Effects of maternal screening and universal immunization to prevent mother-to-infant transmission of HBV

Gastroenterology. 2012 Apr;142(4):773-781.e2. doi: 10.1053/j.gastro.2011.12.035. Epub 2011 Dec 23.

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 of 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 (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 also was higher among children with HBeAg-positive mothers than children with HBeAg-negative mothers (54% vs 17%; P = .002). Similar rates of antibodies against the hepatitis B core protein (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 who were or were not given HBIG. Infantile fulminant hepatitis developed in 1 of 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.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Biomarkers / analysis
  • Chi-Square Distribution
  • Child
  • Child, Preschool
  • Female
  • Hepatitis B Antibodies / blood
  • Hepatitis B Surface Antigens / blood
  • Hepatitis B Vaccines / administration & dosage*
  • Hepatitis B, Chronic / diagnosis*
  • Hepatitis B, Chronic / prevention & control*
  • Hepatitis B, Chronic / transmission*
  • Humans
  • Immunity, Humoral
  • Immunization Schedule
  • Immunoglobulins / administration & dosage*
  • Infant
  • Infant, Newborn
  • Infectious Disease Transmission, Vertical*
  • Liver Failure, Acute / prevention & control
  • Liver Failure, Acute / virology
  • Mass Screening*
  • Predictive Value of Tests
  • Pregnancy
  • Prenatal Care*
  • Taiwan
  • Time Factors
  • Treatment Outcome
  • Viral Load

Substances

  • Biomarkers
  • Hepatitis B Antibodies
  • Hepatitis B Surface Antigens
  • Hepatitis B Vaccines
  • Immunoglobulins
  • hepatitis B hyperimmune globulin