Effects of Maternal Screening and Universal Immunization to Prevent Mother-To-Infant Transmission of HBV

Gastroenterology. 2011 Dec 22. [Epub ahead of print]

Chen HL, Lin LH, Hu FC, Lee JT, Lin WT, Yang YJ, Huang FC, Wu SF, Chen SC, Wen WH, Chu CH, Ni YH, Hsu HY, Tsai PL, Chiang CL, Shyu MK, Lee PI, Chang FY, Chang MH.

Source

Department of Pediatrics, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Department of Primary Care Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Department of Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.

Abstract

BACKGROUND & AIMS:

Mother-to-infant transmission is the major cause of hepatitis B virus (HBV) infection among immunized children. There has been much debate about screening pregnant women and administering hepatitis B immunoglobulin (HBIG) to newborns. We analyzed the rate of HBV infection among children born to hepatitis B surface antigen (HBsAg)-positive mothers and whether HBIG administration reduces transmission.

METHODS:

We analyzed data from 2356 children born to HBsAg-positive mothers, identified through prenatal maternal screens. In addition to HBV vaccines, HBIG was given to all 583 children with hepatitis B e antigen (HBeAg)-positive mothers and to 723/1773 children with HBeAg-negative mothers. Serology tests for HBV were performed from 2007 to 2009, when children were 0.5-10 years old.

RESULTS:

A significantly greater percentage of children with HBeAg-positive mothers tested positive for antibodies against the hepatitis B core protein (anti-HBc, 16.76%) and HBsAg (9.26%) than children with HBeAg-negative mothers (1.58% and 0.29%, respectively; P<.0001 and <.001). Among the HBV infected children, the rate of chronicity was also higher among children with HBeAg-positive mothers than children with HBeAg-negative mothers (54% vs 17%; P=.002). Similar rates of anti-HBc (0.99% and 1.88%; P=.19) and HBsAg (0.14% and 0.29%; P=.65) were noted in children born to HBeAg-negative mothers that were or were not given HBIG. Infantile fulminant hepatitis developed in 1/1050 children who did not receive HBIG (.095%).

CONCLUSIONS:

Children born to HBeAg-positive mothers are at greatest risk for chronic HBV infection (9.26%), despite immunization. Administration of HBIG to infants born to HBeAg-negative mothers did not appear to reduce the rate of chronic HBV infection, but might prevent infantile fulminant hepatitis. Screening pregnant women for HBsAg and HBeAg might control mother-to-infant transmission of HBV.

Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.

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