Open Journal of Gastroenterology, 2013, 3, 311-313 OJGas Published Online November 2013 (
Hbs antigen, what prevalence among pregnant women in
Morocco? Preliminary results of a prospective study
conducted in Hospital University Hassan II, Fez*
Laila Sedreddine, Meryem Sekkat, Sidi Adil Ibrahimi, Noureddine Aqodad
Department of Hepatology and Gastroenterology, Hassan II University Hospital of Fez, University Sidi Mohamed Ben Abdellah, Fez,
Received 11 October 2013; revised 5 November 2013; accepted 12 November 2013
Copyright © 2013 Laila Sedreddine et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
The chronic viral hepatitis B is a public health prob-
lem and remains a global challenge with 350 million
carriers of HBs antigen (HBsAg). The prevalence of
HBsAg varies from one country or continent to an-
other. In France, it is estimated to be 0.5%. In Mo-
rocco, the data are rare but some studies have esti-
mated the prevalence to be 2.5%. Our aim is to esti-
mate the prevalence of HBsAg among women who
have recently given birth at the maternity CHU Has-
san II of Morocco Fez, and to describe the epidemi-
ological profile and risk facto rs for infe ction. In preg-
nancy, infection with hepatitis B virus (HBV) is do-
minated by the risk of mother to child transmission
(vertical transmission), which can be avoided by se-
rovaccination of the newborn. The search for HBsAg
should be performed in all pregnant women.
Keywords: HBs Antigen; Prevalence; Pregnancy
Prenatal screening for hepatitis B is not currently ques-
tioned as the benefit of serovaccination of children born
to mothers carrying HBsAg is firmly established [1].
However, this recommendation has not yet been system-
atically applied, particularly in the areas of higher en-
demicity where vaccination policies are little or not im-
plemented for economic reasons. This justifies screening
for HBV infection in pregnant women and the systematic
newborns’ serovaccination to limit the spread of this in-
fection. Pregnant patients with high viral load, some
studies have demonstrated the benefit of antiviral treat-
ment allowing the reduction of the risk of transmission in
utero [2]. In Morocco, little epidemiological testing are
available but it is estimated that the prevalence of
HBsAg in the general population is 1.5% [3]. To our
knowledge ther e are no data on the prevalence of hepati-
tis B among pregnant women in Morocco. The aim of
our study is to find out whether the pregnant woman is
the main reservoir for the transmission of this virus in
our context so as to propose in this case a strategy
against HBV especially since it is a chemoprophylaxis
highly effective.
This is a prospective, observational single center study
on the prevalence of HBsAg in pregnant women in hos-
pital university Hassan II of Fez, conducted ov er a period
of 18 months (February 2010-August 2011), and con-
ducted within the hepato-gastroenterology service, ma-
ternity center and obstetrics and immuno-serology labo-
ratory of the University Hospital Hassan II of Fez.
2.1. Inclusion Criteria
1) Pregnancy scalable for at least 4 months.
2) Informed Agreement gestating.
2.2. Exclusion Criteria
1) Chronic HBV carrying known by pregnant.
2) Carrying another viral marker known by pregnant
2.3. Terms of the Study
*Competing interest: The authors declare that they have no competing
Author’s contribution: All authors wrote, read and approved the manu-
After an informed consent by the patients, the various
parameters were collected prospectively for all patients.
L. Sedreddine et al. / Open Journal of Gastroenterology 3 (2013) 311-313
Blood samples were taken by a trained nurse for this
study during a prenatal consultation (2nd or 3rd quarter
view) or at the time of delivery. HBsAg assay was per-
formed in the laboratory of immuno-serology of the
University Hospital Hassan II of Fez by manual ELISA.
During the study period, 350 parturient have been in-
cluded, their average age was 29 years [16 - 46 ± 6]. The
average age of the current pregnancy was 39 [17 - 45 SA
± 4] weeks of amenorrhea. The enrollment rate was
35.5%. All these women had had at least one pregnancy
in 36% of cases (127/350) with an average of 2.5 [0 - 9].
Eighty-two women had received dental care (23.5%) of
which 16% were traditional care. One hundred and two
women had received parenteral injections (29%). Six
pregnant were transfused (1.7%), 16.33% had a piercing
(N = 57), 3.15% had a tattoo (N = 11) (Figure 1).
Among our patients, 58% of women have given birth
vaginally (N = 74) and 24.4% have given birth by cae-
sarean section. Sixty-three pregnant unaware of their
HIV status vis-à-vis the HBV (18%) about 17 2 who wer e
not vaccinated (4 9%).
HBsAg was found in two of our pregnant (0.5%). No
vaccination against hepatitis B prior to pregnancy was
observed in any of our seronegative patients as the two
HBsAg positive patients.
The HBV infection is one of the most common infections
in the world with about 350 million chronic carriers of
HBs antigen (HBsAg): 5% of th e general population is a
reservoir for the perpetuation of viral transmission [2,3].
In some countries, the HBsAg is required in the sixth
month of pregnancy. [4] This testing should be per-
formed in all pregnant women, even those who have
been vaccinated against HBV, as vaccination could be
performed while the woman was already chronic carriers
of HBV. The detection of HBsAg in pregnant women
should always lead to a well standardized approach [4].
The detection the presence of HBsAg in pregnant women
Figure 1. Risk factors of viral contamination in our serie.
should always lead to a well standardized approach [4].
Firstly, it’s important to inform the mother of this infec-
tion and the necessity of the serovaccination of her child
at birth. Secondly, a serological survey for HBV (HBsAg,
anti-HBc and anti-HBs) should be proposed in the en-
tourage of the pregnant woman. Finally, a further as-
sessment should be performed in pregnant women, and
hepatology consultation should be provided.
The prevalence of HBsAg in pregnant women in the
world is variable (Table 1). These prevalences are proba-
bly consistent with the level of endemicity of HBV in-
fection in these countries.
In our series, the prevalence of HBsAg on 350 preg-
nant was 0.5%.Our study allowed us to assess the preva-
lence of HBsAg in pregnant women, and this result is
identical to that found in countries geographically and
demographically close to Morocco, like Tunisia, and
identical to the results of some French series. Moreover,
our study allowed us to detect and to treat two cases of
hepatitis B in pregnant women.
Four modes of transmission from mother to child can
be observed: [10]
1) Transmission in utero.
2) Transmission by amniocentesis and mode of deliv-
3) Neonatal transmission.
4) Transmission postnatal.
The hepatitis B virus is detectable in breast milk by
PCR and breastfeeding could theoretically be a mode of
transmission. This may be due to the ingestion of the
virus, or by contact with excoriations or abscesses pre-
sent on the nipple. Insofar newborns are properly immu-
nized; there is no contraindication to breastfeeding [10].
The prevention of mother to child transmission of
hepatitis B virus (HBV) is a measure of universal public
health. The risk of mother to child transmission can in-
deed reach 90% depending on the viral load of the
mother [2]. More than 90% of infected newborns de-
velop chronic infection with subsequent risk of cirrhosis
and hepato-cellular carcinoma [2,11]. Newborn of chro-
nic carrier mothers’ serovaccination is an effective meas-
Table 1. Literature’s review.
Series Total
AgHB+ Percentage
AgHB+ (%)
Burkina Faso [5] 492 84 17 %
Tanzanie [6] 980 62 6.3 %
Tunisie [7] 2023 92 4 %
Limoges 1999 [8] France 913 5 0.54 %
Picardie 2010 [9] France 1178 2 0.18 %
Our serie 350 2 0.5 %
Copyright © 2013 SciRes. OPEN ACCESS
L. Sedreddine et al. / Open Journal of Gastroenterology 3 (2013) 311-313
Copyright © 2013 SciRes.
ure to fight against this mode of transmission [12]. In
France for example, the obligation to detect HBsAg in
the fourth prenatal examination (sixth month of preg-
nancy) was established in 1992 by decree [13]. The anti-
HBs immunoglobulin administration and vaccination in
the first 24 hours after birth are recommended for infants
whose mother is a carrier of HBsAg [11]. Recent publi-
cations also suggest that treatment with lamivudine dur-
ing the last trimester of pregnancy in pregnant women
with high viral load reduces the risk of transmission in
utero and perinatal of HBV whether this drug is given in
combination with serovaccination [11]. Our study allowed
detecting two cases of hepatitis B in pregnant women in
the University Hospital Hassan II of Fez, which shows
that the detection of HBsAg during pregnancy should
absolutely be part of prenatal diagnosis. The continuation
of the study would recruit a sufficient number of patients
to specify the precise prevalence of this virus in pregnant
women, identify risk factors and to adopt a strategy and
effective control not only in Fez and regions but nation-
The current situation is worrying given the severe short-
age of vaccine policy. The public health actions should
be assessed, strengthened and accompanied. It is impor-
tant to promote screening for HBsAg and premarital
pregnancy. The continuity of the study would recruit a
sufficient number of patients to determine the exact
prevalence of this virus in pregnant women, and to iden-
tify risk factors and would allow us to adopt a strategy
and effective control not only in Fez and regions but also
in the whole nat i on.
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[13] Circulaire DGS/SD5C/DHOS/E2 no 2004-532 du 10
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de la grossesse de l’antigène HBs du virus de l’hépatite B
(VHB) et à la vaccination des nouveau-nés de femmes
porteuses de l’antigène du virus de l’hépatite B NOR.