% (68/243) of serum samples tested were positive for hepatitis B core antigen. In the hepatitis-C-positive group, 37.8% (31/82) were positive for hepatitis B core antigen. Total hepatitis B virus exposure prevalence was 30.4% (99/325); 54.5% (54/99) showing low immunity (hepatitis B virus surface antigen <50 IU/L) and 24% of these (13/54), occult hepatitis. There was no statistically significant association between hepatitis B virus DNA and any of the clinical variables studied. CONCLUSIONS Low-immunity HIV-positive persons in our study were exposed to hepatitis B virus. Diagnosis of occult hepatitis B infection is frequent in these patients. This study suggests that diagnostic protocols for persons with HIV and without hepatitis B surface antigen should include testing for hepatitis B core antigen, with positive results followed by molecular techniques to detect occult hepatitis B. This study makes a useful contribution to prevention and control of hepatitis B in Cuba.

[Prevention and control of vertical HIV transmission program in Cuba. January 1986-December 2007]. / Programa de prevención y control de la transmisión vertical del VIH en Cuba. Enero de 1986-Diciembre de 2007.

The HIV/AIDS epidemic continues to increase in spite of the strategies developed, including the use of HAART. One of the vulnerable populations is the child of HIV+ mothers. In Cuba, a prevention and control program of HIV infection was implemented in 1986 and one of the key aims was to reduce perinatal infection. In this study, the medical records of all 314 children born to HIV/AIDS positive mothers between January 1986 to December 2007 are described. Our aim was to determine the relationship between Program compliance and prevention of vertical transmission (VT). A total of 248/314 infants completed a full virological evaluation at the time of this report 32 (12.9%) were HIV-infected. In these 32 children, mortality due to AIDS related events was 31.2%, of which 60% died before their first year of life. VT rate decreased from 50,0% to 14,6% after implementation of prophylactic caesarean section and to 2.2% in 99 women complying with the new adopted program including HAART antiviral therapy in pregnant woman, caesarean section, and AZT to the newborn. The effectiveness of combining a caesarean section and HAART was 95.2%. The prevention program for HIV/AIDS vertical transmission implemented in Cuba has been effective in reducing VT, similar to other worldwide reports.

Diagnosis and screening for cytomegalovirus infection in pregnant women in Cuba as prognostic markers of congenital infection in newborns: 2007-2008.

BACKGROUND: Human cytomegalovirus (HCMV) has established itself as the most significant cause of congenital infection in the developed world. The objective of this research was prenatal identification of pregnant women at risk for developing active infection due to HCMV as well as to diagnose congenitally infected newborns. METHODS: A diagnostic algorithm based on specific immunoglobulin G (IgG), IgM, and, IgG avidity was used to screen serum from 1131 pregnant women enrolled prospectively from 3 municipalities from Havana City, Cuba during 2007-2008. Qualitative multiplex nested PCR and quantitative real time-based PCR testing for HCMV DNA were performed on urine and saliva specimens from women detected with active infection and from their newborns. RESULTS: Most women were seropositive to HCMV (92.7%), with 2.38% (27 women) having active infection. Primary infection was detected in 20 pregnant women (1.77%) while 7 patients (0.62%) had active nonprimary infection. HCMV DNA was detected in specimens from 9 of the 27 pregnant women by both PCR methods. HCMV congenital infection was diagnosed in 12 (1.06%) of the 26 live children born from 25 mothers with active infection, for a vertical transmission rate of 46.2%. Two fetal deaths were reported from 2 women with active infection; furthermore 2 newborns were symptomatic at birth and 2 showed sequelae during the follow-up done until 6 months age. CONCLUSIONS: Mothers with active infection during the pregnancy and with HCMV excretion had significant risks, RR = 1.16 and RR = 1.35, respectively, to have congenitally infected children.